Chemotherapy for Cervical Cancer
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This page discusses the use of chemotherapy for the treatment of cervical cancer. For a thorough review of chemotherapy for cancer treatment, please see the chemotherapy treatment monograph .
Cancer chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas.
For years, chemotherapy was considered an ineffective treatment modality for women with invasive cervical cancer. Its use was limited to treating women with advanced metastatic disease. In 1999, five landmark papers reported significant improvements in the survival rates of women with locally advanced cervical cancer with the concurrent administration of cisplatin-based chemotherapy and radiation therapy. Because of these findings, the National Cancer Institute issued a recommendation that cisplatin-based chemotherapy be added to the treatment of women receiving radiation therapy for cervical cancer .
The Use of Chemotherapy by Stage of Cancer
Currently, chemotherapy is used in a number of different stages of cervical cancer. It is usually used in combination with radiation therapy. Chemotherapy alone is not a curative treatment option, and should only be added to radiation therapy if cure is in mind.
Chemotherapy is used in the following cervical cancer stages:
Stage IB:
- Radiation therapy plus chemotherapy
- Radical hysterectomy followed by radiation therapy plus chemotherapy
Stage IIA:
- Radiation therapy plus chemotherapy
Stage IIB:
- Internal and external radiation therapy combined with chemotherapy
Stage III:
- Internal and external radiation therapy combined with chemotherapy
Stage IVA:
- Internal and external radiation therapy combined with chemotherapy
Stage IVB:
- Chemotherapy or radiation therapy as palliative therapy to relieve symptoms
Chemotherapy Drugs Used for Cervical Cancer:
Chemotherapy is usually given intravenously and within a hospital setting. Any of the following drugs may be used:
- Cisplatin (Platinol)
- Paclitaxel (Taxol)
- Gemcitabine (Gemzar)
- Carboplatin (Paraplatin)
- Ifosfamide (IFEX)
- 5-fluorouracil (Adrucil)
- Doxorubicin (Adriamycin)
- Methotrexate (MTX, Amethopterin)
- Vinblastine (Velban)
- Vinorelbine (Navelbine)
- Bleomycin (Blenoxane)
Effectiveness of Chemotherapy for Cervical Cancer
The effectiveness of chemotherapy in the treatment of cervical cancer is dependent on many factors, including the stage of the cancer and your general health.
As mentioned above, when chemotherapy—specifically cisplatin or cisplatin plus 5-fluorouracil—was used in women with locally advanced disease in combination with radiation therapy in five separate randomized trials, an overall survival advantage was seen. These trials included women with stage IB2 to IVA. Cisplatin and 5-FU are the only chemotherapeutics used in conjunction with radiotherapy in the management of cervical cancer, and shown to be better than radiation alone (with excellent tolerance in terms of toxicity).
Management and treatment of persistent or recurrent cervical cancer has not improved significantly with the advances in chemotherapy. Cisplatin has a response rate of about 20%. Other agents, like paclitaxel and ifosfamide, added to cisplatin have increased response rates. Cisplatin with paclitaxel is considered to be the standard regimen in the palliative management of cervical cancer. Survival rates have not changed.
Source:
Cervical cancer (PDQ): Treatment. National Cancer Institutes Web site.
Available at:
http://www.cancer.gov/
.
Accessed on December 21, 2002.
DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology , 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2001:1519-1549.
Im SS, Monk BJ. New developments in the treatment of invasive cervical cancer. Obstetrics and Gynecology Clinics . 2002;29.
Otto SE. Oncology Nursing . 4th ed. St. Louis, MO: Mosby, Inc; 2001:248-257.
Last reviewed February 2003 by Jondavid Pollock, MD, PhD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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