Concurrent chemoradiotherapy (CCRT) with cisplatin is widely recommended as a treatment option for patients with advanced cervical cancer because of its better prognosis than radiotherapy. However, cisplatin should be reluctantly avoided or reduced for patients with renal dysfunction because of nephrotoxicity. In contrast, carboplatin is adjusted to a dose according to renal function, to insure safety independent of renal function. Here we evaluated the efficacy and feasibility of CCRT with paclitaxel and carboplatin (TC) for patients with advanced cervical cancer with renal dysfunction.
We retrospectively analyzed the safety and efficacy of TC-CCRT for 11 patients with advanced cervical cancer with renal dysfunction between December 2015 and May 2017 in our hospital (TC-group). Patients who underwent radiotherapy alone between January 2012 and December 2015 (RT-group, n = 15) because of renal dysfunction served as historical controls. Chemotherapy using 135 mg/m2 paclitaxel followed by carboplatin with a dosage at area under the curve = 5 mg/ml/min was given every 3 weeks. Three cycles, maximum, were expected. Radiotherapy of both groups was performed using whole pelvic external irradiation and brachytherapy.
The TC group received triweekly chemotherapy (average 2.4 cycles). All patients received the planned full radiation. Radiotherapy was temporarily discontinued for two patients (18.2%) in the TC-group and for one patient (6.7%) in the RT group because of toxicity. The TC-group required 6.0 days (average) extended radiation therapy, which was not significantly longer than the RT-group (7.0 days). The rates of local complete response did not differ significantly between groups (90.9% vs 86.7%).
TC–CCRT for patients with advanced cervical cancer with renal dysfunction was safe, with minimal postponement of radiotherapy because of toxicity, suggesting that this therapy is effective. The advantage of TC–CCRT for increasing survival compared with RT or CCRT using reduced doses of cisplatin is further evaluated.
Yokohama City University Hospital, Department of Obstetrics and Gynecology
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All authors have declared no conflicts of interest.