Treatment options in recurrent cervical cancer (Review)

Abstract

Abstract. the management of recurrent cervical cancer depends mainly on previous treatment and on the site and extent of recurrence. concurrent cisplatin-based chemoradiation is the treatment of choice for patients with pelvic failure after radical hysterectomy alone. However, the safe delivery of high doses of radiotherapy is much more difficult in this clinical setting compared with primary radiotherapy. Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation. In a recent series, the 5-year overall survival and operative mortality after pelvic exenteration ranged from 21 to 61% and from 1 to 10%, respectively. Free surgical margins, negative lymph nodes, small tumour size and long disease-free interval were associated with a more favourable prognosis. currently, pelvic reconstructive procedures (continent urinary conduit, low colorectal anastomosis, vaginal reconstruction with myocutaneous flaps) are strongly recommended after exenteration. concurrent cisplatin-based chemo-radiation is the treatment of choice for isolated para-aortic lymph node failure, with satisfactory chances of a cure in asymptomatic patients. chemotherapy is administered with palliative intent to women with distant or loco-regional recurrences not amenable by surgery or radiotherapy. cisplatin is the most widely used drug, with a response rate of 17-38% and a median overall survival of 6.1-7.1 months. cisplatin-based combination chemotherapy achieves higher response rates (22-68%) when compared with single-agent cisplatin, but median overall survival is usually less than one year. In a recent gynecologic Oncology Group (GOG) trial the combination topotecan + cisplatin obtained a significantly longer overall survival than single-agent cisplatin in patients with metastatic or recurrent or persistent cervical cancer. A subsequent gog study showed a trend in terms of longer overall survival and better quality of life for the doublet cisplatin + paclitaxel vs. the doublets cisplatin + topotecan, cisplatin + vinorelbine, and cisplatin + gemcitabine. Molecularly targeted therapy may represent a novel therapeutic tool, but its use alone or in combination with chemotherapy is still investigational.

Palliative chemotherapy in recurrent carcinoma cervix: experience from a regional cancer centre in southern India

“…Worldwide, chemotherapy has been used in recurrent cervical carcinoma with variable results. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] At present, cisplatin in combination with paclitaxel is the standard-of-care chemotherapy in the palliative management of cervical cancer.…”

Adrenal gland metastasis - an unusual manifestation of cancer cervix

“…8 Treatment of metastatic disease is based on the general condition, the site and extent of the relapse and/or metastases and the initial treatment. 9,10 The limited disease needs local therapy i.e. surgery or radiotherapy…”

Prognostic Indicators for Treatment Outcome in Cervical Cancer: A Mini Review

“…8,9 Although local control and toxicity rates have been slightly improving, recurrence rates remain as high as one-third, and toxicity rates remain as high as one-half among cervical cancer patients. 10,11 Therefore, it has been of great clinical importance to investigate early indicators for optimal therapeutic response based on which treatments can be adjusted to minimize recurrence or toxicity outcomes. Once prognostic factors are identified, the aggressiveness of treatment can be properly determined.…”