Intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical cancer.
Nedaplatin is a platinum analog that has less renal toxicity and higher efficacy for uterine cervical cancer than cisplatin. Intraarterial cisplatin has been shown to be more effective than intravenous cisplatin in the treatment of cervical cancer. To improve the prognosis of cervical cancer, we studied combination chemotherapy of intravenous nedaplatin and intraarticular cisplatin with transcatheter arterial embolization (TAE). The criteria for selecting patients for this study were as follows: age 16-75 years, stage Ib2-IV according to the classification of the International Federation of Gynecology and Obstetrics (FIGO), performance status between 0 and 2, a creatinine clearance of >40 ml/min, adequate bone marrow and adequate renal and hepatic function. Thirty-two patients, aged 29-72 years (median: 55) were treated. FIGO stage was Ib2 in seven patients, IIa in seven patients, IIb in four, IIIa in one, IIIb in seven and IVa in six. Twenty-four patients had squamous cell carcinoma, three had adenocarcinoma and five had adenosquamous carcinoma. Written informed consent was obtained from all patients. Nedaplatin (30-70 mg/m2) was administered intravenously on day 1 and cisplatin (70 mg/m2) was administered intraarticularly via both uterine arteries on day 3 using the Seldinger method. TAE was then performed. This course of treatment was repeated every 3 weeks for 2-3 cycles. Response to the therapy was defined by magnetic resonance imaging. Partial response was found in 59% patients (19/32) and complete response in 34% (11/32), with an overall response rate of 94% (30/32). Myelosuppression was manageable. No grade 2 neurotoxicity was observed. The median follow-up was 32 months (6-53 months), with 84% of patients showing an overall survival of 1 year and 77% showing an overall survival of 2 years. These results show that this combination chemotherapy effected a high response rate. However, its influence on long-term survival remains to be determined.
Adachi
S
S
Department of Obstetrics and Gynecology, Hyogo College of Medicine, Japan. adachi@hyo-med.ac.jp
Ogasawara
T
T
Tsubamoto
H
H
Oku
H
H
Hori
Y
Y
Tsuji
Y
Y
Takemura
T
T
Koyama
K
K
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D021721:Balloon Occlusion / Q000379:methods*; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; C053989:nedaplatin; D002945:Cisplatin