Chemotherapy and Pelvic Radiation Therapy With or Without Additional Chemotherapy in Treating Patients With High-Risk Early-Stage Cervical Cancer After Radical Hysterectomy
Cervical Cancer
About this trial
This is an interventional treatment trial for Cervical Cancer focused on measuring cervical adenocarcinoma, cervical adenosquamous cell carcinoma, cervical squamous cell carcinoma, stage IA cervical cancer, stage IB cervical cancer, stage IIA cervical cancer
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed squamous, adenosquamous, or adenocarcinoma of the cervix with any/all of the following high-risk features after surgery:
- Positive pelvic nodes
- Positive parametrium
Positive para-aortic nodes that have been completely resected and are PET/CT scan-negative
- PET only required if positive para-aortic nodes during surgery
- Clinical stage IA2, IB, or IIA disease (this corresponds to surgical tumor node metastasis (TNM) staging of T1-T2, N1, M0)
Must have undergone radical hysterectomy (open, laparoscopically, or robotic) and staging within the past 70 days
Para-aortic and pelvic node sampling required
- If the patient did not have a para-aortic lymph node sampling/dissection, but had common iliac node dissection that was negative, a PET-CT is recommended, but not required
- A negative pre- or post-operative PET scan or PET-CT scan of the para-aortic nodes is required if the patient did not undergo para-aortic or common iliac nodal sampling/dissection
- No gross residual disease
- No neuroendocrine histology
- No distant metastases
PATIENT CHARACTERISTICS:
- Zubrod performance status 0-1
- Absolute neutrophil count (ANC) ≥ 1,800/mm³
- Platelets ≥ 100,000/mm³
- White blood cell count (WBC) ≥ 4,000/mm³
- Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)
- Serum creatinine ≤ 1.5 mg/dL
- Bilirubin ≤ 1.5 times upper limit of normal
- Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) normal
- Alkaline phosphatase normal
- Known HIV positivity allowed provided cluster of differentiation 4 (CD4) count is ≥ 350/mm³ within the past 14 days
- No other invasive malignancy within the past 3 years, except nonmelanomatous skin cancer or carcinoma in situ of the breast, oral cavity, or cervix
No severe, active co-morbidity, including any of the following:
- Unstable angina and/or congestive heart failure requiring hospitalization within the past 6 months
- Transmural myocardial infarction within the past 6 months
- Acute bacterial or fungal infection requiring IV antibiotics at the time of study entry
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of study entry
- Coagulation defects
- No prior allergic reaction to carboplatin, paclitaxel, and/or cisplatin
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
No prior systemic chemotherapy for the current cervical cancer
- Prior chemotherapy for a different cancer is allowed
- No prior radiotherapy to the pelvis that would result in overlap of radiotherapy fields
Sites / Locations
- University of Alabama at Birmingham
- Providence Hospital
- Providence Alaska Medical Center
- Arizona Center for Cancer Care-Peoria
- Saint Joseph's Hospital and Medical Center
- Providence Saint Joseph Medical Center/Disney Family Cancer Center
- Mercy San Juan Medical Center
- City of Hope Medical Center
- Saint Joseph Hospital - Orange
- Pomona Valley Hospital Medical Center
- Mercy Cancer Center
- Mercy General Hospital Radiation Oncology Center
- Saint Helena Hospital
- University of California At San Diego
- Penrose-Saint Francis Healthcare
- Hartford Hospital
- The Hospital of Central Connecticut
- University of Miami Sylvester Comprehensive Cancer Center at Deerfield Beach
- Memorial Healthcare System - Joe DiMaggio Children's Hospital
- Jackson Memorial Hospital-Holtz Children's Hospital
- University of Miami Miller School of Medicine-Sylvester Cancer Center
- Baptist Hospital of Miami
- Florida Hospital
- Grady Health System
- Northside Hospital
- Northeast Georgia Medical Center
- Memorial Health University Medical Center
