Cervical Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IB Cervical Cancer
Although the positive trials vary somewhat in terms of the stage of disease, dose of radiation, and schedule of cisplatin and radiation, the trials demonstrate significant survival benefit for this combined approach. The risk of death from cervical cancer was decreased by 30% to 50% with the use of concurrent chemoradiation therapy. 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.[11,12,13,14,15,16,17,18,19]
Standard treatment options:
- Radiation therapy. External-beam pelvic radiation therapy combined with two or more intracavitary brachytherapy applications is appropriate therapy for stage IA2 and IB1 lesions. Although low-dose rate (LDR) brachytherapy, typically with cesium Cs 137, has been the traditional approach, the use of high-dose rate (HDR) therapy, typically with iridium Ir 192, is rapidly increasing. HDR brachytherapy provides the advantage of eliminating radiation exposure to medical personnel, a shorter treatment time, patient convenience, and outpatient management. In three randomized trials, HDR brachytherapy was comparable with LDR brachytherapy in terms of local-regional control and complication rates.[20,21,22][Level of evidence: 1iiDii] The American Brachytherapy Society has published guidelines for the use of LDR and HDR brachytherapy as components of cervical cancer treatment.[23,24] For stage IB2 lesions, radiosensitizing chemotherapy is indicated. The role of radiosensitizing chemotherapy in IA2 and IB1 lesions is untested and likely to be of only marginal benefit since the cure rates with radiation alone exceed or approach 90%.
- Radical hysterectomy and bilateral pelvic lymphadenectomy.
- Postoperative total pelvic radiation therapy plus chemotherapy following radical hysterectomy and bilateral pelvic lymphadenectomy. Radiation in the range of 50 Gy administered for 5 weeks plus chemotherapy with cisplatin with or without fluorouracil (5-FU) should be considered in patients at high risk of recurrence including those with positive pelvic nodes, positive surgical margins, and residual parametrial disease.[11,12,13,14,15,16]
- Radiation therapy plus chemotherapy with cisplatin or cisplatin/5-FU for patients with bulky tumors.[11,12,13,14,15,16,25]