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Original Articles
- Gynecologic cancer
- Effectiveness of Concomitant Chemoradiotherapy with Gemcitabine in Locally Advanced Cervical Cancer Patients with Comorbidities
- Hasan Brau-Figueroa, Eder Arango-Bravo, Denisse Castro-Eguiluz, Tatiana Galicia-Carmona, Leopoldo Abraham Lugo-Alferez, Ivette Cruz-Bautista, Roberto Jiménez-Lima, Lucely Cetina-Pérez
- Cancer Res Treat. 2022;54(2):554-562. Published online August 10, 2021
- DOI: https://doi.org/10.4143/crt.2021.375
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Abstract
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Supplementary Material
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ePub - Purpose
The standard treatment for locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy with cisplatin (CDDP) followed by brachytherapy. The presence of comorbidities are risk factors for nephrotoxicity and are associated with lower survival. Gemcitabine is a radiosensitizing drug that has shown efficacy and safety in this context. The effectiveness of concomitant chemoradiotherapy with gemcitabine was evaluated versus cisplatin in LACC patients with comorbidities and preserved renal function.
Materials and Methods
An observational, longitudinal and paired study was carried out that included patients treated between February 2003 and December 2015. The primary objectives were to evaluate response rates, progression-free survival, and overall survival; the secondary objectives were to evaluate toxicity and renal function.
Results
Sixty-three patients treated with gemcitabine at 300 mg/m2 weekly and 126 patients treated with CDDP 40 mg/m2 weekly were included. There were no significant differences in response rates and survival rates. Treatment with cisplatin presented a higher frequency of hematological toxicities, while gemcitabine presented a higher frequency of gastrointestinal toxicities. A decrease in glomerular filtration rate (GFR; baseline vs. 1-year post-treatment) was observed in the cisplatin group (p=0.002), while not in the gemcitabine group (p=0.667). In a multivariate analysis, it is observed that only CDDP correlates with the decrease in GFR (hazard ratio, 2.42; p=0.012).
Conclusion
In LACC patients with comorbidities, gemcitabine and CDDP show the same efficacy, with different toxicity profiles. Treatment with cisplatin is associated with a significant decrease in GFR during follow-up, compared to treatment with gemcitabine that does not decrease it. -
Citations
Citations to this article as recorded by
- Medical nanoscale materials for virus-induced cervical cancer therapeutic modalities: For targeting delivery
Adane Adugna, Mamaru Getinet, Gashaw Azanaw Amare, Mohammed Jemal
OpenNano.2025; 21: 100221. CrossRef - The Long Term Effects of a 12‐Session Community Exercise Program on Health Measures in Cancer Patients
Isaac Oppong, Roozbeh Naemi
Aging and Cancer.2025;[Epub] CrossRef - Chemoradiotherapy treatment with gemcitabine improves renal function in locally advanced cervical cancer patients with renal dysfunction
Silvia Alarcón-Barrios, Julissa Luvián-Morales, Denisse Castro-Eguiluz, Merari Delgadillo-González, Brenda Olivia Lezcano-Velázquez, Eder Alexandro Arango-Bravo, Laura Flores-Cisneros, Sebastián Aguiar Rosas, Lucely Cetina-Pérez
Current Problems in Cancer.2024; 48: 101041. CrossRef - Association between body composition phenotypes and treatment toxicity in women with cervical cancer undergoing chemoradiotherapy
Mariah Azevedo Aredes, Nathália Silva de Paula, Gabriela Villaça Chaves
Nutrition.2024; 127: 112539. CrossRef - Older adults with cancer and common comorbidities—challenges and opportunities in improving their cancer treatment outcomes
Weiwei Chen, Rachel D Altshuler, Phil Daschner, Carolina Salvador Morales, Diane C St. Germain, Jennifer Guida, Pataje G S Prasanna, Jeffrey C Buchsbaum
JNCI: Journal of the National Cancer Institute.2024; 116(11): 1730. CrossRef
- Medical nanoscale materials for virus-induced cervical cancer therapeutic modalities: For targeting delivery
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- The Effects of the Induction Chemotherapy on the Radical Radiotherapy in the Locally Advanced Cervical Cancer
- Ki Mun Kang, Sei Chul Yoon, Hong Seok Jang, Mi Ryeong Ryu, Yeon Shil Kim, Sung Eun Namkoong, Seung Jo Kim
- J Korean Cancer Assoc. 1998;30(4):762-771.
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Abstract
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- PURPOSE
We evaluated the prognostic factors, survivals and patterns of failure of the patients with locally advanced cervical cancer who received radical radiotherapy alone and induction chemotherapy followed by radiotherapy respectively.
MATERIALS AND METHODS
Between May 1985 to December 1992, one hundred and sixty three patients with locally advaneed cervical cancer received curative radiotherapy. Patients were divided into two groups: control group included 69 patients who received curative radiotherapy and combined group included 94 patients who received induction chemotherapy followed by curative radiotherapy. The curative radiotherapy consisted of external pelvic radiotherapy and intracavitary brachytherapy. Induction chemotherapy was delivered in VBP (vincristine, bleomycin, cisplatin) and FP (5-FU, cisplatin). Follow up period ranged from 2 months to 99 months with median of 50 months.
RESULTS
The overall response rate was 94.2% in the control group and 89.4% in the combined group. The response rate by control group was 66.7% for CR (complete response), 27.5% for PR (partial response), 5.8% for NR (no response). The response rate by combined group of CR, PR, NR were 64.9%, 24.5%, 10.6%, respectively. There was no difference in response for control group and combined group (p> 0.05). The 5-year overall survival had no significant difference in between control group and combined group (54.6% vs. 57.3%). The 5-year disease free survival also had no significant difference (52.9% vs. 55.0%). In the control group, 23 patients (33.3%) had treatment failure: twelve (17.4%) at a local recurrence, 9 (13.0%) as distant metastasis, and 2 (2.9%) with both local recurrence and distant metastasis. In the combined group, Thirty patients (31.9%) failed therapy, with local recurrence in 21 patients (22.3%), distant metastasis in 7 patients (7.5%), and both in 2 patients (2.1%). The difference between the two groups was not significant in view of patterns of failure. The major toxicities were nausea/ vomiting, leukopenia, anemia, and diarrhea. The prognostic factors affecting were hemoglobin level, KPS (karnofsky performance status), and treatment response in both group by multivariate analysis.
CONCLUSION
This study did not prove the efficacy of induction chemotherapy followed by radiotherapy in locally advanced cervical cancer.
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