Combined Chemotherapy and Radiation Therapy for Cervical Cancer

Author:
David H. MooreDepartment of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, Indiana

Search for other papers by David H. Moore in
Current site
Google Scholar
PubMedClose
 MD
Volume/Issue:
Volume 2: Issue 6
Online Publication Date:
Nov 2004
DOI:
https://doi.org/10.6004/jnccn.2004.0052
Full access

More than 50% of patients with newly diagnosed cervical cancer will undergo radiation therapy as a primary treatment modality. Results from five phase III trials conducted by National Cancer Institute (NCI)-sponsored cooperative groups showed significant survival advantages from the addition of cisplatin-based chemotherapy to primary radiation therapy, changing the standard of care for patients with bulky or locally advanced cervical carcinoma. The majority of patients for whom treatment fails, however, have persistent pelvic disease. Other agents (alone or in combination with cisplatin) with potential synergy with radiation therapy should be studied. Future trials should investigate potential interrelationships between anemia, tumor hypoxia, angiogenesis, and the effectiveness of radiation therapy. Therapies specific to tumor hypoxia (tirapazamine) or strategies to maintain higher nadir hemoglobin levels during treatment (aggressive transfusion policies; erythropoietin) should also be studied.

Correspondence: David H. Moore, MD, Mary Fendrich Hulman Professor and, Chief of Gynecologic Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT433, Indianapolis, IN 46202-5274. E-mail: dhmoore@iupui.edu
  • Collapse
  • Expand
  • 1

    Jemal A, Murray T, Samuels A et al.. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5–26.

  • 2

    Fu KK. Biological basis for the interaction of chemotherapeutic agents and radiation therapy. Cancer 1985;55: 2123–2130.

  • 3

    Sinclair WK. Hydroxyurea: Effects on Chinese hamster cells grown in culture. Cancer Res 1967;27:297–308.

  • 4

    Phillips RA, Tolmach LJ. Repair of potentially lethal damage in x-irradiated HeLa cells. Radiat Res 1966;29:413–432.

  • 5

    Piver MS, Barlow JJ, Vongtama V, Blumenson L. Hydroxyurea: A radiation potentiator in carcinoma of the uterine cervix. Am J Obstet Gynecol 1983;147:803–808.

    • Search Google Scholar
    • Export Citation
  • 6

    Hreshchyshyn MM, Aron BS, Boronow RC et al.. Hydroxyurea or placebo combined with radiation to treat stages IIIB and IV cervical cancer confined to the pelvis. Int J Radiat Oncol Biol Phys 1979;5:317–322.

    • Search Google Scholar
    • Export Citation
  • 7

    Berry RJ. Effects of some metabolic inhibitors on x-ray dose-response curves for the survival of mammalian cells in vitro, and on early recovery between fractionated x-ray doses. Br J Radiol 1966;39:458–463.

    • Search Google Scholar
    • Export Citation
  • 8

    Byfield JE, Calabro-Jones P, Klisak I, Kulhanian F. Pharmacologic requirements for obtaining sensitization of human tumor cells in vitro to combined 5-fluorouracil or ftorafur and x rays. Int J Radiat Oncol Biol Phys 1982;8:1923–1933.

    • Search Google Scholar
    • Export Citation
  • 9

    Kennedy KA, Rockwell S, Sartorelli AC. Enhancement of mitomycin-C cytotoxic metabolites by hypoxic tumor cells. Cancer Res 1980;40:2356–2360.

    • Search Google Scholar
    • Export Citation
  • 10

    Thomas G, Dembo A, Fyles A et al.. Concurrent chemoradiation in advanced cervical cancer. Gynecol Oncol 1990;38:446–451.

  • 11

    Stehman FB, Bundy BN, Keys H et al.. A randomized trial of hydroxyurea versus misonidazole adjunct to radiation therapy in carcinoma of the cervix: A preliminary report of a Gynecologic Oncology Group study. Am J Obstet Gynecol 1988;159:87–94.

    • Search Google Scholar
    • Export Citation
  • 12

    Stehman FB, Bundy BN, Thomas G et al.. Hydroxyurea versus misonidazole with radiation in cervical carcinoma: Long-term follow-up of a Gynecologic Oncology Group trial. J Clin Oncol 1993;11:1523–1528.

