Controversies in the Management of Gynecological Cancers

pp 79-90


What Is the Role of Cytotoxic Chemotherapy in Advanced Cervical Cancer?

  • Alok PantAffiliated withDepartment of Obstetrics and Gynecology, Northwestern Memorial Hospital Email author 
  • , Nobuyuki SusumuAffiliated withDepartment of Obstetrics and Gynecology, School of Medicine, Keio University
  • , Takafumi ToitaAffiliated withDepartment of Radiology, Ryukyu University Hospital
  • , Satoru SagaeAffiliated withDepartment of Obstetrics and Gynecology, JR Sapporo Hospital
  • , William SmallJr.Affiliated withChairman of Radiation Oncology, Loyola University Medical Center

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Cervical cancer is a significant contributor to worldwide morbidity and mortality. Combined chemotherapy and radiation has recently become widely prevalent in the treatment of locally advanced disease. The use of adjuvant chemotherapy following surgery for early-stage disease remains experimental, and the appropriate regimen is not yet clearly defined. Combined chemoradiation following by adjuvant chemotherapy has shown potential benefit in appropriately selected patients, though an increase in toxicity rates has been noted. Neoadjuvant chemotherapy before a surgery is controversial with prior reports showing differing results and continued ongoing trials. Similar to adjuvant chemotherapy, the appropriate regimen remains undefined. Chemotherapy for widely metastatic or for recurrent disease, while still palliative in nature, is undergoing a transformation from regimens with significant toxicity and minimal survival benefit to those regimens with improved side effect profile and steady gains in clinical activity. Numerous international trials are under way trying to improve outcomes in this unfortunate patient population. Targeted therapy for cervical cancer remains in its infancy, but research continues in the laboratory and clinical setting aiming to improve outcomes. International collaboration via cooperative group trials remains the cornerstone for the advancement of care for patients with cervical cancer.