[Chemotherapy in the management of advanced or high risk cervical cancer]

Most investigators agree that patients with early stages of cervical cancer can be treated effectively with surgery and/or radiation therapy. However, there have been many problems to be solved. Five-year survival following treatment of curative intent is reported to be 87% for stage I, 40% for stage III, and 14% for stage IV. These 66% for stage II, have been unchanged for last two decades and almost similar to those of patients with ovarian cancer. However, much attention has not been paid to the unsatisfactory results for patients with advanced stage, because the success of cytologic techniques in the diagnosis of neoplastic changes in the epithelium of the uterine cervix resulted in dramatic decrease in the incidence of cervical invasive malignancies, leading to the improvement of the survival of all patients with cervical malignancies. To improve such poor prognosis, effective systemic chemotherapy is required. This review will focus on current data on chemotherapy mainly from USA and our institute where our unique protocol, low-dose consecutive CDDP dosing method, is being carried out. The encouraging chemotherapeutic results will prompt investigators to challenge the new approaches to therapy that combine chemotherapy which may precede operation or radiation therapy for advanced stage disease or may follow the main treatment modalities in the adjuvant setting for early stage disease with high risk factors for recurrence.