Objective: To evaluate the efficacy of neoadjuvant chemotherapy, followed by radiotherapy and concurrent hyperthermia (triple therapy) in patients with advanced-stage cervical cancer. Methods: We selected 43 patients from our hyperthermia database, who were treated from 1996 to 2010 with triple therapy for large primary tumours (>6cm) or para-aortic lymph node metastases. All patients received platinum-based chemotherapy followed by full-dose radiotherapy, brachytherapy and five hyperthermia treatments. The response was evaluated by gynaecological examination and a CT-scan. Time-to-event variables were estimated using the Kaplan Meier method and the Cox regression method. Results: The mean age of the patients was 50.4 years (range 2980). The median tumour size was 5.6cm at diagnosis (range 2.68.2), positive lymph nodes were present in 90.7. A total of 67 of the patients completed all six planned courses of chemotherapy. After completion of neoadjuvant chemotherapy, 83.7 of patients achieved a complete or partial response. At the end of treatment, the complete response rate was 81.4 (95CI 69.293.5). Grade 2, 3 and 4 acute vascular toxicity occurred in 17 patients. The incidence of grade 34 haematological toxicity did not exceed 10 and no neutropenic fever occurred. For grade 12 renal toxicity, a switch to carboplatin was made (n6). No acute grade 34 renal toxicity was observed. No treatment-related deaths were recorded. The median follow-up time was 29.8 months (range 4.1124.8). Overall survival rate at 12 months was 79 (95CI 57.492.3). Conclusion: The triple therapy seems feasible and effective in the treatment of advanced-stage, high-risk cervical cancer. However, chemotherapy-induced vascular toxicity occurred frequently, which may warrant the use of prophylactic anticoagulants. We recommend a phase II trial for prospective confirmation for comparison with standard chemoradiation and the use of anticoagulants.

Advanced-stage cervical cancer, Neoadjuvant chemotherapy, Para-aortic lymph nodes, Radiotherapy and hyperthermia
dx.doi.org/10.3109/02656736.2012.674622, hdl.handle.net/1765/63410
International Journal of Hyperthermia
Department of Gynaecology & Obstetrics

Heijkoop, S.T, Franckena, M, Thomeer, M.G.J, Boere, I.A, Montfort, C.A.G.M, & van Doorn, H.C. (2012). Neoadjuvant chemotherapy followed by radiotherapy and concurrent hyperthermia in patients with advanced-stage cervical cancer: A retrospective study. International Journal of Hyperthermia, 28(6), 554–561. doi:10.3109/02656736.2012.674622