Low Dose Chemotherapy with External Radiation
Dear OncoLink "Ask The Experts,"
I recently received surgery to remove a 6" tumor, which appeared 3 years after surgery for a stage 1 endometrial cancer. Following this surgery, I received 3 chemotherapy treatments using taxol and carboplatin. I am now preparing to undergo external radiation, and my radiologist is recommending that I do a course of low-dose cisplatin at the same time.
After receiving several different opinions about the side effects as well as benefits of cisplatin, I would like to know what difference low-dose makes in the risks of this chemo treatment. Does the low-dose make a significant difference in the side effects, particularly neuropathy and renal/kidney effects? Does this chemo make enough of a difference in the effectiveness of the radiation to be worth the risks associated with these side effects?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
The treatment of advanced and recurrent endometrial cancer is very controversial. A large, randomized phase III study conducted by the
Gynecologic Oncology Group compared whole abdominal radiation to treatment with multiagent chemotherapy, and showed better outcome for those patients receiving chemotherapy. Retrospective studies show that patients with advanced endometrial cancer treated with combination chemotherapy and radiation do better than those treated with either chemotherapy or radiation alone. That being said, there is no standard way to administer a combination of chemotherapy and radiation to patients with advanced and recurrent endometrial cancer.
Patients may receive combination chemotherapy first and then radiation afterwards; radiation therapy first and then chemotherapy; chemo/radiation/chemo (in a "sandwich" technique); or receive chemotherapy at the same time as radiation (concurrently, as was suggested for the patient writing the question).
The regimen suggested to the patient is commonly used to treat cervical cancer, and is generally tolerated well. The biggest side effects are nausea and lowering of the blood counts. Patients tend not to have significant long-lasting neuropathy. For patients with cervical cancer, the addition of low-dose cisplatin has significant advantages in response and cure rates. For recurrent endometrial cancer, not all lesions are amenable to radiation therapy. If radiation is an option, most would agree that combination chemotherapy and radiation is promising, but it remains unclear what the best regimen is.