title: Radiochemotherapy combined with regional pelvic hyperthermia induces high response and resectability rates in patients with nonresectable cervical cancer > or =FIGO IIB "bulky".
abstract: OBJECTIVE
  To evaluate preoperative radiochemotherapy combined with regional pelvic hyperthermia in patients with nonresectable cervical cancer >/= International Federation of Gynecology and Obstetrics (FIGO) IIB "bulky" in a Phase II study.
  
  
  METHODS
  Thirty-two patients with nonresectable FIGO IIB-IVA cervical cancer confined to the pelvis were treated with radiochemotherapy (5 x 1.8 Gy/wk, 45-50.4 Gy; cisplatin, 40 mg/m2/wk) and weekly regional pelvic hyperthermia (SIGMA-60 applicator, system BSD-2000; BSD Medical Corp., Salt Lake City, UT). Responders underwent hysterectomy if possible, whereas patients still unresectable received definitive hyperthermic radiochemotherapy. Feasibility, toxicity, as well as response and resectability, local progression free- and overall survival rates, were evaluated.
  
  
  RESULTS
  Thirty of 32 patients completed treatment. Grade III/IV toxicities (National Cancer Institute-Common Toxicity Criteria) were diarrhea (n = 5), weight loss >10 kg (n = 4), and nausea (n = 2). Twenty-four of 32 patients (75%) achieved a partial remission after 45-50 Gy, and 20 patients underwent hysterectomy (18 patients, R0; 8 patients pCR). Three-year overall survival was 60%, with moderate (13%) rates of severe late toxicity. R0-resected patients had a favorable chronic toxicity profile and an excellent prognosis (3-year survival rate: 93%). Response depended on thermal parameters (vaginal reference point), whereas response, R0-resection, and FIGO stage are significant prognostic factors for survival.
  
  
  CONCLUSIONS
  Preoperative hyperthermic radiochemotherapy (45-50 Gy) induces high response rates and enables curative surgery in a high proportion of patients with nonresectable cervical cancer. Therefore, the use of hyperthermia in conjunction with standard chemo-/radiotherapy +/- surgery may allow for more effective tumor treatment while decreasing the risk of complications in patients with locally advanced cervical cancer.
authors.affiliation: Clinic for Radiation Medicine, Campus Virchow-Klinikum, Charité Univesitätsmedizin, Berlin, Germany.
authors.forename: Geetha
authors.initials: G
authors.lastname: Sreenivasa
authors.forename: Bert
authors.initials: B
authors.lastname: Hildebrandt
authors.forename: Sherko
authors.initials: S
authors.lastname: Kümmel
authors.forename: Kirsten
authors.initials: K
authors.lastname: Jungnickel
authors.forename: Chie Hee
authors.initials: CH
authors.lastname: Cho
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tilly
authors.forename: Dirk
authors.initials: D
authors.lastname: Böhmer
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Roland
authors.initials: R
authors.lastname: Felix
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001918:Brachytherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D010388:Pelvis; D011882:Radiotherapy, High-Energy / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin