Optimal treatment in locally advanced cervical cancer

Abstract

Introduction: Locally advanced cervical cancer (LACC) (International Federation of Gynecology and Obstetrics (FIGO) 2009/2018 -stages IB2-IVA/IB3-IVA, respectively) is treated using a multimodal approach that includes chemoradiotherapy followed by brachytherapy.Areas covered: This review provides an overview of the progress made over the past decade in the treatment of LACC. Prognostic factors, FIGO classification and the role of imaging staging will be discussed. Efficacy of external-beam radiotherapy, brachytherapy and chemotherapy will be detailed. Indications for para-aortic staging lymphadenectomy and adjuvant hysterectomy, as well as follow-up and special population, will be covered. Expert opinion:The initial workup is one of the most crucial steps in the optimal care of patients, which should be realized by a multidisciplinary expert team. With the implementation of modern conformal radiotherapy techniques, the local control rate has been optimized. Nevertheless, 40% of patients experience recurrence with distant metastasis and a dismal prognosis. Currently, a clear benefit of neo-and adjuvant chemotherapy has not been established. The future likely involves (1) improved selection of patients for whom treatment intensification is justified, (2) a combination of new drugs with chemoradiation that are currently being tested in trials, and (3) the development of tailored treatment based on molecular characteristics.

Recurrent or primary metastatic cervical cancer: current and future treatments

“… 8 Even with the major progresses made and the optimized treatment of locally advanced CC (LACC) over the past two decades, around 30% of patients will suffer from recurrent disease. 9 Moreover, around 6% of the women are discovered with primary metastatic disease. By a majority, patients in recurrence will benefit from systemic treatments such as chemotherapy (CT) with or without angiogenesis inhibitors.…”

Cancer-Derived Exosomal miR-651 as a Diagnostic Marker Restrains Cisplatin Resistance and Directly Targets ATG3 for Cervical Cancer

“…Nevertheless, not all subjects can achieve satisfactory outcomes, especially for subjects with advanced stages [ 4 – 6 ]. For locally advanced individuals, the current treatment strategy is neoadjuvant chemotherapy followed by surgery for chemotherapy-sensitive patients, while insensitive patients are directly converted to radiotherapy [ 7 ]. If there are indicators that can effectively predict the sensitivity of patients to chemotherapy, this part of the patients who are not sensitive to chemotherapy can save the time and expense of neoadjuvant chemotherapy and directly transfer to radiotherapy to obtain better outcomes [ 8 ].…”

Combined treatment of marizomib and cisplatin modulates cervical cancer growth and invasion and enhances antitumor potential in vitro and in vivo

“…CDDP-based combination chemotherapy is the standard chemotherapy regimen for locally advanced and metastatic cervical cancer ( 23 , 24 ). The 5-year-old overall survival (OS) rates for early-stage, locally advanced, and metastatic cervical cancer are approximately 92%, 65%, and 17%, respectively ( 25 ). Although early-stage cervical cancer is usually curable, there is still no satisfactory treatment for locally advanced, recurrent or metastatic cases.…”