Cervical Cancer Breakthrough

This centre wished to bring to the attention of medical practitioners involved in the management of patients with cervical cancer, new information on the use of chemo-radiation. For over a decade a number of centres, both in Australia and overseas, have been investigating ways of improving survival for patients with locally advanced cervical cancer - FIGO stages I-IIA with poor prognostic factors, such as positive nodes, parametrial involvement or positive surgical margins, and stages IB₂-IVA.

In the past the usual approach to these situations was treatment by radiotherapy, however, the results had not been encouraging. The use of chemotherapy agents with the radiotherapy has been investigated and there are now five large phase III studies, showing survival advantage for concurrent cisplatin based chemotherapy with the radiotherapy. These studies have shown a 30-50% reduction in the risk of death compared with control groups. A summary of these trials is given below, however the results are such that this Clinical Announcement has been put out to suggest that the use of concurrent cisplatin based chemoradiation be considered in patients who would otherwise have radiotherapy alone for locally advanced or poor prognosis cervical cancer.

Trials Summary

While more time needs to pass to ascertain whether or not these results hold up in the long term, current evidence is promising. In the oldest trial (GOG85), the majority of the patients who received concurrent cisplatin based radiotherapy are still alive 7.5 years after diagnosis, compared with a 50% failure to survive in the other arm by 5 years.

While generally recommendations cannot be made on the basis of one or two studies, in this case there are now 5 large phase III studies which show a 30-50% reduction in risk of death in favour of concurrent cisplatin based chemoradiation.

Director,