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Concurrent chemotherapy and radiation therapy as the standard of care for cervical cancer

Nature Clinical Practice Oncology volume 3, pages 248–255 (2006)Cite this article

Abstract

From 1999–2000, each of five randomized trials demonstrated improved rates of survival and local control when concurrent cisplatin-based chemotherapy was added to radiation therapy in patients with locoregionally advanced cervical cancer. These studies demonstrated that addition of chemotherapy to radiation therapy improved the outcome of patients treated with radiation therapy and hysterectomy or radiation therapy alone. Although concurrent chemotherapy increases the severity of acute side effects, it does not appear to increase the risk of late side effects of radiation therapy. A sixth randomized trial, published in 2002, failed to demonstrate improved outcome with concurrent weekly cisplatin over radiation therapy alone; however, the earlier trials demonstrated benefit with this chemoradiation regimen. In addition, three of the earlier randomized trials demonstrated improved outcome with combinations of cisplatin and 5-fluorouracil compared with radiation therapy alone. Although cisplatin-based chemoradiation is the most accepted standard, individual trials have suggested that other drugs, including mitomycin and epirubicin, might be beneficial. Randomized trials that investigated the administration of neoadjuvant chemotherapy before radiation therapy have failed to demonstrate a benefit of this approach. Although the evidence for benefit of concurrent chemotherapy is strong for otherwise healthy patients with newly diagnosed, locoregionally advanced cervical cancers confined to the pelvis, the relative benefits and risks are not well understood for patients who are infirm or who require larger fields of radiation therapy. In such patients, the theoretical benefits and potential risks should be considered carefully before a treatment plan is prescribed.

Key Points

  • Results from phase III randomized trials indicate that the addition of concurrent cisplatin-based chemotherapy to radiation therapy can improve survival rates by as much as 50% in patients with locoregionally advanced cervical cancer

  • The acute side effects of treatment, particularly hematologic effects, are increased with chemoradiation but the rates of late complications appear to be similar to those seen after radiation therapy alone

  • Sequences of neoadjuvant chemotherapy followed by radiation therapy or radiation therapy followed by chemotherapy have not been demonstrated to improve the survival of patients with carcinoma of the cervix

  • Combinations of radiation therapy with mitomycin C or epirubicin are beneficial, but these regimens have not yet been compared with the more extensively studied cisplatin-based regimens

  • Since current chemoradiation regimens have approached the limits of hematologic tolerance, new approaches are focusing on combinations of chemoradiation with targeted biological response modifiers

  • Because the improved outcomes achieved with concurrent chemoradiation have reduced the margin for improvement, increasingly large trials will be needed to evaluate new regimens. The rarity of invasive cervical cancer in developed countries suggests the need for greater international cooperation in the design and conduct of future trials

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  1. Professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, TX, USA

    Patricia J Eifel

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  1. Patricia J Eifel
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Correspondence to Patricia J Eifel.

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The author declares no competing financial interests.

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Eifel, P. Concurrent chemotherapy and radiation therapy as the standard of care for cervical cancer. Nat Rev Clin Oncol 3, 248–255 (2006). https://doi.org/10.1038/ncponc0486

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