Combined modality therapy for gynecologic cancer

The use of combined modality therapy in the primary management of gynecologic cancer continues to be explored. Although early ovarian cancer is treated with postoperative adjuvant treatment, the data to support its value is lacking. In advanced disease, paclitaxel has emerged as the most optimal treatment after maximal cytoreduction. Although studies on consolidative therapy using radiotherapy, intraperitoneal therapy, or further chemotherapy are reported, there are no comparative data against a control arm. In those subsets of endometrial cancer patients who have a poor survival, adjuvant treatment strategies using chemotherapy or wide-field whole-abdominal therapy is being evaluated to improve outcome. Small phase II studies of either sequential or concurrent chemotherapy with radiation continue to be reported in advanced cervix cancer, yet large prospective randomized trials comparing standard radiotherapy to combined chemotherapy and radiotherapy are scarce. Alternative strategies to standard surgery to limit morbidity is being explored in the management of vulvar cancer with encouraging results. More properly conducted phase III trials are necessary to evaluate the efficacy of these newer treatment strategies.