Paclitaxel/Nedaplatin Concomitant Chemoradiotherapy And Consolidation Chemotherapy In Locally Advanced Cervical Cancer

Background:Cervical cancer remains one of the most common malignances in women worldwide,with 510 000 new cases every year and 288 000 deaths.Surgery and radiotherapy are major modalittes,but the result is still unsatisfactory for the locally advanced cervical cancer(LACC).In the past few years,the advantages of concurrent chemoradiotherapy in the management of LACC have been reported.From 1999 to 2000, five randomized trials demonstrated improved survival and local control when cisplatin-containing chemotherapy was added concurrently to radiation treatment in patients with LACC.Based on the results of these five trials,the National Cancer Institute(NCI) released a clinical announcement stating "strong consideration" should be given to the incorporation of concurrent chemotherapy with radiation for patients who require radiation therapy for the management of cervical cancer.But there are still remain a lot of problem,such as which regimen is the best,what is the proper dosage,how the chemotherapy should coordinate with the radiotherapy,and so on.Since there have been a lot of newer chemotherapy agents including carboplatin,paclitaxel,gemcitabine, topotecanm as candidates for study with radiation therapy in cervical cancer,it is still worth furthering the concurrent chemoradiotherapy study.Objectives:Our trial is aim to study on the activity and feasibility of adding Nadplatin/Taxol to radiation therapy in the treatment of locally advanced cervical cancer, also evaluate the adverse effect at the same time.Methods:1.Experimental part:The BALB/c nu/nu mice with Hela cell implanted were divided into six groups.One is control group.Taxol,Nedaplatin,Cisplatin,Taxol-Nedaplatin, Taxol-Cisplatin were used in the other five groups.2.Clinical part:Patients with LACC(FIGO stageⅡB-ⅣB) were enrolled in this study and received paclitaxel-nadaplatin cytotoxic treatment concurrent with radiotherapy. Those who had previous chemotherapy or radiotherapy should be rejected.Four more cycles were given after CCRT.We use WHO standard to evaluate the effect.Adverse events will be recorded according to Common Terminology Criteria for Adverse Events v3.0(CTCAE v3.0) by NCI(National Cancer Institute).Results:1.Experimental part:The antitumor efficacy in combination groups was better than that in single groups.There was no difference in antitumor efficacy between the two combination groups,but Taxol-Nedaplatin group had less toxicity than Taxol-Cisplatin group.2.Clinical part:From May 2007 through January 2008,26 patients have been enrolled in this trial,including 12 patientes of stageⅡB,2 patients of stageⅢA and 14 patients of stageⅢB.24 patients have complete clinical remission after the treatment. 2 have partial remission.Grade 3～4 neutropenia in 2 patients and grade 3 gastrointestinal toxicity in 1 patient.