Chemoradiation and adjuvant chemotherapy in cervical cancer

Purpose: Radiotherapy is the standard treatment for locally advanced cervical cancer, but treatment results remain disappointing, particularly for women with bulky central disease. We investigated the role of concurrent chemoradiation and adjuvant chemotherapy in a randomized trial. Patients and Methods: Two hundred twenty patients with bulky stage I, II, and III cervical cancer were randomized to receive either standard pelvic radio-therapy or chemoradiation (epirubicin 60 mg/m(2)) fallowed by adjuvant chemotherapy with epirubicin 90 mg/m(2) administered at 4-week intervals for five additional cycles. Results: Fifty-nine patients have relapsed, with a median follow-up duration of 77 months. Patients who received epirubicin radiation therapy showed a significantly longer disease-free (P = .03) and cumulative survival (P = .04). Patients who received radiation alone had significantly more distant metastasis than those who received chemoradiation (P = .012), There was no difference in long-term local tumor control (P = .99), Conclusion: Survival benefit has been demonstrated in patients treated with chemoradiation followed by adjuvant chemotherapy with epirubicin as compared with patients treated with standard pelvic radiotherapy alone. (C) 1999 by American Society of Clinical Oncology.