title: Concomitant radiochemotherapy of cervical cancer: is it justified to reduce the dosage of cisplatin?
abstract: OBJECTIVE
  To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses.
  
  
  METHODS
  At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m(2), 30 mg/m(2), or 20 mg/m(2) was administered once a week.
  
  
  RESULTS
  In 17 cases, the cisplatin dose was 30 mg/m(2); during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m(2) cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m(2); in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m(2), and grade G3-4 in 16% of the 40-mg/m(2) cisplatin group. For cisplatin 30 mg/m(2), 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m(2) regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m(2) and 40 mg/m(2), respectively.
  
  
  CONCLUSIONS
  On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m(2) was administered instead of 40 mg/m(2). If cisplatin 20 mg/m(2) was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m(2).
authors.affiliation: Center for Oncoradiology, Municipal Uzsoki Hospital, Uzsoki u.29, Budapest, Hungary.
authors.forename: Mihály
authors.initials: M
authors.lastname: Patyánik
authors.forename: Csaba
authors.initials: C
authors.lastname: Nemeskéri
authors.forename: Zsuzsa
authors.initials: Z
authors.lastname: Póti
authors.forename: Dániel
authors.initials: D
authors.lastname: Sinkó
authors.forename: Csilla
authors.initials: C
authors.lastname: Pesznyák
authors.forename: Réka
authors.initials: R
authors.lastname: Király
authors.forename: Róbert
authors.initials: R
authors.lastname: Kois
authors.forename: Arpád
authors.initials: A
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin