Department of Radiation Oncology(Zhu LH,Tian SQ,Qu A,Wang H,Wang JJ),Department of Obstetrics and Gynecology (Guo HY),Peking University Third Hospital,Beijing 100191,China;Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,China (Zhu LH)
AbstractObjective To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of weekly PTX and DDP concurrent postoperative radiotherapy in Chinese women with high-and intermediate-risk early cervical cancer. Methods Women with high risks postoperative cervical carcinoma,ECOG≤2 were eligible. Pelvis RT (6/10 MV X-ray,3DCRT 40 Gy/20f,para-metrial boost 10-20 Gy/5-10f) was followed by 2-4f brachytherapy applications (192Ir,5 Gy/f).Concurrent weekly chemotherapy was started at DDP 20 mg/m2 and PTX 10 mg/m2 weekly,and escalated in three-patient cohorts according to 3+3 Methods . Results 25 patients were enrolled and treated over seven doses levels until dose-limiting toxicity (DLT) was reached. Median age was 48 years (range,34-66).All of patients finished RT in 7 weeks. Grade 3,4 non-hematologic toxicities were diarrhea and observed in two patients (4 cycles,DLT) at level 7.Grade 3,4 hematologic,principally leukopenia and neutropenia,and occurs late cycles. One grade 4 leukopenia and neutropenia was observed at dose level 6 but not seen in three additional patients. No one was delayed treatment time by concurrent chemotherapy.22 patients finished 6 cycles. Median follow-up is 59.5 months. Three patients have died of cancer metastasis and recurrence. One patient has died of respiratory failure. Conclusions Combination PTX and DDP administered concurrently with pelvic EBRT can be safely administered at the MTD of DDP 35 mg/m2 and PTX 30 mg/m2 weekly for six cycles in Chinese women with postoperative cervical cancer.
Zhu Lihong,Tian Suqing,Qu Ang et al. Phase Ⅰ study of weekly PTX+DDP,and postoperative radiotherapy for early cervical cancer in Chinese women[J]. Chinese Journal of Radiation Oncology, 2016, 25(8): 834-838.
Zhu Lihong,Tian Suqing,Qu Ang et al. Phase Ⅰ study of weekly PTX+DDP,and postoperative radiotherapy for early cervical cancer in Chinese women[J]. Chinese Journal of Radiation Oncology, 2016, 25(8): 834-838.
[1] Samlal RA,van der Velden J.Early cervical carcinoma:how to manage high-risk patients after radical hysterectomy[J].Eur J Obstet Gynecol Reprod Biol,1999,85(2):137-139 [2] Delgado G,Bundy B,Zaino R,et al. Prospective surgical-pathological study of disease-free interval in patients with stage ⅠB squamous cell carcinoma of the cervix:a Gynecologic Oncology Group study[J].Gynecol Oncol,1990,38(3):352-357 [3] Sevin BU,Lu Y,Bloch DA,et al. Surgically defined prognostic parameters in patients with early cervical carcinoma:a multivariate survival tree analysis[J].Cancer,1996,78(7):1438-1446 [4] Hart K,Han I,Deppe G,et al. Postoperative radiation for cervical cancer with pathologic risk factors[J].Int J Radiat Oncol Biol Phys,1997,37(4):833-838 [5] Samlal RAK,Velden JVD,Schilthuis MS,et al. Identification of high-risk groups among node-positive patients with stage ⅠB and ⅡA cervical carcinoma[J]. Gynecol Oncol,1997,64(3):463-467 [6] Tsai CS,Lai CH,Wang CC,The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy[J].Gynecol Oncol,1999,75(3):328-333 [7] Keys HM,Bundy BN,Stehman FB,et al. Cisplatin,radiation and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage ⅠB cervical carcinoma[J].N Engl J Med,1999,340(15):1154-1161 [8] Peters WA,Liu PY,Barrett RJ,et al. Concurrent chemotherapy and pelvic radiation therapy compared with radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix[J].J Clin Oncol,2000,18(8):1606-1613 [9] National Cancer Institute Clinical Announcement. Concurrent chemoradiation for cervical cancer[DB/OL].1999.http://www.cancer.gov/ news center/cervical cancer [10] Cerciello F,Hofstetter B,Fatah SA,et al. G2/M cell check point is functional in cervical cancer patients after initiation of external beam radiotherapy[J].Int J Radiat Oncol Biol Phys,2005,62(5):1390-1398 [11] Moore DH,Blessing JA,McQuellon RP,et al. Phase Ⅲ study of cisplatin with or without paclitaxel in stage ⅠVB,recurrent,or persistent squamous cell carcinoma of the cervix:a Gynecologic Oncology Group study[J].J Clin Oncol,2004,22(15):3113-3119 [12] Chen DM,Paley PJ,Potish RA,et al. Phase Ⅰ trial of Taxol as a radiation sensitizer with cisplatin in advanced cervical cancer[J].Gynecol Oncol,1997,67(2):131-136 [13] Romeo F,Pignata S,Frezza P,et al. Phase Ⅰ study with weekly cisplatin paclitaxel and concurrent radiotherapy in patients with carcinoma of the cervix uteri[J].Ann Oncol,2000,11:455-459 [14] Miglietta L,Franzone P,Centuroni MG,et al. A phase Ⅱ trial with cisplatin-paclitaxel cytotoxic treatment and concurrent external and endocavitary radiation therapy in locally advanced or recurrent cervical cancer[J].Oncology,2006,70(1):19-24 [15] DiSelvestro AP,Walker LJ,Morrison A,et al. Radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in cervical carcinoma limited to pelvis:a phase Ⅰ/Ⅱ study of the Gynecologic Oncology group[J].Gynecol Oncol,2006,103(3):1038-1042 [16] Varghese SS,Ram TS,Pavamani SP,et al. Concurrent chemo-irradiation with weekly cisplatin and paclitaxel in the treatment of locally advanced squamous cell carcinoma of cervix:a phase Ⅱ study[J].J Cancer Res Therap,2014,10(2):330-336.DOI:10.4103/0973-1482.136621 [17] Thakur P,Seam R,Gupta M,et al. Prospective randomized study comparing concomitant chemoradiotherapy using weekly cisplatin& paclitaxel versus weekly cisplatin in locally advanced carcinoma cervix[J].Ann Transl Med,2016,4(3):48-55 [18] Kim K,Kang SB,Chung HH,et al. Comparison of chemoradiation with radiation as postoperative adjuvant therapy in cervical cancer patients with intermediate-risk factors[J].Eur J Surg Oncol,2009,35(2):192-196.DOI:10.1016/j.ejso.2008.04.004 [19] 王海荣,朱卫国,秦珊珊等.高危早期宫颈癌术后放疗联合不同化疗方案随机对照研究[J].中华放射医学与防护杂志,2013,33(1):50-54.DOI:10.3760/cma.j.issn.0254-5098.2013.01.013 Wang HR,Zhu WG,Qin SS,et al. Randomized and controlled study of postoperative radiotherapy combined with different chemotherapy regimens in the treatment of high risk early stage cervical cancer[J].Chin J Radiol Med Protect,2013,33(1):50-54.DOI:10.3760/cma.j.issn.0254-5098.2013.01.013 [20] Pei Shu,Yali Shen,Yaqin Zhao,et al. A phase Ⅰ study of adjuvant intensity-modulated radiotherapy with concurrent paclitaxel and cisplatin for cervical cancer patients with high risk factors[J].Med Oncol,2015:32(11):1-7.DOI:10.1007/s12032-015-0689-5 [21] Jonathan SB.Berek and Novak's gynecology[M].14th ed.Philadelphia: Lippincott Williams and Wilkins,2007:1403-1456 [22] Takeshima N,Umayahara K,Fujiwara K,et al.Treatment results of adjuvant chemotherapy after radical hysterectomy for intermediate- and high-risk stage IB-IIA cervical cancer[J]. Gynecol Oncol,2006,103(2):618-622. DOI:10.1016/j.ygyno.2006.04.019 [23] Markman M.Chemoradiation in the management of cervix cancer:current status and future directions[J].Oncology,2013,84(4):246-250.DOI:10.1159/000346804 [24] Seoud MAF,Shamseddine A,Khalil AM,et al. Randomized trial comparing concurrent radiotherapy with cisplatin compared with paclitaxel in cervical cancer[J].Obstet Gynecol,2006,107(4):43 s [25] Argenta PA,Ghebre R,Dusenbery KE,et al. Radiation therapy with concomitant and adjuvant cisplatin and paclitaxel in high-risk cervical cancer:long-term follow-up[J].Eur J Gynaecol Oncol,2006,27(3):231-235 [26] Walker JL,Morrison A,Disilvestro P,et al. A phase Ⅰ/Ⅱ study of extended field radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in patients with cervical carcinoma metastatic to the para-aortic lymph nodes:a gynecologic oncology group study[J].Gynecol Oncol,2009,112(1):78-84.DOI:10.1016/j.ygyno.2008.09.035 [27] Umayahara K,Takeshima N,Nose T,et al. Phase Ⅰ study of concurrent chemoradiotherapy with weekly cisplatin and paclitaxel chemotherapy for locally advanced cervical carcinoma in Japanese women[J].Int J Gynecol Cancer,2009,19(4):723-727.DOI:10.1111/IGC.0b013e3181a47b53