ESTRO 2024 - Abstract Book

S1120

Clinical - Gynaecology

ESTRO 2024

oncological outcomes at the cost of increased serious toxicities. We aimed to investigate the feasibility, safety and efficacy of concurrent and adjuvant CG for CC in the modern treatment era.

Material/Methods:

Medical records of patients diagnosed with locally advanced CC treated with definitive chemoradiation planned to receive CG were retrospectively assessed. Treatment consisted of chemoradiotherapy (weekly cisplatin 40mg/m2 and gemcitabine 125 mg/m2 with concurrent EBRT using VMAT) followed by image-guided adaptive brachytherapy (IGABT) and two adjuvant 21-day cycles of cisplatin (50 mg/m2 on day 1, plus gemcitabine, 1000 mg/m2 on days 1 and 8). A pelvic MRI and PET/CT was part of the baseline and treatment assessment for all patients. During systematic follow-up toxicities were graded according to the CTCAE v5.0. Survival analysis was carried out with Kaplan-Meier method.

Results:

Between 2011 and 2023, 76 patients with advanced CC were treated with definitive chemoradiotherapy. 50 patients (66%) received at least one cycle of CG and were included in this study. The population consisted of 5 (10%) patients with a FIGO (2018) stage IIB, 6 (12%) with a stage IIIA/IIIB, 23 (46%) with stage IIIC1 46%, 12 (24%) IIIC2 and 4 (8%) with IVA. 35 patients (70%) had lymph node involvement at diagnosis. The median number of concurrent gemcitabine cycles received was 4 (range 1-6) and 5 (range 2-8) for cisplatin, respectively. In 15 patients (30%) a dose modification was required. 38 patients (76%) received at least one cycle of adjuvant chemotherapy. Median follow-up was 65 months (range 7-145). Local, locoregional and distant control rates at 5 years were 79.2%, 68.8% and 84.1%, respectively. Progression-free survival and overall survival were 70.7%/80.8% at 3 years and 51.8%/ 72.3% at 5 years. Acute or late severe toxicities (≥ grade 3) were recorded in 24 patients (48%), predominantly haematological toxicity (64% of all severe events). Acute gastrointestinal grade 3 toxicity developed in 3 patients (6%). 4 patients presented acute grade 4 toxicities, all of which were hematological and no treatment related deaths occurred. 2 patients (4%) developed fistulae.

Conclusion:

Concurrent radiochemotherapy with Cisplatin and Gemcitabine followed by IGABT and adjuvant CG is clinically manageable in daily practice and associated with a lower toxicity profile than previously reported 1 , while maintaining its high efficacy. This approach may be a cost-effective alternative of treatment intensification to the recently presented results with Pembrolizumab 2 .

Keywords: Cervical Cancer, Gemcitabine, systemic treatment

References:

1 Dueñas-González A, et al. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol 2011;29:1678–85. https://doi.org/10.1200/JCO.2009.25.9663.