    • Search Google Scholar
    • Export Citation
  • 13

    Dische S, Chassagne D, Machin D. Randomized controlled trial of the use of pimonidazole (Ro 03 8799) in the treatment of advanced carcinoma of the cervix. In: Seventh International Conference on Chemical Modifiers of Cancer Treatment. Clearwater, FL; 1991:172–173.

    • Search Google Scholar
    • Export Citation
  • 14

    Leibel S, Bauer M, Wasserman T et al.. Radiotherapy with or without misonidazole for patients with stage IIIB or stage IVA squamous cell carcinoma of the uterine cervix: preliminary report of a Radiation Therapy Oncology Group randomized trial. Int J Radiat Oncol Biol Phys 1987;13: 541–549.

    • Search Google Scholar
    • Export Citation
  • 15

    Butler J, Hoey Bm, Swallow AJ. The radiation chemistry of some platinum-containing radiosensitizers and related compounds. Radiat Res 1985;102:1–13.

    • Search Google Scholar
    • Export Citation
  • 16

    Nias AHW. Radiation and platinum drug interactions. Int J Radiat Biol 1985;48:297–314.

  • 17

    Begg AC, Van Der Kolk PJ, Dewit L, Bartelink H. Radiosensitization by cisplatin of RIF1 tumour cells in vitro. Int J Radiat Biol 1986;50:871–884.

    • Search Google Scholar
    • Export Citation
  • 18

    Potish R, Twiggs L, Adcock L et al.. Effect of cisplatinum on tolerance to radiation therapy in advanced cervical cancer. Am J Clin Oncol 1986;9:387–391.

    • Search Google Scholar
    • Export Citation
  • 19

    Malfetano J, Keys H, Kredentser D et al.. Weekly cisplatin and radical radiation therapy for advanced, recurrent, and poor prognosis cervical carcinoma. Cancer 1993;71:3703–3706.

    • Search Google Scholar
    • Export Citation
  • 20

    Runowicz CD, Wadler S, Rodriguez-Rodriguez L et al.. Concomitant cisplatin and radiotherapy in locally advanced cervical carcinoma. Gynecol Oncol 1989;34:395–401.

    • Search Google Scholar
    • Export Citation
  • 21

    Choo YC, Choy TK, Wong LC, Ma HK. Potentiation of radiotherapy by cis-dichlorodiammine platinum (II) in advanced cervical carcinoma. Gynecol Oncol 1986;23: 94–100.

    • Search Google Scholar
    • Export Citation
  • 22

    Whitney CW, Sause W, Bundy BN et al.. A randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stages IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: A Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339–1348.

    • Search Google Scholar
    • Export Citation
  • 23

    Morris M, Eifel PJ, Lu J et al.. Pelvic radiation with concurrent chemotherapy versus pelvic and para-aortic radiation for high-risk cervical cancer: A randomized Radiation Therapy Oncology Group clinical trial. N Engl J Med 1999;340:1137–1143.

    • Search Google Scholar
    • Export Citation
  • 24

    Rose PG, Bundy BN, Watkins EB et al.. Concurrent cisplatin based radiotherapy and chemotherapy for locally-advanced cervical cancer. N Engl J Med 1999;340:1144–1153.

    • Search Google Scholar
    • Export Citation
  • 25

    Keys HM, Bundy BN, Stehman FB et al.. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340:1154–1161.

    • Search Google Scholar
    • Export Citation
  • 26

    Peters WA III, Liu PY, Barrett RJ et al.. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606–1613.

    • Search Google Scholar
    • Export Citation
  • 27

    Clinical Announcement. National Cancer Institute. Concurrent chemoradiation for cervical cancer. U. S. Department of Health and Human Services, Public Health Service, National Institutes of Health; February, 1999. Available at: http://www.cancer.gov/clinicaltrials/developments/exerpt-announcement0300. Accessed September 2004.

    • Search Google Scholar
    • Export Citation
  • 28

    Pearcey R, Brundage M, Drouin P et al.. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 2002;20:966–972.

    • Search Google Scholar
    • Export Citation
  • 29

    Grogan M, Thomas GM, Melamed I et al.. The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999;86:1528–1536.

    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2004 by the National Comprehensive Cancer Network 2004
Page Numbers:
5
Article Category:
Research Article
Received:
06 Aug 2004
Accepted:
10 Sep 2004
Print Publication Date:
01 Nov 2004
Online Publication Date:
Nov 2004
Keywords:
Cervical cancer; radiation; chemotherapy; phase III trials
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 220 84 10
PDF Downloads 186 70 6
EPUB Downloads 0 0 0