Regimen: Cisplatin + Fluorouracil + Radiation Therapy
Roberts WS et al. Gynecol Oncol 1991;43:233–236
Hydration before cisplatin: 1000 mL 0.9% sodium chloride injection (0.9% NS); administer intravenously over a minimum of 2 hours
Cisplatin 50 mg/m2; administer intravenously in 100–1000 mL 0.9% sodium chloride injection (0.9% NS), over 6 hours on day 1, every 4 weeks for 2 cycles (total dosage/4-week cycle = 50 mg/m2)
Followed by:
Fluorouracil 1000 mg/m2 per day; administer as a continuous intravenous infusion in 250–2000 mL 0.9% NS or 5% dextrose injection over 24 hours for 4 consecutive days, on days 1–4, every 4 weeks for 2 cycles (total dosage/4-week cycle = 4000 mg/m2)
Hydration after cisplatin: 1000 mL 0.9% sodium chloride injection (0.9% NS); administer intravenously over a minimum of 2 hours. Encourage patients to increase oral intake of non-alcoholic fluids, and provide electrolyte replacement as needed (potassium, magnesium, sodium)
Concurrent with chemotherapy administer radiation therapy as follows:
External beam radiation with 20-MeV linear accelerator, 180 cGy/day fractions to a total dose of 4000–5000 cGy to the whole pelvis, ± periaortic radiation to a dose of 3600–4500 cGy
±
Additional external pelvic irradiation to limited fields to a total dose of 6480 cGy
±
Additional brachytherapy starting 2–3 weeks after external beam radiation
Supportive Care
Antiemetic prophylaxis
Emetogenic potential on day 1: HIGH. Potential for delayed symptoms
Emetogenic potential on days 2–4: LOW
See Chapter 39 for antiemetic recommendations
Hematopoietic growth factor (CSF) prophylaxis
Primary prophylaxis is NOT indicated
See Chapter 43 for more information
Antimicrobial prophylaxis
Risk of fever and neutropenia is LOW
Antimicrobial primary prophylaxis to be considered:
See Chapter 47 for more information
Patient Population Studied
Study of 67 patients with advanced carcinomas of the lower female genital tract that were not amenable to resection were eligible, among whom 7 had vaginal cancers. Of the 7 patients with vaginal cancer, 5 had Stage III disease and 2 had recurrent disease
Treatment Modifications
Roberts WS et al. Gynecol Oncol 1991;43:233–236
Whitney CW et al. J Clin Oncol 1999;17:1339–1348✫
Therapy Monitoring
Weekly: CBC with differential, LFTs, electrolytes, and creatinine