Induction Chemotherapy Plus Chemoradiation as First Line Treatment for Locally Advanced Cervical Cancer

Inclusion Criteria:

• Histologically confirmed FIGO stage Ib2-IVa squamous, adeno or adenosquamouscarcinoma of the cervix (except FIGO IIIA). Patients with histologically confirmedFIGO stage IB1 and positive lymph nodes are also eligible

• Deemed suitable and fit for radical chemoradiation

• Medically fit to receive carboplatin and paclitaxel

• ECOG performance status 0 - 1

• No evidence of active TB

• Aged 18 and over

• Adequate renal function, defined as a GFR ≥ 60 ml/min calculated using the Wrightequation (or ≥ 50 ml/min for radioisotope GFR assessment)

• Adequate liver function, as defined by ALT or AST < 2.5 ULN and bilirubin < 1.25 ULN

• Adequate bone marrow function as defined by ANC ≥1.5 x 109/L, platelets ≥ 100 x 109/L

• Using adequate contraception precautions if relevant

• A documented negative HIV test (patients recruited from high risk countries or whohave moved within the past 10 years from high risk countries)

• A documented negative pregnancy test (if applicable)

• Capable of providing written or witnessed informed consent

Patients with positive (pelvic/para-aortic/both) nodes (either histologically/PET positive ≥15 mm on CT/MRI) at or below the level of the aortic bifurcation may be included in the study provided none of the exclusion criteria apply.

Exclusion Criteria:

• Previous pelvic malignancy (regardless of interval since diagnosis)

• Previous malignancy not affecting the pelvis (except basal cell carcinoma of theskin) where disease free interval is less than 10 years

• Positive lymph nodes (imaging or histological) above the aortic bifurcation*

• Hydronephrosis which has not undergone ureteric stenting or nephrostomy except wherethe affected kidney is non-functioning

• Evidence of distant metastasis i.e. any non-nodal metastasis beyond the pelvis

• Previous pelvic radiotherapy

• Prior diagnosis of Crohn's disease or Ulcerative colitis

• Uncontrolled cardiac disease (defined as cardiac function which would precludehydration during cisplatin administration and any contraindication to paclitaxel)

• Pregnant or lactating * i.e. PET any size, CT/MRI ≥ 15mm