New approaches to high-risk cervical cancer. Advanced cervical cancer.

Abstract

The role of chemotherapy in the surgical management of high-risk cervical cancer has not yet been defined. Based on the ability of numerous cytotoxic agents to induce regressions in advanced and recurrent cervical cancer, there is now a trend toward early use of these drugs. The efficacy of cisplatin-containing regimens in particular suggests that new strategies combining chemotherapy and surgery may result in improved survival rates in patients with high-risk cervical cancer. In this review of the literature, two groups of patients who may benefit from this approach to therapy are discussed. In the first group are patients with local or regionally advanced cervical carcinoma who receive chemotherapy (neoadjuvant) with the goal of reducing tumor bulk and thus allowing surgical treatment in normally inoperable cases. The second group consist of patients with identifiable adverse risk factors after radical hysterectomy and pelvic lymphadenectomy who receive postoperative chemotherapy (adjuvant) in an effort to decrease local and distant recurrences. The administration of neoadjuvant chemotherapy to patients with local and locally advanced cervical cancer allows radical surgery to be performed in many patients who otherwise would be considered inoperable. In these patients, there also appears to be a decrease in the incidence of pelvic and distant recurrences and possibly an improvement in survival rates. Adjuvant chemotherapy after radical surgery for patients at high risk for recurrence appears to provide a survival advantage in some high-risk patients. Preliminary results in the new approaches to therapy that combine chemotherapy with surgery in patients with high-risk cervical cancer are encouraging. Randomized prospective trials are warranted to identify the most active chemotherapeutic regimens and to determine the patient selection criteria most likely to result in improved survival rates.