Vol 26, No 6 (2021)
Research paper
Published online: 2021-11-05

open access

Page views 6022
Article views/downloads 453
Get Citation

Connect on Social Media

Connect on Social Media

Weekly vs. tri-weekly cisplatin based chemoradiation in carcinoma cervix: a prospective randomized study of toxicity and compliance

Aradhana Katke1, Nanda R1, Thejaswini B1, Tanveer Pasha1, Giri G V1, Govind Babu1, Yashwant Pawar1
Rep Pract Oncol Radiother 2021;26(6):948-954.


Background: Addition of chemotherapy to radiation has improved 5-year survival by 6%. However, the optimal dose and schedule of concurrent cisplatin is not well defined, though widely accepted practice is the weekly schedule of 40 mg/m2 for 5 weeks. Repeated admissions for weekly cisplatin drain the limited resources in high volume centres. We intended to study the compliance and toxicity of two cisplatin schedules in our patients diagnosed with carcinoma cervix.

Materials and methods: Between 2007–2011, 212 patients, histologically proven squamous cell carcinoma with stages IIB to IIIB were randomized into two arms. All patients were planned for external beam radiotherapy 45 Gy/25frs over 5 weeks followed by Intracavitary or Interstitial brachytherapy to a total BED dose of 75–85 Gy. Single agent cisplatin given concomitantly, was scheduled weekly (40 mg/m2/cycle, 5 cycles) in an arm A and three weekly (100 mg/m2/cycle, 2 cycles) in an arm B. Toxicity and compliance were evaluated weekly according to the RTOG guidelines. Analysis of the compiled data was done using SSPS version 20.

Results: Of the evaluable 212, 109 patients received weekly cisplatin chemotherapy and 103 patients received three weekly cisplatin. The most common acute toxicity observed was grade I–II leucopoenia. The upper and lower gastrointestinal reactions were high in three weekly arms, which was statistically significant (57% and 42.7%, p < 0.05). Proctitis was observed in 10% of patients in both of the arms and only two patients had Gr1 cystitis after 6 months of treatment.

Conclusions: Tri-weekly cisplatin based concurrent chemoradiation can be adopted in high volume centres with manageable haematological and gastrointestinal acute toxicities.

Article available in PDF format

View PDF Download PDF file


  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Aruna Rastogi; National Health Portal India. www.nhp.gov.in/disease/reproductive-system/female-gynaecological-diseases-/cervical-cancer (Aug 2016).
  3. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008; 26(35): 5802–5812.
  4. Tzioras S, Pavlidis N, Paraskevaidis E, et al. Effects of different chemotherapy regimens on survival for advanced cervical cancer: systematic review and meta-analysis. Cancer Treat Rev. 2007; 33(1): 24–38.
  5. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999; 340(15): 1154–1161.
  6. Gaffney DK, Erickson-Wittmann BA, Jhingran A, et al. ACR Appropriateness Criteria® on Advanced Cervical Cancer Expert Panel on Radiation Oncology-Gynecology. Int J Radiat Oncol Biol Phys. 2011; 81(3): 609–614.
  7. Ryu SY, Lee WM, Kim K, et al. Randomized clinical trial of weekly vs. triweekly cisplatin-based chemotherapy concurrent with radiotherapy in the treatment of locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2011; 81(4): e577–e581.
  8. Lee HN, Lee KHo, Lee DW, et al. Weekly cisplatin therapy compared with triweekly combination chemotherapy as concurrent adjuvant chemoradiation therapy after radical hysterectomy for cervical cancer. Int J Gynecol Cancer. 2011; 21(1): 128–136.
  9. Bonomi P, Blessing JA, Stehman FB, et al. Randomized trial of three cisplatin dose schedules in squamous-cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 1985; 3(8): 1079–1085.
  10. Serkies K, Jassem J. Concurrent weekly cisplatin and radiotherapy in routine management of cervical cancer: a report on patient compliance and acute toxicity. Int J Radiat Oncol Biol Phys. 2004; 60(3): 814–821.
  11. Adelstein DJ, Li Yi, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003; 21(1): 92–98.
  12. Bernier J, Domenge C, Ozsahin M, et al. European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004; 350(19): 1945–1952.
  13. Cooper JS, Pajak TF, Forastiere AA, et al. Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004; 350(19): 1937–1944.
  14. Fountzilas G, Skarlos D, Kosmidis P, et al. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic Co-operative Oncology Group study. Acta Oncol. 1994; 33(7): 825–830.
  15. Nagy VM, Ordeanu C, Coza O, et al. Randomized phase 3 trial comparing 2 cisplatin dose schedules in 326 patients with locally advanced squamous cell cervical carcinoma: long-term follow-up. Int J Gynecol Cancer. 2012; 22(9): 1538–1544.
  16. Kim YS, Shin SS, Nam JH, et al. Prospective randomized comparison of monthly fluorouracil and cisplatin versus weekly cisplatin concurrent with pelvic radiotherapy and high-dose rate brachytherapy for locally advanced cervical cancer. Gynecol Oncol. 2008; 108(1): 195–200.
  17. Rose PG, Ali S, Watkins E, et al. Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007; 25(19): 2804–2810.
  18. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999; 17(5): 1339–1348.
  19. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999; 340(15): 1137–1143.
  20. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999; 340(15): 1144–1153.
  21. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000; 18(8): 1606–1613.
  22. Pearcey R, Brundage M, Drouin P, et al. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol. 2002; 20(4): 966–972.
  23. Runowicz CD, Wadler S, Rodriguez-Rodriguez L, et al. Concomitant cisplatin and radiotherapy in locally advanced cervical carcinoma. Gynecol Oncol. 1989; 34(3): 395–401.
  24. Clark BG, Souhami L, Roman TN, et al. Weekly cisplatin plus external beam radiotherapy and high dose rate brachytherapy in patients with locally advanced carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 1993; 27(4): 871–878.
  25. Hu Y, Cai ZQ, Su XY. Concurrent weekly cisplatin versus triweekly cisplatin with radiotherapy in the treatment of cervical cancer: a meta-analysis result. Asian Pac J Cancer Prev. 2012; 13(9): 4301–4304.
  26. Zhu J, Ji S, Hu Q, et al. Concurrent weekly single cisplatin vs triweekly cisplatin alone with radiotherapy for treatment of locally advanced cervical cancer: a meta-analysis. Cancer Manag Res. 2018; 10: 1975–1985.