Is concurrent chemotherapy and radiotherapy the new standard of care for locally advanced cervical cancer?

The results of five multi-institutional randomized controlled trials demons trating a survival advantage for the concurrent administration of chemother apy and radiotherapy in the management of cervix canter represented the fir st major advance in the management of this malignancy in many years and pro mpted many practitioners to alter their pattern of practice. More recently, the results of the National Cancer Institute of Canada (NCIC) trial demons trating no survival benefit when combined modality therapy is compared with optimally delivered radiotherapy, has led many to question the strength of the evidence supporting the adoption of combined modality therapy as the s tandard therapy for cervix cancer and in particular the magnitude of the be nefit derived from the addition of chemotherapy to an optimally delivered r adiotherapy regimen. This review paper will critically examine the evidence presented in the literature indicating a benefit for the use of combined m odality therapy, discuss possible reasons why the conclusions of negative t rials such as the NCIC study differ from those of the other studies and hig hlight those aspects of the use of combined modality therapy that require f urther evaluation.