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

The results of five multi-institutional randomized controlled trials demonstrating a survival advantage for the concurrent administration of chemotherapy and radiotherapy in the management of cervix cancer represented the first major advance in the management of this malignancy in many years and prompted many practitioners to alter their pattern of practice. More recently, the results of the National Cancer Institute of Canada (NCIC) trial demonstrating 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 standard therapy for cervix cancer and in particular the magnitude of the benefit derived from the addition of chemotherapy to an optimally delivered radiotherapy regimen. This review paper will critically examine the evidence presented in the literature indicating a benefit for the use of combined modality therapy, discuss possible reasons why the conclusions of negative trials such as the NCIC study differ from those of the other studies and highlight those aspects of the use of combined modality therapy that require further evaluation.