Concurrent chemotherapy and radiation for locally advanced cervical cancer: the new standard of care.

Radical pelvic irradiation has constituted the definitive therapy for patients with large cervical cancers. No substantial improvements have been made in treatment outcomes. In the past year, however, a series of large, well-conducted randomized trials has evaluated the role of concurrent chemotherapy with pelvic irradiation in cervical cancer. These trials include definitive treatment of patients with stage IB2 to IVA disease and adjuvant treatment after radical surgery in stage IB2-IIA disease. Five trials have shown a consistent 30% to 50% reduction in the risk of death from disease when concurrent chemotherapy is used. Questions still remain as to what constitutes the best chemotherapy dose and schedule. In all of the positive trials, cisplatin was used, but three also used 5-fluorouracil. The level of survival improvement that occurs when chemotherapy is added to optimal irradiation and whether patients with stage IIIB and IVA benefit are also unclear. Improvements in survival rates for patients with solid tumors occur slowly. Based on the evidence, it is likely that concurrent chemotherapy with radiation will become the new standard of care for bulky and advanced cervix cancer.