CHEMOTHERAPY IN CERVICAL-CANCER

An overview of the present role of chemotherapy for the treatment of c ervical cancer is presented. 167 publications with a total of 6624 pat ients have been reviewed, Particular emphasis was placed on treatment results and side-effects of the respective drug regimens. Among single -drug regimens, platinum derivates appear to be superior to other cyto toxic drugs with overall response rates of 18-47 % and a median respon se duration of 4 6 months. Of the other agents, only ifosfamide appear s to be equally effective: the average response rate was 31 33 % with a median duration of response of 7 20 months. Using combination therap y with two different agents, carboplatinum/ifosfamide, cisplatinum/met hotrexate, and cisplatinum/mitomycin C yield the best results. The ove rall response rates were 40 59, 57 77, and 17 77 %, respectively. Amon g the non-platinum regimens, bleomycin/mitomycin C is the most effecti ve combination with an average response rate of 40 %. If more than two agents are used, the platinum containing regimens are superior to the non-platinum combinations. Cisplatinum/bleomycin/methotrexate (respon se rate: 53 83 %), cisplatinum/adriamycin/bleomycin/vincristine (respo nse rate: 81 %), cisplatinum/bleomycin/ifosfamide (response rate: 69-7 0%), and cisplatinum/bleomycin/methotrexate/vincristine (response rate : 67 - 77 %) were the most effective treatments. However, looking at t he duration of response of 4-18 months and the median survival of 6 - 12 months, these combinations did not differ significantly from other regimens. Primary (neoadjuvant) chemotherapy is a novel therapeutic ap proach in cervical carcinoma. The rationale is the improvement of loca l tumor control prior to surgery or radiation therapy. If combinations of drugs are used, response rates of up to 100% have been reported an d the disease-free survival was also increased. Combination of chemoth erapy and radiation therapy represents another treatment strategy. Res ponse rates between 11 and 100% are reported. The best results were ac hieved by platinum-containing regimens. However, toxicity of combined irradiation and chemotherapy is considerable with frequent severe bone marrow suppression. In conclusion, chemotherapy for the treatment of cervical carcinoma may be considered a promising and effective approac h. From the available data, no final conclusions are yet to be drawn a s to its value in an adjuvant and neoadjuvant setting.