## Concurrent Chemoradiation for Cervical Cancer **Key Point:** Cisplatin is the gold-standard chemotherapy agent for concurrent chemoradiation in locally advanced cervical cancer (stages IB–IVA). ### Evidence Base The GOG 120 and GOG 165 trials established that concurrent cisplatin-based chemoradiation improves overall survival and disease-free survival compared to radiation alone in patients with stage IB–IVA cervical cancer. Cisplatin enhances radiosensitivity through: - Inhibition of DNA repair mechanisms - Increased free radical formation - Synchronization of cells in radiosensitive phases of the cell cycle ### Dosing in Concurrent Regimen - **Standard dose:** 40 mg/m² IV weekly during pelvic radiation (5–6 weeks) - Total cumulative dose: 200 mg/m² over the treatment course - Administered on day 1 of each week of radiation **High-Yield:** Cisplatin is preferred over other platinum agents because: 1. Superior radiosensitizing effect compared to carboplatin 2. Established survival benefit in RCTs 3. Better tolerability profile when given concurrently with radiation (lower hematologic toxicity than carboplatin) ### Contraindications to Cisplatin - Severe renal impairment (CrCl < 60 mL/min) - Severe hearing loss or peripheral neuropathy - In such cases, carboplatin or 5-FU-based regimens are alternatives **Clinical Pearl:** Adequate hydration and antiemetic prophylaxis (5-HT3 antagonist + dexamethasone) are essential to minimize nephrotoxicity and emesis during concurrent therapy. [cite:Park 26e Ch 10]
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