## First-Line Chemotherapy in Cervical Cancer **Key Point:** Cisplatin is the gold standard chemosensitizing agent used concurrently with radiotherapy in locally advanced cervical cancer (stages IIB–IVA). ### Mechanism of Benefit Cisplatin acts as a radiosensitizer by: - Enhancing DNA damage from radiation - Inhibiting DNA repair mechanisms - Increasing apoptosis in tumor cells ### Evidence Base **High-Yield:** Multiple randomized trials (RTOG, GOG) have demonstrated a 6–12% absolute survival benefit when cisplatin-based concurrent chemoradiation (CCRT) is used versus radiation alone in locally advanced cervical cancer. ### Dosing & Administration - Standard dose: **40 mg/m² weekly** during radiation (5–6 cycles) - Alternative: 75 mg/m² every 3 weeks (less commonly used in concurrent setting due to toxicity) - Requires adequate renal function (creatinine clearance >60 mL/min) ### Comparison with Other Agents | Agent | Role in Cervical Cancer | Rationale | |-------|-------------------------|----------| | **Cisplatin** | First-line CCRT agent | Superior radiosensitization, proven OS benefit | | **Carboplatin** | Alternative in renal dysfunction | Less nephrotoxic but inferior radiosensitizing effect; not preferred for CCRT | | **Paclitaxel** | Recurrent/metastatic disease | No proven benefit in concurrent CCRT setting | | **5-FU monotherapy** | Rarely used alone | Inferior to cisplatin; historical use only | **Clinical Pearl:** Cisplatin-based CCRT is now the standard of care for stage IIB–IVA cervical cancer per NCCN, FIGO, and Indian guidelines (AIIMS consensus). ### Toxicity Monitoring - Nephrotoxicity: monitor creatinine, electrolytes (Mg²⁺, K⁺) - Ototoxicity: baseline audiometry recommended - Myelosuppression: CBC weekly - Nausea/vomiting: aggressive antiemetic prophylaxis mandatory [cite:Harrison 21e Ch 102]
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