Comparison between the Efficacy of Concurrent Chemo-Radiation with Gemcitabine Followed by Intracavitary Radiotherapy in Patients with Locally Advanced Cervical Carcinoma

Introduction: Commonest threatening cancer in our Asian round is Cervical cancer. Currently, platinum based concurrent chemo-radiation therapy is the standard of care for locally advanced cervical cancer but treatment results are disappointing, particularly for women with bulky tumor. To improve this result, several non-platinum based agents with concurrent chemo-radiation have been evolved. Objective: To observe the response and toxicity of concurrent chemo-radiation with Gemcitabine including intracavitary radiotherapy in patients with locally advanced cervical carcinoma. Material and Methods: This was a quasi-experimental study, where 33 patients with untreated invasive squamous cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study from the Radiation Oncology Department of Rajshahi Medical College Hospital from April 2019 to March 2020. Duration of the study was 2 years. All patients received 150 mg/m² of Gemcitabine weekly along with external beam radiation therapy (EBRT). EBRT dose was 50 Gy in 25 daily fractions followed by intracavitary radiotherapy (ICRT) of 21 Gy in 3 fractions. Results: The mean age was 45.4 years. Most of the patients were in stage IIB group (59.1% patients) and most of them were moderately differentiated (62.1% patients). After 3 months of treatment, the complete response was found in 81.8% patients and partial response was seen in 12.1% patients and progressive disease was found in 6.1% patients. The grade 2 and 3 haematological toxicity was higher. The grade 2 and 3 anaemia was seen in 60.6% and 24.2% patients, neutropenia was observed in 24.2% and 6.1% patients respectively. The grade 2 diarrhoea (42.4%), proctitis (36.4%) and skin toxicity (45.5%) were more common. The grade 1 renal toxicity was observed in 3% patients and grade 2 cystitis was found in 9.1% patients. Conclusion: Concurrent chemo-radiation with Gemcitabine can be used as an alternative to Cisplatin, when cisplatin is contraindicated. ......