Comparison of outcomes and toxicities of concurrent chemo-radiation with weekly cisplatin versus weekly paclitaxel in locally advanced carcinoma cervix
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261469Keywords:
Chemo-radiation, Carcinoma cervix, Cisplatin, Paclitaxel, ToxicityAbstract
Background: Cervical cancer remains a leading cause of cancer-related death among women. Concurrent chemoradiation with Cisplatin is the standard treatment for locally advanced disease, though outcomes remain suboptimal. Alternative non-platinum agents like Paclitaxel have been explored to improve efficacy and tolerability. Methods: This quasi-experimental study was conducted at the Department of Radiotherapy, Rajshahi Medical College Hospital, from January 2022 to June 2023. Seventy patients with locally advanced squamous cell cervical cancer were equally assigned into two groups by purposive sampling. Arm A received weekly cisplatin (40 mg/m²) and Arm B received weekly paclitaxel (50 mg/m²), both with external beam radiotherapy followed by HDR brachytherapy. Patients were evaluated at weeks 4, 8, and 12 post-treatments. Data were analyzed using SPSS version 25.
Results: Of 70 patients, 68 completed treatment. Mean age was 48.46±8.80 years. Most patients were stage IIB (60.3%) and moderately differentiated (63.2%). Complete response was observed in 82.4% (Arm A) and 73.5% (Arm B), while partial response occurred in 14.7% and 20.6%, respectively (p>0.05). Hematologic toxicity and gastrointestinal side effects were higher in Arm B, whereas nausea, vomiting, and renal toxicity were more frequent in Arm A; differences were not statistically significant.
Conclusions: Weekly paclitaxel is not inferior to cisplatin in treatment response and may serve as an alternative when cisplatin is contraindicated, considering toxicity and cost.
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
Cotran RS, Kumar V, Fausto N. Robbins and Cotran pathologic basis of disease. Philadelphia, PA, USA: Elsevier. 2021.
Hull R, Mbele M, Makhafola T, Hicks C, Wang SM, Reis RM, et al. Cervical cancer in low and middle‑income countries. Oncology letters. 2020;20(3):2058-74.
International Agency for Research on Cancer. GLOBOCAN 2020: Cancer Today. Lyon: IARC. 2020. Available at: https://gco.iarc.fr/today. Accessed on 24 January 2026.
Islam MJ, Kamal MM, Talukder MH, Laila N. Trends and distributions of cancer at NICRH: extract from the cancer registry data 2005-2014. Cancer J Bangladesh. 2021;2(1):5-14.
Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591-603.
Pang SS, Murphy M, Markham MJ. Current management of locally advanced and metastatic cervical cancer in the United States. JCO Oncology Pract. 2022;18(6):417-22.
Balan J, Shehna A, George D, Mahadevan R. A Prospective Survival Analysis in Locally Advanced Carcinoma Cervix Patients Following Concurrent Chemoradiation with Weekly Cisplatin. Int J Sci Study. 2017;5(1):152-7.
Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. 2020;32(6):720-8.
DeVita VT, Lawrence TS, Rosenberg SA. DeVita, Hellman, and Rosenberg's cancer: principles and practice of oncology. Lippincott Williams and Wilkins. 2008.
Maurya N, Singotia L, Saxena A, Rawat S, Pounikar T. A comparative evaluation of radiotherapy with concurrent weekly cisplatin versus concurrent weekly paclitaxel in patients with locally advanced carcinoma cervix. J Evol Med Dent Sci. 2016;5(31):1667-72.
Jouya S, Shahabinia Z, Mazidimoradi A, Allahqoli L, Salehiniya H, Lee DY. Cervical cancer epidemiology: global incidence, mortality, survival, risk factors, and equity in HPV screening and vaccination. J Clin Med. 2026;15(3):1079.
Manso L, Ramchandani-Vaswani A, Romero I, Sánchez-Lorenzo L, Bermejo-Pérez MJ, Estévez-García P, et al. SEOM-GEICO clinical guidelines on cervical cancer (2023). Clin Transl Oncol. 2024;26(11):2771-82.
Tekalegn Y, Sahiledengle B, Woldeyohannes D, Atlaw D, Degno S, Desta F, et al. High parity is associated with increased risk of cervical cancer: systematic review and meta-analysis of case–control studies. Women’s Health (Lond). 2022;18:17455065221075904.
Hoque SM, Sarkar UK, Rahamatullah M, Sarker NK, Uddin MJ, Bari MA. Effect of concurrent chemoradiation with cisplatin versus concurrent chemoradiation with carboplatin in locally advanced carcinoma cervix: a quasi-experimental study. Bangabandhu Sheikh Mujib Med Univ J. 2025;18(2):e77007.
Das P, Bandyopadhyay A, Sikdar S, Mitra D, Sarkar S. A prospective study of response and toxicity of weekly concurrent chemoradiation with cisplatin versus paclitaxel in patients with locally advanced carcinoma cervix. Clin Cancer Investig J. 2016;5(6):507-12.
Hasan MR, Bari MA, Alam S, Sah GS. Concurrent weekly versus three-weekly cisplatin with radiotherapy in locally advanced uterine cervical carcinoma. JNMA J Nepal Med Assoc. 2018;56(213):842-7.
Sharmin S, Bari MA, Ruma RS, Anika AS, Shimul AR. Toxicity outcome of concurrent teletherapy and brachytherapy compared with teletherapy followed by brachytherapy in locally advanced carcinoma cervix. Int J Res Med Sci. 2022;10(7):1474-9.
Laan JJ, Van Lonkhuijzen LR, Stokking JA, Barten DL, Hinnen KA, Pieters BR, et al. The effect of contemporary brachytherapy practices on prognosis in women with locally advanced cervical cancer. Curr Oncol. 2023;30(4):4275-88.
Xie R, Xie K, Lin X, Ji Y, Chen J, Chen C. A comparison of neoadjuvant chemotherapy and concurrent chemoradiotherapy for FIGO 2018 stage IB3/IIA2 cervical squamous cell carcinoma: long-term efficacy and safety in a resource-limited setting. PLoS One. 2025;20(3):e0319405.
Peng QH, Chen K, Li JY, Chen L, Ye WJ. Analysis of treatment outcomes and prognosis after concurrent chemoradiotherapy for locally advanced cervical cancer. Front Oncol. 2022;12:926840.
McSweeney KR, Gadanec LK, Qaradakhi T, Ali BA, Zulli A, Apostolopoulos V. Mechanisms of cisplatin-induced acute kidney injury: pathological mechanisms, pharmacological interventions, and genetic mitigations. Cancers (Basel). 2021;13(7):1572.
Zhang Y, Fan S, Shan M, Zou W, Feng Y, Hou T, et al. Propensity score matching analysis comparing cisplatin versus nedaplatin-based doublet agent concurrent chemoradiotherapy for locally advanced cervical cancer. Sci Rep. 2023;13:9352.
Niu Y, Du C, Zhou Y, Zhang M, Guo Q, Zhou H. A comparative analysis of survival outcomes and adverse effects between preoperative brachytherapy with radical surgery and concurrent chemoradiotherapy in patients with locally advanced cervical cancer. Front Oncol. 2025;15:1511748.