CONCURRENT CHEMORADIATION WITH WEEKLY CISPLATIN AND PACLITAXEL IN LOCALLY ADVANCED CARCINOMA CERVIX

Introduction:Carcinoma cervix is the most common gynaecological malignancy in women. Concurrent chemoradiotherapy is an effective treatment for locoregionally advanced squamous cell carcinoma of the cervix, with established benefits in both organ preservation and survival. Aims:1. To assess the immediate locoregional response rates of locally advanced squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy using weekly low dose cisplatin and low dose paclitaxel followed by HDR intracavitary brachytherapy. 2. To assess the acute toxicity. Materials and methods:This is a single arm prospective study in which 30 patients with cervical carcinoma of stages IB2-IIIB, presenting to our hospital, were given concurrent chemoradiation: EBRT 50Gy/25# with weekly Cisplatin 30mg/m2 and Paclitaxel 30mg/m2 followed by intracavitary brachytherapy 8Gy/2# and response was assessed, both clinical and radiological, at the end of 6 weeks after completion of therapy, using RECIST criteria. Toxicity was assessed using RTOG morbidity scoring. Results:Clinically, there was complete locoregional response in 27 patients (90%), partial response in 3 patients (10%). Acute toxicities were observed but they were manageable. Diarrhea presented as grade I, II and III in 5 (16.7%), 3 (10%) and 2 (6.7%) patients respectively. Grade Ihaematological toxicity was seen in 7 patients (23.3%) and grade II in 3 patients (10%) during the 5th week of chemo-radiation. Grade I and II skin reactions were seen in 7 patients (23.3%) with grade III reactions in one patient. Grade I bladder toxicity is seen is 2 patients (6.7%). Conclusion:This study shows including a taxane as a radiosensitiser, in the standard concurrent chemoradiation with weekly cisplatin schedule, yields better loco-regional response with acceptable toxicity, especially in locally advanced stages and those with pelvic nodal involvement.