Cervical Cancer
Cancer of the cervix was once the most common type of cancer in women. Today, better testing that helps doctors detect changes in the cervix before cancer develops has made cervical cancer less common. In 2006, cancer of the cervix was diagnosed in approximately 1 out of every 10,000 women over the age of 20 in the United States. The disease occurs most often in women over 40.
The exact causes of cervical cancer are not known. Risk factors that have been suggested as possible causes include infection with human papillomavirus (HPV), human immunodeficiency virus (HIV), or the common sexually transmitted disease chlamydia; smoking; older age; having first sexual intercourse before age 18; and having many sexual partners, or having sexual partners who have had their first sexual intercourse young and/or have had many sexual partners themselves.
Cervical Cancer Treatment Summaries
Radiation with concurrent cisplatin-based chemotherapy
Radiation with concurrent cisplatin-based chemotherapy is superior to radiation alone in women at high risk for recurrence following radical hysterectomy (stage IB, IIA with tumors less than 5 centimeters, or positive lymph nodes, IIB-IVA), for cervical carcinoma. Chemoradiation therapy is associated with a significant overall reduction in the risk of disease recurrence of 51%, which translates to an improvement in survival at eight years of 67% with concurrent therapy, compared to 41% survival with radiotherapy alone (p<.0001). A recent meta-analysis of 24 trials including 4921 patients reported a 13%- absolute benefit in progression free survival and 10%- absolute benefit in overall survival for chemoradiation.
References
- Eifel, Patricia J et al. “Pelvic Irradiation with Concurrent Chemotherapy versus Pelvic and Para-Aortic Irradiation for High-Risk Cervical Carcinoma: An Update of RTOG Trial 90-01”. JCO (2004) 22:872-880.
- Green, J et al. “Concomitant Chemotherapy and Radiation Therapy for Cancer of the Uterine Cervix”. Cochrane Database System Review (2005) CD002225.
In metastatic cervical carcinoma, several chemotherapy agents and combination regimens are active. The most active agents are cisplatin, paclitaxel, and topotecan. The effectiveness of chemotherapy is related to disease location; objective responses are more likely for disease that is located outside of as compared to within a radiated field.
References:
- More, DH et al. “Phase III Study of Cisplatin with or without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: A GOG Study”. JCO (2004) 22: 3113-3119.
- Long, HJ et al. “Randomized Phase III Trial of Cisplatin with or without Topotecan in Carcinoma of the Uterine Cervix: A GOG Study”. JCO (2005) 23: 4626-4633.
- Tinker, AV et al. “Carboplatin and Paclitaxel for Advanced and Recurrent Cervical Carcinoma: The British Columbia Cancer Agency Experience”. Gynecol Oncol (2005) 98: 54-58.