- Saint Joseph's-Candler Health System
- Queen's Medical Center
- University of Hawaii
- Saint Alphonsus Regional Medical Center
- Northwestern University
- Rush University Medical Center
- OSF Saint Francis Medical Center
- Saint Vincent Anderson Regional Hospital/Cancer Center
- Saint Francis Hospital and Health Centers
- Franciscan Saint Margaret Health-Hammond Campus
- Franciscan Saint Francis Health-Indianapolis
- Michiana Hematology Oncology PC-Mishawaka
- University of Iowa Hospitals and Clinics
- Mercy Medical Center - North Iowa
- University of Kansas Medical Center
- Kansas City Cancer Centers-Southwest
- Via Christi Regional Medical Center
- University of Maryland/Greenebaum Cancer Center
- Greater Baltimore Medical Center
- Sinai Hospital of Baltimore
- Central Maryland Radiation Oncology in Howard County
- Holy Cross Hospital
- Hickman Cancer Center
- Saint John Hospital and Medical Center
- West Michigan Cancer Center
- Saint Joseph Mercy Port Huron
- Saint John Macomb-Oakland Hospital
- Abbott-Northwestern Hospital
- Mayo Clinic
- University of Mississippi Medical Center
- Kansas City Cancer Center - South
- Kansas City Cancer Centers - North
- Kansas City Cancer Center-Lee's Summit
- Phelps County Regional Medical Center
- Saint John's Mercy Medical Center
- Mercy Hospital Springfield
- CoxHealth South Hospital
- Nebraska Methodist Hospital
- The Nebraska Medical Center
- Elliot Hospital
- Cooper Hospital University Medical Center
- Morristown Memorial Hospital
- Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
- UMDNJ - New Jersey Medical School
- MD Anderson Cancer Center at Cooper-Voorhees
- Montefiore Medical Center-Weiler Division
- Montefiore Medical Center
- State University of New York Downstate Medical Center
- Memorial Sloan-Kettering Cancer Center
- Highland Hospital
- University of Rochester
- Carolinas Medical Center
- Summa Akron City Hospital/Cooper Cancer Center
- Akron General Medical Center
- Summa Barberton Hospital
- University of Cincinnati
- Case Western Reserve University
- Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
- Summa Health Center at Lake Medina
- UHHS-Chagrin Highlands Medical Center
- Southern Ohio Medical Center
- Robinson Radiation Oncology
- Cancer Care Center, Incorporated
- Ireland Cancer Center at Firelands Regional Medical Center
- Flower Hospital
- University of Toledo
- UHHS-Westlake Medical Center
- Cancer Treatment Center
- University of Oklahoma Health Sciences Center
- Providence Portland Medical Center
- Providence Saint Vincent Medical Center
- Delaware County Memorial Hospital
- Reading Hospital
- Lankenau Hospital
- Women and Infants Hospital
- Rapid City Regional Hospital
- Sanford Cancer Center-Oncology Clinic
- University of Tennessee - Knoxville
- University of Texas Southwestern Medical Center
- M D Anderson Cancer Center
- Methodist Hospital
- Intermountain Medical Center
- McKay-Dee Hospital Center
- Dixie Medical Center Regional Cancer Center
- Huntsman Cancer Institute/University of Utah
- Seattle Cancer Care Alliance
- North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
- Wheeling Hospital
- Saint Vincent Hospital
- Aurora Saint Luke's Medical Center
- Froedtert and the Medical College of Wisconsin
- Aurora West Allis Medical Center
- McGill University Department of Oncology
- Pamela Youde Nethersole Eastern Hospital
- Seoul National University Bundang Hospital
- Seoul National University Hospital
- Gangnam Severance Hospital
- Korea Cancer Center Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Arm I: Cisplatin/Radiation Therapy
Arm II: Cisplatin/Radiation Therapy + Carboplatin/Paclitaxel
Patients undergo standard EBRT or IMRT to the pelvis once daily 5 days a week for 5-6 weeks. Patients also receive concurrent cisplatin IV over 1 hour once weekly for 6 weeks.
Patients receive chemoradiotherapy as in arm I. Beginning 4-6 weeks after completion of chemoradiotherapy, patients receive paclitaxel IV over 3 hours and carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.