Adding Chemotherapy to Radiation May Help Prevent Spread of Cervical Cancer
Cervical Cancer Treatment
Cervical cancer that has begun to spread locally, to nearby lymph nodes in the pelvis, for example, should be treated with chemotherapy in addition to radiation, suggest the results of a new review of studies.
"For women with locally advanced cervical cancer, the weight of evidence seems to favor the use of chemoradiotherapy," says lead author John Green, M.D., at Clatterbridge Hospital in England.
Cervical cancer is largely preventable if caught early through use of Pap screening, common in North America and Europe. But on a global scale, it is the second most common cancer in women and the most common in some low-income countries.
The systematic evidence review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Green and his colleagues summed up the findings of 24 studies of nearly 5,000 women. These studies compared chemotherapy combined with radiation, known as chemoradiotherapy, with radiation alone for locally advanced cervical cancer.
They found that chemoradiotherapy potentially increases survival in women with locally advanced cervical cancer by 12 percent, meaning that out of 100 women, 12 more would survive with the combination therapy. It helped stop the growth of cervical cancer as well as its recurrence better than radiation alone.
Chemoradiotherapy helped reduce the incidence of cancer spreading to distant sites in the body, known as metastases. This result, which Green and colleagues called "the most striking finding," suggests the combination of chemotherapy and radiation may have an anti-cancer effect throughout the body, not just at the site of the cervical cancer. This finding also suggests that chemotherapy and radiation may interact in such a way that they increase each other's power.
Adding chemotherapy to radiation also adds the well-known side effects of nausea, fatigue and thinning of the hair. "Still, it's a fairly well tolerated regimen," compared to the intense chemotherapy that's given for cancers such as ovarian cancer, says Barbara Goff, M.D., a professor of obstetrics and gynecology at the University of Washington in Seattle.
"The chemotherapy doesn't add a significant amount of toxicity beyond what you are already getting with the radiation," she adds.
Goff says "these findings add further evidence to what we have already known" and notes that the standard of care in the United States for locally advanced cervical cancer includes weekly treatments of radiation combined with the chemotherapy drug called cisplatin.
Green and colleagues say this exact regimen would be suitable in the developing world, which needs "cheap, and simple to administer," cervical cancer treatments.
Ideally, Pap screening for cervical cancer should be prioritized in developing countries, says Goff. "You can do a lot of Pap smears for the money you spend on chemo and radiation," she says. "But if we are going to give radiation in developing countries, we should include chemotherapy, the weekly cisplatin."
Green and colleagues call for more research into whether early stage patients benefit more from chemoradiotherapy than later stage patients; the impacts of varied chemoradiotherapy dosing, timing and duration; and the use of other chemotherapy drugs beside cisplatin.