Chemotherapy of advanced and recurrent cervical carcinoma

Chemotherapy is used primarily to treat advanced or recurrent cervical canc er. There are three major applications: primary therapy, as a radiation sen sitizer, and neoadjuvant therapy. Primary chemotherapy is employed in advan ced and disseminated cervical carcinoma (Stage VB). The four best single dr ugs with moderate activity against cervical cancer are: cisplatin, ifosfami de, dibromodulcitol (mitolactol), and Adriamycin (doxorubicin). Cisplatin a nd ifosfamide appear to be the best combination therapy: they provide an ob jective response rate of 33%. However, because the overall survival was not significantly improved with combination therapy, single-agent therapy with one of the above active drugs is acceptable. For stages IIB, III and TVA, the primary therapy is still radiation. Concomitant chemotherapy with hydro xyurea or a combination of cisplatin and 5-fluorouracil (5-FU) have been sh own to enhance radiation response in several randomized trials. Hydroxyurea is the preferred radiation sensitizer because it offers less toxicity, eas e of administration, and equivalent results. Chemotherapy in neoadjuvant se tting produces promising results. Various cisplatin combinations of mitomyc in C, 5-FU, vincristine, and bleomycin have been employed to shrink locally advanced cervical cancer and permit safe, radical excision. Early results with these combinations in small trials are encouraging but further studies are needed to fully evaluate their potential. Semin. Surg. Oncol. 16:247-2 50, 1999. (C) 1999 Wiley-Liss, Inc.