Role of neoadjuvant chemotherapy and radiotherapy in locally advanced carcinoma of the cervix

Aim: To study the outcome and complications of neoadjuvent chemotherapy in locally advanced Carcinoma of Cervix in Indian patients. To study the outcome and complications of Radiotherapy in locally advanced Carcinoma of Cervix in Indian patients. Materials and Methods: It is a Prospective analytical study of 95 (n=95) patients registered in the Out-patient section (OPD) of Department of Radiation Therapy and Oncology and indoor patients in gynaec oncology ward in tertiary care institute with histopathologically proven carcinoma of cervix were included in the study. Study duration was from August 2012 to August 2014. Patients with Histologically confirmed cases of carcinoma of cervix with FIGO stage IIB to IVA who were suitable for chemoradiotherapy were included in the study. The baseline characteristics Age, Parity, Weight, Height, Body Surface Area, Socioeconomic Status, FIGO Staging, Histological Variety of Carcinoma Cervix, pre and post treatment ECOG score were noted. The median follow up period was 18 months. All patients were given 3 cycles of Neoadjuvent chemotherapy with each cycle 3 weeks apart, consisting of the drugs dose calculated according to body surface area, Injection Paclitaxel was given as intravenous infusion in a dose of 175 mg /m² on day 1 of chemotherapy cycle whereas Injection Cisplatin was given in a dose of 60 mg /m² intravenous infusion in two divided doses on day 1 and day 2 of neoadjuvent chemotherapy cycle. NACT was followed by concurrent chemoradiotherapy which included conventional fractionated radiotherapy (CFR) with weekly injection cisplatin 35mg/m², EBRT of total dose 50Gy (Gray) in 25 fractions, 200cGy (centigray) per fraction daily for 5 days a week and brachytherapy i.e. Intracavitary Radiation Therapy (ICRT) was given. Results: RECIST 1.0 criterion was used for assessment of the response to treatment. Out of 95 patients, 72 patients (75.78%) had complete response. Partial response was seen in 13 patients (13.68%). Stable disease was seen in 7 patients (7.3)%. 3 patients (3.15%) had progressive disease. Subjective response was evaluated after asking the patient about status of their presenting symptoms one month after completion of whole treatment. Out of 90 patients who had vaginal discharge, 80 patients (88.89%) got relief after complete treatment. Out of 65 patients who had vaginal bleeding, 59 patients (90.76%) were free of this symptom at the completion of treatment. Out of 36 patients who suffered with pelvic discomfort at the start of therapy, 16 patients (44.44%) got symptomatic improvement. During the course of treatment, 56 patients (58.94%) developed Nausea and Vomiting, 30 patients (31.57%) had diarrhoea, 10 patients (10.52%) had cystitis, 7 patients (7.36%) had proctitis, 9 patients (9.47%) developed peripheral neuropathy, 15 patients (15.78%) suffered fever and rash. Renal complications occurred in 7 patients (7.36%). Hematological side effects including anemia neutropenia and thrombocytopenia were noted in 25 patients (26.31%) Median follow-up period for patients was 18 months. Overall survival rate at 1 year after treatment was 74.73% whereas Disease free survival rate at 1 year after treatment was 69.47%. Conclusions: We conclude that, the study has demonstrated a good response rate to NACT followed by CRT in patients with locally advanced carcinoma of cervix with regard to tumour response, overall and disease free survival. The combination of paclitaxel with cisplatin for use in neoadjuvnant chemotherapy showed acceptable adverse effects.