Weekly versus Three-Weekly Cisplatin as an Adjunct to Radiation Therapy in High-Risk Stage I-IIA Cervical Cancer after Surgery: A Randomized Comparison of Treatment Compliance
Bandit Chumworathayi MD*, Prapaporn Suprasert MD**, Kittipat Charoenkwan MD**, Jatupol Srisomboon MD**, Chailert Phongnarisorn MD**, Sitticha Siriaree MD**, Chalong Cheewakriangkrai MD**, Jaruwan Tantipalakorn MD**, Chamnan Kiatpeerakul MD**, Aree Pantusart BSc (Nursing)**
Affiliation : * Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen ** Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objectives : To compare weekly and three-weekly cisplatin as an adjunct to radiation therapy in high-risk
early-stage cervical cancer after surgery with regard to treatment compliance.
Materials and Methods : From June 1st, 2003 to February 29th, 2004, the authors performed a randomized trial
of radiotherapy in combination with two concurrent chemotherapy regimens - weekly or three-weekly cisplatin
- in patients with high-risk cervical cancer FIGO stage I-IIA after surgery. Women with primary invasive
squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix were enrolled. The
patients also had to have an absolute neutrophil count of at least 1,500 cells per cubic millimeter, a platelet
count of at least 75,000 cells per cubic millimeter, a creatinine clearance higher than 40 milliliter per minute,
and adequate hepatic function. All patients received external-beam radiotherapy according to a strict proto-
col. Patients were randomly assigned to receive one of two chemotherapy regimens: 75 mg per square meter of
cisplatin on days 1, 22, 43 and 64 or every three weeks for 4 cycles (group 1) or 40 mg per square meter of
cisplatin per week for six cycles (group 2).
Results : The analysis included 40 women. The first group that received three-weekly cisplatin had a higher
rate of incomplete and delayed treatments than the second group that received weekly cisplatin (p < 0.001
and p = 0.0236 respectively). The relative risks of delayed courses were 2.06 (95 percent confidence interval,
1.15 to 3.68) for group 1, compared with group 2. The toxicity-related incomplete treatments rate and G-CSF
doses used were significantly higher in group 1 than in group 2.
Conclusion : Concurrent chemoradiation with weekly cisplatin regimen has more complete treatment rate
and less delayed courses than that with three- weekly cisplatin among women with high-risk cervical cancer
after surgery.
Keywords : Cisplatin, Concurrent chemoradiation, High-risk cervical cancer
