Comparative Study of Response and Toxicities between Induction Chemotherapy Followed by Concurrent Chemoradiation versus Concurrent Chemoradiation Only in the Treatment of Locally Advanced Carcinoma Cervix (Stage IB2, IIB-IVA)

Background: In Bangladesh majority cases of carcinoma cervix being diagnosed in advanced stage.This study was aimed to determine whether induction chemotherapy would improve disease control and clinical outcome of patients with locally advanced cervical cancer undergoing radiotherapy.Methods: A quasi experimental study was carried out among 60 patients of histologically proven locally advanced carcinoma cervix patients at Radiation Oncology Department of National Institute of Cancer Research & Hospital, Dhaka from June 2016 to May 2017.Patients were accrued to arm A and arm B purposively to receive sequential chemotherapy followed by concurrent chemoradiation or chemoradiation only.Results: The mean age of the arm A patients was 49.1 (SD ± 8.65) years and that of the arm B patients was 50.5 (SD ± 7.99) years.Majority of the study subjects were from middle economic class.Most of the patients (arm a 50% and arm B 73.3%) were in stage IIB.Vaginal discharge (arm A 56.7% vs. arm B 60%), post-menopausal P/V bleeding (arm A 40% vs. arm B 43.3%) and irregular p/v bleeding (arm A 33.3% vs. arm B 43.3 %) were leading complaints.In arm A 17 patients (56.7%) showed complete response where in arm B complete response was noticed in 20 patients (66.7%); partial responses were 11 (36.7%) and 10 (33.3%) in the two arms respectively.No statistically significance was found between these two arms (p=0.526).Different treatment related toxicities like anemia, vomiting, leucopenia, enteritis, dermatitis were reported in the both arms which faded away with time.Most importantly there were no significant difference across the two arms in this regard.Conclusion: Induction chemotherapy followed by concurrent chemoradiation was non inferior in respect to relieving symptoms and achieving complete response than concurrent chemoradiotherapy only in treatment of locally advanced cervical carcinoma.