1000P - Neoadyuvant chemotherapy followed by chemorradiation in locally-advanced squamous cervical cancer

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Cervical Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Maria Vieito Villar
Authors M. Vieito Villar1, N. Martinez Lago1, J.F. Cueva1, E. Gonzalez Patiño2, M.T. Curiel3, P. Palacios Ozores3, S. Candamio Folgar3, N. Salvador Garrido2, B. Taboada4, R. Lopez5
  • 1Dept. Of Medical Oncology, Complejo Hospitalario Universitario de Santiago de Compostela SERGAS, 15706 - Santiago de Compostela/ES
  • 2Radiocherapy Oncology, Hospital Clínico de Santiago de Compostela, 15706 - santiago de compostela/ES
  • 3Medical Oncology, Hospital Clínico de Santiago de Compostela, 15706 - santiago de compostela/ES
  • 4Oncoloxia Radioterápica, Hospital Clinico Universitario de Santiago, Santiago de Compostela/ES
  • 5Complejo Hospitalario Universitario de Santiago de Compostela SERGAS, 15706 - Santiago de Compostela/ES

Abstract

Introduction

Although there has not been a direct comparison between neoadjuvant chemotherapy followed by chemor-radiation with the standard treatment of concurrent chemor-radiation, neoadjuvant chemotherapy is active in squamous cervical cancer.

Material and methods

In this open label 1 arm phase two trial we accrued 19 patients from 2007 to 2011 diagnosed with squamous cervical cancer deemed to be unresectable and poor candidates to concurrent chemor-radiation. Patients had to be over 18 years of age, give informed consent, have a PS0-1 and adequate organ function.

They received neoadjuvant chemotherapy with paclitaxel 80mg/m2 and cisplatin33mg/m2 days 1,7,15/28 for two cycles and then external radiation in 1.8 Gy/ fraction with concurrent cisplatin 40mg/m2/weekly followed by brachytherapy in 5-6 applications. After completion of neoadjuvant treatment and after concurrent chemor-radiation patients were evaluated by RECIST 1,1 criteria for tumor response with a CT scan and pelvic MNR and data of dose intensity and toxicity was accrued.

Results

Median age at diagnosis was 51 years (27 to 72 years); all the patients had PS1 due to local pain, asthenia or genital discharge. Neoadjuvant treatment was feasible in all patients with manageable toxicities; the dose intensity delivered was 97% of the preplanned dose. Only 2 episodes of grade III anemia were observed. In the first radiologic evaluation 4 patients had a complete response, 12 had partial response and 3 disease stabilization. Patients received external radiotherapy in fractions of 1.8 Gy achieving a dose of 66 GY in patients that could not receive brachytherapy. Mean EQD2C for those who did (68%) was 72 GY. Only 68% of the patients received the full preplanned concomitant dose due to toxicity, mainly grade III anemia and diarrhea. In the second radiological evaluation 9 patients had a complete response, 9 partial and only 1 stable disease. At a mean of 24 months of follow up only 5 patients (26%) thus far have developed recurrent disease, all of the recurrences were simultaneously local as well as systemic.

Conclusion

Our weekly cisplatin-paclitaxel regimen has been demonstrated to be feasible and effective in terms of dose delivery, tolerance and radiological responses without compromising definitive treatment with chemor-radiation.

Disclosure

All authors have declared no conflicts of interest.