title: Survival and toxicity differences between 5-day and weekly cisplatin in patients with locally advanced cervical cancer.
abstract: BACKGROUND
  Cisplatin (CDDP) administration concomitant with radiotherapy (RT) for the treatment of locally advanced cervical cancer has evolved from an inpatient 5-day every 21-day regimen to a weekly outpatient regimen. This study was designed to test for differences in progression-free survival (PFS) and toxicity between the 2 regimens.
  
  
  METHODS
  In all, 77 consecutive patients at a single institution with stage IB2-IV cervical cancer were included in this analysis (using the International Federation of Gynecologists and Obstetricians staging system). All patients were treated with CDDP, external beam RT, and 2 9-Gy high-dose-rate brachytherapy treatments. Two cohorts were compared: 1) 5-day, patients treated from 1995 to 2001 with CDDP 20 mg/m(2) x 5 days every 21 days concomitant with RT; 2) weekly, treated after May 2001 with CDDP 40 mg/m(2) weekly concomitant with RT.
  
  
  RESULTS
  In all, 50 patients were treated with the 5-day regimen and 27 patients with the weekly regimen. There were no significant demographic differences between the groups. Overall 3-year PFS, controlling for stage, was 90% and 76% for 5-day and weekly groups, respectively (P = .01). Adjusting for stage, age, and completion of treatment, the risk of treatment failure among the weekly group was 3.46 times higher than the 5-day group (P = .02). The weekly group had a 3.43 times higher risk of developing acute toxicities than the 5-day group (P = .02) in advanced-stage patients.
  
  
  CONCLUSIONS
  Patients who received weekly CDDP have a shorter 3-year PFS. Patients with advanced-stage cervical cancer who received weekly CDDP had significantly more acute toxicities. These data should be confirmed in a multi-institutional, randomized, controlled study.
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Division of Gynecologic Oncology, Montefiore Medical Center, Bronx, New York, USA. meinstei@montefiore.org
authors.forename: Mark H
authors.initials: MH
authors.lastname: Einstein
authors.forename: Akiva P
authors.initials: AP
authors.lastname: Novetsky
authors.forename: Madhur
authors.initials: M
authors.lastname: Garg
authors.forename: Susan M
authors.initials: SM
authors.lastname: Hailpern
authors.forename: Gloria S
authors.initials: GS
authors.lastname: Huang
authors.forename: Arielle
authors.initials: A
authors.lastname: Glueck
authors.forename: Abbie L
authors.initials: AL
authors.lastname: Fields
authors.forename: Shalom
authors.initials: S
authors.lastname: Kalnicki
authors.forename: Gary L
authors.initials: GL
authors.lastname: Goldberg
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000633:toxicity*; D001918:Brachytherapy; D002945:Cisplatin / Q000008:administration & dosage* / Q000633:toxicity*; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin