J Cancer 2020; 11(9):2632-2638. doi:10.7150/jca.40276 This issue

Research Paper

Tolerability, Efficacy and Feasibility of Concurrent Gemcitabine and Cisplatin (CGP) Combined With Intensity Modulated Radiotherapy for Loco-Regionally Advanced Carcinoma of the Cervix

Emmanuel Kwateng Drokow1, Liu Zi2, Han Qian1, Lanlan Xu1, Francis Foli3, Hafiz Abdul Waqas Ahmed4, Gloria Selorm Akpabla5, Guangyin Wu1, Emmanuel Bamfo Agyekum6, Weihua Gao1, Marie-Anne Deku7, Juanjuan Song4, Kai Sun4✉

1. Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
2. Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
3. Department of Internal Medicine, Seventh Day Adventist Hospital, Takoradi MC 1034, Ghana
4. Department of Haematology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
5. Department of Internal Medicine, Tianjin Medical University, Tianjin 300033, China
6. Department of Pharmacy, Zhengzhou University, 450001, Zhengzhou-China.
7. Department of Oncology, Binzhou Medical University, Yantai-Shandong 264003, China

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Citation:
Drokow EK, Zi L, Qian H, Xu L, Foli F, Ahmed HAW, Akpabla GS, Wu G, Agyekum EB, Gao W, Deku MA, Song J, Sun K. Tolerability, Efficacy and Feasibility of Concurrent Gemcitabine and Cisplatin (CGP) Combined With Intensity Modulated Radiotherapy for Loco-Regionally Advanced Carcinoma of the Cervix. J Cancer 2020; 11(9):2632-2638. doi:10.7150/jca.40276. Available from https://www.jcancer.org/v11p2632.htm

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Abstract

Background: Gemcitabine and cisplatin combined with conventional radiotherapy in treating patients with cervical cancer, resulted in a favourable conclusion but accompanied with high toxicity. The objective of our research was to assess the tolerability, efficacy and feasibility of dual chemotherapy in addition to image-guided adaptive brachytherapy and highly conformal external beam radiation therapy.

Methods & Materials: From June 2011 to November 2013, 81 cervical cancer patients with FIGO stage IB2-IIIB medical records were retrospectively reviewed. All patients received whole pelvic radiotherapy (WPRT) to a total dose of 50.4 Gy/ 1.8 Gy Chemoradiotherapy prescription objectives were: concurrent gemcitabine (125 mg/m2) and cisplatin (30 mg/m2) during the 6 weeks of external beam radiation therapy (EBRT) followed by two cycles of gemcitabine (1 g/m2, d1, d8) and cisplatin (25 mg/m2 d1-d3) on the tenth week. External beam radiotherapy was followed by image-guided brachytherapy of 24 Gy/ 4 fractions. Version 4 of the common terminology criteria for adverse events (CTCAE v 4.0) was used in grading the toxicities.

Results: Sixty-nine patients obtained complete response (CR), six had a partial response (PR), and five patients had stable disease (SD). The disease control rate (DCR= SD and ORR) and overall response rate (ORR= PR, CR or PR) were 92.6% and 85.2% respectively. The 3-year and 5-year estimated overall survival (OS) was 75.4% and 66.3%, and the 3-year and 5-year estimated progression-free survival (PFS) were 78.2% and 65.4%. The median PFS time and OS time were 36.8 months and 45.5 months, respectively. Distance metastasis was evident in the lung (3 patients), pelvic wall (2 patients), liver (3 patients) and bone (2 patients). Six (6) had a local relapse, and two (2) patients had local relapse plus simultaneous systemic metastatic tumour.

Conclusions: Unlike past results, gemcitabine and cisplatin appear to be tolerable, efficient and feasible when combined with conformal radiotherapy.

Keywords: gemcitabine, cisplatin, cervical cancer, chemoradiotherapy, overall survival