Intensified radiochemotherapy with cisplatin and gemcitabine for cervical cancer in the modern era: a retrospective cohort study

Objective Combining cisplatin and gemcitabine (CG) in the concurrent and adjuvant treatment phase of advanced cervical cancer has improved oncological outcome at the cost of excess toxicity. We aimed to investigate the feasibility and safety of this treatment intensification in the era of modern radiotherapy.Methods A retrospective review was performed on patients treated with definitive chemoradiation including CG for advanced cervical cancer. Treatment consisted of chemoradiotherapy (weekly cisplatin 40 mg/m² and gemcitabine 125 mg/m² with volumetric-modulated arc therapy) followed by image-guided adaptive brachytherapy and 2 cycles of adjuvant CG.Results Fifty-five patients were included with a median follow-up of 48 months (range, 7-130). Patients with FIGO stage IIIC1 accounted for 49.1% of cases, with an additional 23.6% being stage IIIC2. The median number of concurrent gemcitabine and cisplatin administrations was 4 (range, 1-6), and 5 (range, 2-8), respectively. Forty-four patients (80%) received adjuvant chemotherapy. Hematological severe short-term toxicity (grade ≥3) occurred in 22 patients (43.1%). There was no deviation from planned radiotherapy-schedule. No treatment-related death occurred. Five patients experienced late grade ≥3 adverse events. Local, locoregional and distant control rates at 5 years were 82.0%, 70.5% and 69.3%, respectively. Five-year progression-free survival was 50.9% and overall survival was 70.9%.Conclusion Concurrent chemoradiation with CG followed by image-guided adaptive brachytherapy and adjuvant CG is feasible and associated with a lower toxicity profile than previously reported. Further research is needed to refine patient selection for different treatment intensification strategies in advanced cervical cancer.