A Phase I Trial of Intensity Modulated Radiation Therapy With Concurrent Cisplatin and Escalating Gemcitabine for Locally Advanced Cervical Carcinoma

Inclusion Criteria:

- Diagnosis: Histologically-proven, invasive primary carcinoma of the cervix.

- Disease Status: Stage IB2-IVA cervical cancer or stage I with biopsy-proven pelvic
node metastases, positive surgical margins, or parametrial extension based upon
standard diagnostic workup, including:

- History/physical examination

- Examination under anesthesia (if indicated)

- Biopsy

- Intravenous pyelogram and/or cystoscopy (if indicated)

- Colonoscopy, sigmoidoscopy, or rigid proctoscopy (if indicated)

- PA and lateral chest x-ray or chest CT

- CT or MRI of the pelvis

- PET, PET/CT, or PET/CT simulation (encouraged)

- Performance Level: Karnofsky Performance Status ≥ 60 - Peripheral ≥ ANC
1500/uL

- Platelet count ≥ 100,000/uL (transfusion independent)

- Hemoglobin ≥ 8.0 g/dL (Note: The use of transfusion or other intervention to achieve
Hgb ≥ 8.0 g/dL is acceptable)

- Serum creatinine ≤ 1.5 mg/dl

- Bilirubin (sum of conjugated + unconjugated) < 1.5 mg/dl, and

- SGPT (ALT) < 1.5 x upper limit of normal (ULN) for age, and

- SGOT (AST) < 1.5 x upper limit of normal (ULN) for age

Exclusion Criteria:

- Pregnancy or Breast-Feeding: Pregnant or breast-feeding women will not be entered on
this study due to risks of fetal and teratogenic adverse events.(Note: Serum
Pregnancy tests must be obtained in women of child bearing potential). Sexually
active females may not participate unless they have agreed to use an effective
contraceptive method (such as abstinence, diaphragm, condom, or intrauterine device)
to prevent pregnancy for the duration of the study.

- Concomitant Medications, if taken within the last 28 days.

- Growth factor(s): Growth factors that support platelet or white cell number or
function must not have been administered within the past 28 days.

- Erythropoietic drug(s): Erythropoietin or related hormones must not have been
administered within the past 28 days.

- Infection: Patients who have an uncontrolled infection.

- Evidence of para-aortic lymphadenopathy or distant metastases

- Prior invasive malignancy (except non-melanomatous skin cancer), unless disease free
for a minimum of 3 years.

- Prior systemic chemotherapy within the last three years.

- Prior radiotherapy to the pelvis

- Allergic to iodinated contrast if undergoing a contrast enhanced CT scan of the
pelvis