The National Cancer Institute (NCI) recently sent a clinical
announcement to thousands of physicians stating that strong
consideration should be given to adding chemotherapy to radiation
therapy in the treatment of invasive cervical cancer.
The mailing alerts physicians who treat cancer to the findings of
five different studiesall large, randomized clinical
trialsshowing that women in the studies benefited from the
concurrent administration of radiation therapy and chemotherapy. Up
to now, surgery or radiation therapy alone has been the standard
therapy for cervical cancer that has metastasized locally or regionally.
The findings of these five trials are remarkably
consistent, said NCI director, Richard D. Klausner, MD.
They are likely to change the standard of care for invasive
Three of the studies cited in the NCIs clinical announcement
will appear in the New England Journal of Medicine. Because of
their potential implications for public health, the articles
describing these studies were released in advance of their
publication date, and are accessible on the journals web site
at www.nejm.org. The remaining two studies will be published later in
Several hundred women were enrolled in each of the five trials,
conducted by NCIs Clinical Trials Cooperative Groups in centers
around the country. Their cancers varied from disease confined to the
cervix to disease that had spread from the cervix to other pelvic tissues.
In three of the studies, women were randomly divided into groups that
received either radiation alone or radiation plus concomitant
chemotherapy. The chemotherapy agents used were cisplatin (Platinol)
and fluorouracil (5-FU) (two studies) or cisplatin alone (one study).
In all three trials, the proportion of women alive after about 3
years of follow-up was higher in the groups receiving chemotherapy
plus radiation than in the groups receiving radiation therapy only.
In the two other studies, all patients received concomitant
chemotherapy and radiation. However, the chemotherapy drugs differed
between the arms. In one arm of each of these trials, the
chemotherapy used was hydroxyurea (Hydrea), while in the other arms,
it included cisplatin. In both trials, the groups treated with
cisplatin had better survival rates.
The NCIs clinical announcement states that, although the best
chemotherapy regimen for cervical cancer has not been determined,
significant results were seen using cisplatin alone or
cisplatin in combination with 5-FU and other agents.