[Cervical cancer--phase III studies of radiation therapy combined modality]

The number of patients with cervical cancer has been constantly reduced but it remains a leading cause of death among gynecologic malignancies in Japan. In 1990, 5,793 patients with cervical cancer were registered and 1,892 cases (32.7%) were stage 0, 2,074 cases (35.8%) were stage I, 991 cases (17.1%) were stage II, 659 cases (11.4%) were stage III and 172 cases (3.0%) were stage IV. Among these patients, about 40% were treated with radiation therapy alone or combined with radiation therapy. The five-year survival rates of stage I, II, III, and IV patients were 83.4%, 65.3%, 40.3% and 13.1%, respectively. Phase III studies have been conducted to compare surgical treatment and radiation therapy, and it is clarified that radiation therapy is equivalent to surgical therapy in young healthy patients with an early-stage tumor, while combined radiation therapy followed by surgery did not improve results over radiation alone. It is thus justified to offer postoperative irradiation to selected patients who have high-risk factors in the surgical specimen. Effects of chemotherapy were also compared to radiation therapy. Multiagent chemotherapy such as bleomycin, vincristine, mitomycin C, and cisplatin or bleomycin, ifosphamide and cisplatin are standard regimens for cervical cancer. However, because the toxicity of chemotherapy along with radiation therapy is much higher than that of radiation alone, there is a need to develop an adequate adjuvant chemotherapy regimen for cervical cancer. Other ongoing trials are also discussed.