Concurrent Chemoradiation for Cervical Cancer.

The current practice of treating cervical cancer with surgery or radiation alone has been challenged by the recent information from the National Cancer Institute regarding concurrent chemoradiation for cervical cancer. Results from each of five randomized phase III trials show an overall survival advantage of 30% — plus acceptable toxicity — for cisplatin-based therapy given concurrently with radiation therapy (Table). The patient populations in these studies included women with FIGO stages IB2-IVA cervical cancer treated with primary radiotherapy and women with FIGO stage I-IIA disease with poor prognostic factors (metastatic disease in pelvic lymph nodes, parametrial disease, or positive surgical margins) at the time of primary surgery. Although the trials varied in terms of stage of disease, dose of radiation, and schedule of cisplatin and radiation, they all demonstrated significant survival benefit for this combined approach. The risk of death from cervical cancer was decreased by 30% to 50% with concurrent chemoradiation. Based on these results, strong consideration should be given to the incorporation of concurrent cisplatin-based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervical cancer.