Palliative cytostatic treatment of cervical carcinoma

PURPOSE OF THE ARTICLE: In patients recurring after primary therapy for cervical cancer, treatment remains palliative. In the present article we focus on treatment results with single cytostatic drugs or combinations in randomized trials in squamous cell cervical cancer.

In one randomized trial, monotherapy with platinum analogues lead to overall remission rates between 11% and 15% only. The median overall survival ranged between 5.6 and 6.5 months. Various combinations lead to overall remission rates between 21% and 31% and the median overall survival ranged between 7.3 and 14.3 months. The most active combinations were cisplatin/bleomycin/mitomycin C/vindesine, cisplatin/paclitaxel, and cisplatin/irinotecan. There are several smaller studies with cystostatic therapy in cervical adenocarcinoma. However, using 5-fluoruracil, ifosfamide, paclitaxel, or cisplatinum, only response rates between 15 and 30% can be achieved. Predictors of a favorable chemotherapy response include a higher performance status, higher age, extrapelvic recurrence sites (especially lung metastases), a recurrence-free interval > 1 year, and no previous radiotherapy and chemotherapy.

In conclusion, palliative cytostatic therapy with single agents has moderate activity. Combinations are more active but also more toxic. In general, chemotherapy needs to be used earlier in the course of disease when tissue vascularization is preserved.