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

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 loco-regionally 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, loco-regionally 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.