title: Concurrent chemoradiation versus radiotherapy alone in cervical carcinoma: A randomized phase III trial.
abstract: OBJECTIVE
  Chemo-radiotherapy (CRT) is the standard of care for treating almost all cervical carcinoma patients on the basis of the National Cancer Institute (NCI) alert. The disease burden in developing countries is more advanced with poor general condition than in patients in the trials prompting the NCI alert. Therefore, practicing CRT as standard of care should be tested in these patients.
  
  
  METHODS
  A randomized controlled trial was conducted comparing radiotherapy (RT) alone with CRT (cisplatin 40 mg/m(2) weekly × 5) in patients with localized stage Ib to IVa cervical carcinoma between September 2006 and December 2008. External beam RT was delivered using a telecobalt unit. This was followed by 12-18 Gy of brachytherapy.
  
  
  RESULTS
  In total, 305 patients were recruited: RT alone (150) and CRT (155). The median follow up was 34 months. Locoregional relapse-free survival (LRFS) at 2 years was 55 and 54% for the RT and CRT group, respectively, with a median LRFS time of 27 and 30 months for the RT and CRT group, respectively, (P = 0.624). Overall survival (OS) at 2 years was 58 and 60%, with a median OS of 31 and 34 months for the RT and CRT group, respectively; (P = 0.9). The toxicity profile, both acute and late, were comparable in both groups;
  
  
  CONCLUSIONS
  No improvement in outcome was seen with addition of cisplatin. In the Indian subcontinent where patients present at late stages with poor general condition and limited access to good supportive care, RT alone still remains a valid option.
authors.affiliation: Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India.
authors.forename: Kirti
authors.initials: K
authors.lastname: Srivastava
authors.forename: Sayan
authors.initials: S
authors.lastname: Paul
authors.forename: Kundan Singh
authors.initials: KS
authors.lastname: Chufal
authors.forename: Sunkappa Dayashankara
authors.initials: SD
authors.lastname: Shamsundar
authors.forename: Punita
authors.initials: P
authors.lastname: Lal
authors.forename: Mohan C
authors.initials: MC
authors.lastname: Pant
authors.forename: Madanlal
authors.initials: M
authors.lastname: Bhatt
authors.forename: Sudhir
authors.initials: S
authors.lastname: Singh
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: cancer; cervix; chemoradiation; radiation