Chemoradiotherapy in the treatment of cervical cancer

The advantage of concurrent chemoradiotherapy over radiotherapy alone in patients with cervical cancer has now been well documented in a series of prospective randomized trials. Six of these trials compared a cisplatin-based regimen (either cisplatin alone administered weekly or a combination of cisplatin and 5-fluorouracil) with radiotherapy alone or radiotherapy plus another, less effective chemotherapy; 5 of these 6 trials showed a benefit with concurrent chemotherapy. Individual trials have also suggested that epirubicin and the combination of mitomycin plus 5-fluorouracil are effective when administered concurrently with radiotherapy. Other drugs, particularly biologic response modifiers, are currently being studied for their potential benefit in combination with radiation and cisplatin. Although the side effects of chemoradiotherapy with weekly cisplatin or cisplatin plus 5-fluorouracil are tolerable for most patients, the addition of concurrent chemotherapy to radiotherapy markedly increases hematologic and gastrointestinal side effects and adds to the overall complexity of treatment. Successful management requires particularly close monitoring of hematologic parameters, fluid balance, electrolyte levels, dietary condition, and social support. Careful coordination between caregivers is crucial. Although early publication of some trials precluded mature analysis of late radiation effects, available data suggest that the addition of concurrent chemotherapy does not markedly increase the risk of major late complications. Most women with locoregionally advanced cervical cancers (stage IB2 or greater or positive pelvic lymph nodes) that are confined to the pelvis are candidates for chemoradiotherapy. However, the benefit of adding concurrent chemotherapy to radiotherapy should always be weighed against the risk of serious acute side effects, particularly in patients who have serious coexisting medical conditions that would have precluded or discouraged enrollment in the prospective trials.