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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.[1] 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 cancerConization
Total hysterectomy
Modified radical hysterectomy with lymphadenectomy
Radical trachelectomy
Intracavitary radiation therapy
Stages IB, IIA cervical cancerRadiation therapy with concomitant chemotherapy
Radical hysterectomy and bilateral pelvic lymphadenectomywith or without total pelvic radiation therapy plus chemotherapy
Radical trachelectomy
Neoadjuvant chemotherapy
Radiation therapy alone
Intensity Modulated Radiation Therapy (IMRT)
Stages IIB, III, and IVA cervical cancerRadiation therapy with concomitant chemotherapy
Interstitial brachytherapy
Neoadjuvant chemotherapy
Stage IVB cervical cancerPalliative radiation therapy
Palliative chemotherapy
Recurrent cervical cancerRadiation therapy and chemotherapy
Palliative chemotherapy
Pelvic exenteration

Chemoradiation Therapy

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.[7] 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]
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