Fourteen patients with poor-prognosis
cervical cancer were treated with concurrent
chemotherapy (
cisplatin and
mitomycin-C), external
radiation therapy (RT), and high-dose-rate (HDR)
brachytherapy. Pelvic RT was delivered as (a) external-beam radiation (four-field box technique, 40.0 Gy), (b)
brachytherapy using HDR 60Co or 192Ir (3.80 Gy/fraction, thrice weekly; total dose, 46.83 Gy) with intrauterine
stent, and (c) parametrial boost using an AP field with custom-fabricated step wedges. Post-radical-
hysterectomy patients received 50.40 Gy external RT and 3.23 Gy/day vaginal cylinder HDR at 1/2-cm depth (total dose, 16.15 Gy). Complete clinical and radiographic response was noted in all evaluable patients who are alive with no evidence of disease, 3 to 27 months after completion of
therapy (median, 9 months). Toxicity consisted of grade 2 to 3 hematologic toxicity (4 patients) and
nausea and
vomiting in all, but grade 3 in only 2 patients. One patient had grade 2
diarrhea. The only major complication (small bowel obstruction) occurred in a patient with lupus
vasculitis. This pilot study demonstrates the feasibility of this regimen in an outpatient setting with acceptable toxicity. More prolonged follow-up of our patients is required to determine its impact on long-term survival.