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 studies—all large, randomized clinical trials—showing 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 cervical cancer.”
Three of the studies cited in the NCI’s 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 journal’s web site at www.nejm.org. The remaining two studies will be published later in the year.
Several hundred women were enrolled in each of the five trials, conducted by NCI’s 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.
Study Results
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(Drug information on cisplatin) (Platinol) and fluorouracil(Drug information on 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 NCI’s 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.”
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
