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Cervical Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IB Cervical Cancer

Either radiation therapy or radical hysterectomy and bilateral lymph node dissection results in cure rates of 85% to 90% for women with Féderation Internationale de Gynécologie et d'Obstétrique (FIGO) stages IA2 and IB1 small-volume disease. The choice of either treatment depends on patient factors and available local expertise. A randomized trial reported identical 5-year overall survival (OS) and disease-free survival rates when comparing radiation therapy to radical hysterectomy.[1] The size of the primary tumor is an important prognostic factor and should be carefully evaluated in choosing optimal therapy.[2] For adenocarcinomas that expand the cervix more than 4 cm, the primary treatment should be concomitant chemotherapy and radiation therapy.[3]

After surgical staging, patients found to have small volume para-aortic nodal disease and controllable pelvic disease may be cured with pelvic and para-aortic radiation therapy and concomitant chemotherapy.[4] The resection of macroscopically involved pelvic nodes may improve rates of local control with postoperative chemotherapy and radiation therapy.[5] Treatment of patients with unresected periaortic nodes with extended-field radiation therapy and chemotherapy leads to long-term disease control in those patients with low volume (<2 cm) nodal disease below L3.[6] A single study (RTOG-7920) showed a survival advantage in patients with tumors larger than 4 cm who received radiation therapy to para-aortic nodes without histologic evidence of disease.[7] Toxic effects were greater with para-aortic radiation therapy than with pelvic radiation therapy alone but were mostly confined to patients with prior abdominopelvic surgery.[7] Patients who underwent extraperitoneal lymph node sampling had fewer bowel complications than those who had transperitoneal lymph node sampling.[6,8,9] Patients with close vaginal margins (<0.5 cm) may also benefit from pelvic radiation therapy.[10]

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General Information About Cervical Cancer

Incidence and Mortality Estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2013:[1] New cases: 12,340. Deaths: 4,030. Prognostic Factors The prognosis for patients with cervical cancer is markedly affected by the extent of disease at the time of diagnosis. A vast majority (&gt;90%) of these cases can and should be detected early through the use of the Pap test and human papillomavirus (HPV) testing; however,[2] the current death rate...

Read the General Information About Cervical Cancer article > >

Five randomized, phase III trials have shown an OS advantage for cisplatin-based therapy given concurrently with radiation therapy,[11,12,13,14,15,16] while one trial examining this regimen demonstrated no benefit.[17] The patient populations in these studies included women with FIGO stages IB2 to IVA cervical cancer treated with primary radiation therapy, and women with FIGO stages I to IIA disease who, at the time of primary surgery, were found to have poor prognostic factors, which included the following:

  • Metastatic disease in pelvic lymph nodes.
  • Parametrial disease.
  • Positive surgical margins.
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