A 55-year-old woman with locally advanced cervical cancer (FIGO 2018 Stage IIIC1r, positive pelvic lymph nodes on PET-CT, 5 cm tumor) is planned for definitive chemoradiation. She has a baseline creatinine of 2.8 mg/dL. Which modification to the standard treatment protocol is appropriate?

• A Use cisplatin at reduced dose of 20 mg/m² weekly
• B Replace cisplatin with carboplatin at AUC 2
• C Omit concurrent chemotherapy and proceed with radiation alone ✓
• D Administer cisplatin 40 mg/m² weekly with aggressive hydration and hydration monitoring

Explanation

Cisplatin is nephrotoxic and requires adequate renal function (GFR >60 mL/min) for safe administration. In patients with significant renal impairment, omitting concurrent cisplatin and proceeding with radiation alone is the standard modification. Carboplatin has not been shown to be an effective substitute in the definitive chemoradiation setting for cervical cancer. Dose reduction of cisplatin does not overcome the nephrotoxicity risk sufficiently. Multiple randomized trials established cisplatin 40 mg/m² weekly with radiation as the standard, but renal dysfunction is a contraindication to cisplatin.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.