Role of chemotherapy in the management of locally advanced carcinoma cervix

Authors

  • Huma Firdaus Department of Obstetrics and Gynecology, ERA's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
  • Ayanat Husain Department of Surgery, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183330

Keywords:

Cancer cervix, Cervix, Chemotherapy

Abstract

Background: This study was undertaken to evaluate role of chemotherapy in the management of locally advanced carcinoma cervix in J.N. Medical College Hospital, A.M.U. Aligarh.

Methods: A total of 50 cases were studied. 25 cases received radiotherapy alone or surgery followed by radiotherapy. In remaining 25 cases, 18 patients received neoadjuvant chemotherapy followed by surgery or radiotherapy where as seven patients out of 25 received concurrent chemo-radiation. SPSS software was used for data analysis.

Results: Mean age of patient was 51.5 years. Majority of patients (60%) were in FIGO clinical stage IIB followed by stage IIIB (20%), stage IVA (12%) and stage IIA (8%). Out of 25 patients receiving chemotherapy, 68% showed CR whereas 20% showed PR, 4% showed minimal response and 8%showed PD while on chemotherapy. In radiotherapy group, CR was found in 56% and PR in 36% of cases.

8% of patients showed PD while on radiotherapy. Patients with stage IIB disease showed best response with CR in 70% and PR in 16.66% cases. 6.66% of patients showed SD and 6.66% showed PD while on therapy. 55.55% of patients with SCC showed CR and 33.33% showed PR. In adenocarcinoma, CR was seen in 100% cases. In adenosquamous carcinoma, 66.66% showed CR whereas 33.33% showed PR. 61.9% of well differentiated carcinoma showed CR and 28.57% showed PR. 4.76% showed SD and 4.76% showed PD. 58.33% of moderately differentiated carcinoma showed CR, 37.5% showed PR and 4.17% showed SD. 20% of poorly differentiated carcinoma showed CR, 60% showed PR and PD was seen in 20%cases. Patients with bulkly tumours in present study, irrespective of their response to chemotherapy, appeared to have worse prognosis than patients with more advanced pelvic disease. These findings suggest that the biology of bulky stage lb, IIa & IIb disease may be more aggressive than that of more extensive locally advanced disease.

Conclusions: Chemotherapy can be considered as an adjuvant to available modalities of treatment, like surgery or radiotherapy, to improve the overall survival of cancer cervix patients.

References

ICO Information Centre on HPV and cancer (Summary Report 2014-08-22). Human Papillomavirus and Related Diseases in India. 2014

Panici PB, Scambia G, Baiocchi G, Greggi S, Ragusa G, Gallo A, et al. Neoadjuvant Chemotherapy and radical surgery in locally advanced cervical cancer. Cancer. 1997;67:372-9.

Haskell CM. Cancer treatment. 4th ed. Philadelphia: W.B. Saunders;1995.

Buxton EJ, Meanwell CA, Hilton C, Mould JJ, Spooner D, Chetiyawardana A et al. Combination Bleomycin, Ifosfamide, and Cisplatin Chemotherapy in Cervical Cancer, JNCI. 1989,81(5):359-61.

Kaushal V, Goel A. Chemotherapy for carcinoma cervix : with what and when? Obstet Gynae. 2001;3:171-4.

Wynder El, Cornfield J, Schroff PD, Doraiswami KR. A study of environmental factors in carcinoma of the cervix. Am J Obstet Gynecol. 1954;68(4):1016-52.

Parikh S, Brennan P, Boffetta P. Meta-analysis of social inequality and the risk of cervical cancer. Int J Cancer. 2003;105:687-91

Khan MJ, Partridge EE, Wang SS, Schiffman M. Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology. Cancer 2005;104:61-70.

International Collaboration of Epidemiological Studies of Cervical Cancer Cervical carcinoma and reproductive factors: collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies. Int J Cancer. 2006;119:1108-24

Louie KS, de Sanjose S, Diaz M, Castellsague X, Herrero R, Meijer CJ, et al (2009) Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009;100:1191-7.

de Sanjose S, Bosch FX, Munoz N, Shah K (1997) Social differences in sexual behaviour and cervical cancer. IARC Sci Publ. 1997;138:309-17

Friedlander ML, Atkinson K, Coppleson JVM, Elliot P, Green D, Houghton R et al. The integration of chemotherapy into the management of locally advanced cervical cancer: A pilot study. Gynaecol Oncol. 1984;19:1-7.

Desai M, Desai B. Cisplatin MTX chemotherapy before radiotherapy improves survival in cancer cervix. J Obstet Gynecol India. 2001;51:187-9.

Downloads

Published

2018-07-26

Issue

Section

Original Research Articles