What chemotherapy (chemo) regimen is used in cervical cancer concurrent chemoradiation therapy (CRT) treatment?

From the Guidelines

Cisplatin is the standard chemotherapy agent used in concurrent chemoradiation therapy (CRT) for cervical cancer, with a typical regimen consisting of weekly cisplatin at a dose of 40 mg/m² given intravenously during the course of external beam radiation therapy, usually for 5-6 weeks. This approach has been shown to improve survival rates compared to radiation alone, as demonstrated in multiple studies, including a meta-analysis that reported a 6% improvement in 5-year survival with chemoradiotherapy 1. For patients who cannot tolerate cisplatin due to renal dysfunction or other contraindications, carboplatin can be used as an alternative, though it may be slightly less effective. Some centers may use combination regimens such as cisplatin with 5-fluorouracil, but single-agent weekly cisplatin remains the most widely accepted standard, as recommended by the National Comprehensive Cancer Network (NCCN) guidelines 1. The chemotherapy acts as a radiosensitizer, enhancing the effectiveness of radiation by inhibiting DNA repair in cancer cells and promoting cell death. Patients receiving this treatment should be monitored for common side effects including nausea, vomiting, myelosuppression, and nephrotoxicity, with appropriate supportive care provided. Adequate hydration before and after cisplatin administration is essential to minimize kidney damage.

Key points to consider in the treatment of cervical cancer with CRT include:

• The use of concurrent platinum-containing chemotherapy, with cisplatin being the preferred agent 1
• The importance of adequate hydration to minimize kidney damage from cisplatin administration
• The need for monitoring and management of common side effects, including nausea, vomiting, myelosuppression, and nephrotoxicity
• The consideration of alternative chemotherapy regimens, such as carboplatin, for patients who cannot tolerate cisplatin
• The role of radiation therapy in the treatment of cervical cancer, including the use of external beam radiation therapy and brachytherapy 1

From the Research

Chemotherapy Regimens Used in Cervical Cancer Concurrent Chemoradiation Therapy (CRT) Treatment

• The chemotherapy regimen commonly used in cervical cancer concurrent chemoradiation therapy (CRT) treatment is cisplatin-based chemoradiation 2, 3, 4, 5, 6.
• Cisplatin is typically administered weekly at a dose of 40 mg/m2 for patients under 65 years old and 30 mg/m2 for those 65 years or older 3, 4, 5.
• The planned five cisplatin cycles are often administered concurrently with radiation therapy, with a maximum single dose of cisplatin up to 70 mg/body 2, 3.
• Other chemotherapy agents, such as 5-fluorouracil, mitomycin, and epirubicin, have also been investigated in combination with cisplatin, but cisplatin-based chemoradiation remains the most accepted standard 6.

Toxicity and Efficacy of Cisplatin-Based Chemoradiation

• Cisplatin-based chemoradiation has been shown to be effective in treating locally advanced cervical cancer, with overall response rates ranging from 92% 4.
• However, this treatment regimen is also associated with significant acute toxicity, including hematological, gastrointestinal, and dermatological side effects 2, 3, 4, 5.
• The incidence of severe acute hematological toxicity has been reported to be higher in patients receiving 40 mg/m2 of cisplatin compared to those receiving 30 mg/m2 3.