Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

Abstract

In the past, women with early stage cervical cancer have been treated with radical radiotherapy or radical surgery, and women with locally advanced disease with radical radiotherapy, each offering a good chance of cure. Numerous trials have investigated whether giving cytotoxic chemotherapy alongside radiotherapy or prior to local treatment could augment the established benefits of these therapies, and are reviewed here. There is a strong basis for the use of platinum-based chemoradiotherapy, the current standard of care, but little convincing evidence as to the therapeutic benefits of using concomitant hydroxyurea. Chemoradiotherapy based on other non-platinum agents may offer alternatives. The effect of chemoradiotherapy appears to vary according to the stage of disease, but all types of women benefit. Neoadjuvant chemotherapy prior to radiotherapy could jeopardise survival and should be avoided unless perhaps a 'quick', dose intense regimen is used. Neoadjuvant chemotherapy before surgery may be beneficial, but the approach will remain controversial until it is tested against platinum-based chemoradiotherapy. Future studies many include combinations of other cytotoxics such as topotecan with cisplatin-based concomitant chemoradiotherapy or the addition of agents targeted against specific receptors such as EGFR.

Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

“…In addition, NACT has also been shown to reduce lymph node metastasis and parametrial invasion in patients with cervical cancer[11]. However, as some investigators have reached opposite conclusions[11],[12], there is still no agreement on whether NACT can significantly improve the prognosis of cervical cancer. NACT regimens, cycles, and drug dosages vary among different studies, which led to difficulties in drawing certain conclusions in previous meta-analyses[11].…”

Improvements in survival of gynaecological cancer in the Anglia region of England: are these an effect of centralisation of care and use of multidisciplinary management?

“…Advanced‐stage cervical cancer (stages 2–4) had always been referred to the centre for radiotherapy, so there was no change in referral practice. In 2000 combination chemoradiotherapy was introduced as standard care for advanced cervical cancer, which accounts for a 3‐year survival benefit of 5–8% (although this slight effect was not significant in the Anglia region because of the small numbers involved) 18 . Thus the effect of the IOG was only apparent for patients managed by radical surgery, and together with vulval cancer, these groups are too small for statistical assessment.…”

Cancer of the cervix uteri

“…A meta‐analysis of randomized trials of neoadjuvant platinum‐based chemotherapy prior to definitive surgery shows that patients treated with NACT have better survival outcomes than those treated with primary radiation alone, given at a relatively low dose [60]. No randomized data compare the results of NACT followed by surgery with concurrent chemoradiation.…”