Cervical Cancer
Conditions
Keywords
cervical adenocarcinoma, cervical adenosquamous cell carcinoma, cervical squamous cell carcinoma, stage IB cervical cancer
Brief summary
RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known which regimen of radiation therapy combined with chemotherapy, with or without surgery, is more effective in treating early cancer of the cervix. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery followed by different regimens of radiation therapy and chemotherapy with that of chemotherapy and radiation therapy alone in treating patients who have stage I cancer of the cervix.
Detailed description
OBJECTIVES: * Compare progression-free survival and survival of patients with stage IB2 carcinoma of the cervix after radical hysterectomy with tailored chemoradiotherapy vs primary chemoradiotherapy. * Compare the toxicity of these regimens in these patients. * Compare the health-related quality of life of patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms. * Arm I: (Surgery followed by chemoradiotherapy): Patients undergo exploratory laparotomy followed by radical hysterectomy and bilateral pelvic and para-aortic lymphadenectomy. Depending on the findings at surgery, the radical hysterectomy and lymphadenectomy are either completed or aborted. * Aborted hysterectomy: Patients with aborted hysterectomy are assigned to 1 of 3 groups, depending on the findings at surgery. * Group 1: Within 4 weeks of surgery, patients undergo pelvic radiotherapy 5 times weekly for 4-6 weeks and intracavitary irradiation during or after external radiotherapy. Patients also receive concurrent cisplatin IV over 1 hour once weekly for a total of 5-6 doses. * Group 2: Patients receive radiotherapy and cisplatin as in group 1 with additional extended field radiotherapy. * Group 3: Patients receive further treatment at the discretion of the investigator. * Completed hysterectomy: Patients completing the radical hysterectomy are assigned to 1 of 3 groups, depending on the findings at surgery. * Group A: Patients receive treatment as in group 1 above without intracavity irradiation. * Group B: Patients receive treatment as in group 2 above without intracavity irradiation. * Group C: Patients receive no further treatment. * Arm II (Primary chemoradiotherapy): Patients undergo pelvic radiotherapy 5 times weekly for 4-6 weeks and intracavity irradiation during or after external radiotherapy. Patients also receive concurrent cisplatin IV over 1 hour once weekly for a total of 6 doses. Quality of life is assessed at baseline, during week 5 of therapy, and then at 3, 6, and 12 months. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 740 patients (370 per treatment arm) will be accrued for this study within 7.5 years.
Interventions
DRUGcisplatin
PROCEDUREadjuvant therapy
PROCEDUREconventional surgery
RADIATIONbrachytherapy
RADIATIONradiation therapy
Sponsors
National Cancer Institute (NCI)
Gynecologic Oncology Group
Study design
Allocation
RANDOMIZED
Primary purpose
TREATMENT
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed stage IB2 invasive carcinoma of the uterine cervix of one of the following types: * Squamous cell carcinoma * Adenocarcinoma * Adenosquamous carcinoma * Primary, previously untreated disease * Exophytic cervical lesions greater than 4 cm in diameter OR * Cervical expansion to greater than 4 cm in diameter, presumed to be the result of principal involvement with cancer * No evidence of extrauterine disease other than pelvic lymph node involvement (by clinical and radiographic examinations) * No para-aortic lymph nodal disease (suspected on CT scan, MRI, positron-emission tomography, or lymphangiogram) unless nodes are confirmed to be pathologically negative (by CT-guided biopsy or extraperitoneal lymph node dissection) * Eligible for radical hysterectomy and lymph node dissection PATIENT CHARACTERISTICS: Age * 18 and over Performance status * GOG 0-2 Life expectancy * Not specified Hematopoietic * Absolute neutrophil count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 Hepatic * Bilirubin no greater than 1.5 times normal * SGOT no greater than 3 times normal * Alkaline phosphatase no greater than 3 times normal Renal * Creatinine no greater than 2.0 mg/dL * No renal abnormalities requiring modification of radiation fields Gastrointestinal * No gastrointestinal bleeding * No intestinal obstruction Other * Not pregnant * Negative pregnancy test * No septicemia or severe infection * No other invasive malignancy with any evidence of disease within the past 5 years except nonmelanoma skin cancer * No circumstances that would preclude study completion or required follow-up PRIOR CONCURRENT THERAPY: Biologic therapy * Not specified Chemotherapy * No prior chemotherapy Endocrine therapy * Not specified Radiotherapy * No prior radiotherapy Surgery * See Disease Characteristics * No prior hysterectomy (total or subtotal)
Countries
Japan, United States
Outcome results
None listed