Cervical Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for Cervical Cancer
Patterns-of-care studies clearly demonstrate the negative prognostic effect of increasing tumor volume and spread pattern. Treatment, therefore, may vary within each stage as the individual stages are currently defined by Féderation Internationale de Gynécologie et d'Obstétrique (FIGO).
Table 5. Standard Treatment Options for Cervical Cancer
|Stage (FIGO Staging Criteria)||Standard Treatment Options|
|FIGO = Féderation Internationale de Gynécologie et d'Obstétrique.|
|In situ carcinoma of the cervix (this stage is not recognized by FIGO)||Conization|
|Hysterectomy for postreproductive patients|
|Internal radiation therapy for medically inoperable patients|
|Stage IA cervical cancer||Conization|
|Modified radical hysterectomy with lymphadenectomy|
|Intracavitary radiation therapy|
|Stages IB, IIA cervical cancer||Radiation therapy with concomitant chemotherapy|
|Radical hysterectomy and bilateral pelvic lymphadenectomywith or without total pelvic radiation therapy plus chemotherapy|
|Radiation therapy alone|
|Intensity Modulated Radiation Therapy (IMRT)|
|Stages IIB, III, and IVA cervical cancer||Radiation therapy with concomitant chemotherapy|
|Stage IVB cervical cancer||Palliative radiation therapy|
|Recurrent cervical cancer||Radiation therapy and chemotherapy|
Five randomized, phase III trials (GOG-85, RTOG-9001, GOG-120, GOG-123, and SWOG-8797) have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy,[2,3,4,5,6] while one trial examining this regimen demonstrated no benefit. 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 were found to have poor prognostic factors (metastatic disease in pelvic lymph nodes, parametrial disease, or positive surgical margins) at the time of primary surgery.
- Although the positive trials vary 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.[2,3,4,5,6]