Cervical Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IIA Cervical Cancer
Although the positive trials vary somewhat in terms of 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:
- Intracavitary radiation therapy combined with external-beam pelvic radiation therapy plus chemotherapy with cisplatin or cisplatin/5-FU for patients with bulky tumors.[11,12,13,14,15,16,20] 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 to LDR brachytherapy in terms of local-regional control and complication rates.[21,22,23][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.[24,25] Radiation therapy to para-aortic nodes may be indicated in primary tumors 4 cm or larger.
- Radical hysterectomy and pelvic lymphadenectomy. Radical surgery has been performed for small lesions, but the high incidence of compromised margins, parametrial spread, and positive nodes leading to postoperative radiation with or without chemotherapy make primary concomitant chemotherapy and radiation a more common approach.
- Postoperative total pelvic radiation therapy plus chemotherapy following radical hysterectomy and bilateral pelvic lymphadenectomy. Radiation therapy 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 with positive pelvic nodes, positive surgical margins, and residual parametrial disease.[11,12,13,14,15,16]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIA cervical cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.