Treatment of Cervical Cancer
Article information
J Korean Med Assoc. 2007;50(9):785-795
Publication date (electronic) : 2007 September 30
doi :
https://doi.org/10.5124/jkma.2007.50.9.785
Abstract
The treatment modality of cervical cancer depends on the stage and tumor size. In non-advanced, non-bulky cervical cancers, both surgery and chemoradiation are equally effective. Therefore, the treatment modality is chosen based on the complication rate and the quality of life after treatment. When risk factors such as the positive resection margin, lymph node metastasis, parametrial invasion, bulky disease over 4cm, deep stromal invasion, and lymphovascular space involvement are present after surgery, adjuvant chemoradiation should be performed. In non-advanced, bulky cervical cancers, the optimal treatment is controversial. As a primary therapy, chemoradiation, neoadjuvant chemotherapy and radical surgery, or radical surgery is used. In advanced cervical cancers, chemoradiation is the treatment of choice. However, the indication of paraaortic radiation is still controversial.
Keywords: Cervical cancer; Radical hysterectomy; Chemoradiation
References
1. Vistad I, Fossa SD, Dahl AA. A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer. Gynecol Oncol 2006. 102563–572.
2. Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999. 3401383–1389.
3. Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2003. 56937–949.
4. Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer 2004. 10097–106.
5. Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol 2005. 237428–7436.
6. Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 1974. 44265–272.
7. Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, Mangioni C. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol 2001. 803–12.
8. Hertel H, Kohler C, Michels W, Possover M, Tozzi R, Schneider A. Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 2003. 90505–511.
9. Sevin BU, Nadji M, Averette HE, Hilsenbeck S, Smith D, Lampe B. Microinvasive carcinoma of the cervix. Cancer 1992. 702121–2128.
10. Benedet JL, Anderson GH. Stage IA carcinoma of the cervix revisited. Obstet Gynecol 1996. 871052–1059.
11. Angioli R, Palaia I, Cipriani C, Muzii L, Calcagno M, Gullotta G, Panici PB. Role of sentinel lymph node biopsy procedure in cervical cancer: a critical point of view. Gynecol Oncol 2005. 96504–509.
12. Marchiole P, Buenerd A, Scoazec JY, Dargent D, Mathevet P. Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma. Cancer 2004. 1002154–2159.
13. Green J, Kirwan J, Tierney J, Symonds P, Fresco L, Williams C, Collingwood M. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane database of systematic reviews (Online) 2001. CD002225.
14. Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000. 181606–1613.
15. Ang KK. Concurrent radiation chemotherapy for locally advanced head and neck carcinoma: are we addressing burning subjects? J Clin Oncol 2004. 224657–4659.
16. Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, Zaino RJ. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J radiat Oncol Biol Phys 2006. 65169–176.
17. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999. 73177–183.
18. Monk BJ, Wang J, Im S, Stock RJ, Peters WA 3rd, Liu PY, Barrett RJ 2nd, Berek JS, Souhami L, Grigsby PW, Gordon W Jr, Alberts DS. Gynecologic Oncology Group. Southwest Oncology Group. Radiation Therapy Oncology Group. Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. Gynecol Oncol 2005. 96721–728.
19. Ayhan A, Tuncer ZS, Kucukali T, Tuna T, Enunlu T. Correlation between pathological risk factors and pelvic lymph node metastases in stage I squamous carcinoma of the cervix: a multivariate analysis of 194 cases. J Surg Oncol 1991. 48207–209.
20. Gauthier P, Gore I, Shingleton HM, Soong SJ, Orr JW, Hatch KD. Identification of histopathologic risk groups in stage IB squamous cell carcinoma of the cervix. Obstet Gynecol 1985. 66569–574.
21. Roman LD, Felix JC, Muderspach LI, Varkey T, Burnett AF, Qian D, Morrow CP. Influence of quantity of lymph-vascular space invasion on the risk of nodal metastases in women with early-stage squamous cancer of the cervix. Gynecol Oncol 1998. 68220–225.
22. Roman LD, Felix JC, Muderspach LI, Agahjanian A, Qian D, Morrow CP. Risk of residual invasive disease in women with microinvasive squamous cancer in a conization specimen. Obstet Gynecol 1997. 90759–764.
23. Hertel H, Köhler C, Grund D, Hillemanns P, Possover M, Michels W, Schneider A. German Association of Gynecologic Oncologists (AGO). Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer. Gynecol Oncol 2006. 103506–511.
24. Plante M, Renaud MC, Francois H, Roy M. Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. Gynecol Oncol 2004. 94614–623.
25. Boss EA, van Golde RJ, Beerendonk CC, Massuger LF. Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 2005. 99S152–S156.
26. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecol Oncol Group study. Gynecol Oncol 1990. 38352–357.
27. Decker MA, Burke JJ 2nd, Gallup DG, Silverio RW, Weems D, Duttenhaver J, Purcell D. Completion hysterectomy after radiation therapy for bulky cervical cancer stages IB, IIA, and IIB: complications and survival rates. Am J Obstet Gynecol 2004. 191654–658.
discussion 8-60.
28. Perez CA, Grigsby PW, Camel HM, Galakatos AE, Mutch D, Lockett MA. Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys 1995. 31703–716.
29. Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF, Rotman MZ, Fowler WC Jr. Gynecol Oncol Group. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecol Oncol Group. Gynecol Oncol 2003. 89343–353.
30. Sardi JE, Giaroli A, Sananes C, Ferreira M, Soderini A, Bermudez A, Snaidas L, Vighi S, Gomez Rueda N, di Paola G. Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol 1997. 6761–69.
31. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer 2003. 392470–2486.
32. Allen HH, Nisker JA, Anderson RJ. Primary surgical treatment in one hundred ninety-five cases of stage IB carcinoma of the cervix. Am J Obstet Gynecol 1982. 143581–584.
33. Lanciano RM, Pajak TF, Martz K, Hanks GE. The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys 1993. 25391–397.
34. Perez CA, Grigsby PW, Castro-Vita H, Lockett MA. Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 1995. 321275–1288.
35. Hareyama M, Sakata K, Oouchi A, Nagakura H, Shido M, Someya M, Koito K. High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix: a randomized trial. Cancer 2002. 94117–124.
36. Lertsanguansinchai P, Lertbutsayanukul C, Shotelersuk K, Khorprasert C, Rojpornpradit P, Chottetanaprasith T, Srisuthep A, Suriyapee S, Jumpangern C, Tresukosol D, Charoonsantikul C. Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma. Int J Radiat Oncol Biol Phys 2004. 591424–1431.
37. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys In J Radiat Oncol Biol Phys 2000. 48201–211.
38. Haie C, Pejovic MH, Gerbaulet A, Horiot JC, Pourquier H, Delouche J, Heinz JF, Brune D, Fenton J, Pizzi G. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol 1988. 11101–112.
39. Rotman M, Pajak TF, Choi K, Clery M, Marcial V, Grigsby PW, Cooper J, John M. Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA 1995. 274387–393.
40. Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, Rotman M, Gershenson D, Mutch DG. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol 2004. 22872–880.
41. Grigsby PW, Heydon K, Mutch DG, Kim RY, Eifel P. Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 2001. 51982–987.
42. Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, Connelly P. Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecol Oncol Group study. Int J Radiat Oncol Biol Phys 1998. 421015–1023.
43. Ferrandina G, Distefano M, Smaniotto D, Morganti A, Paglia A, Macchia G, Corvari B, Lorusso D, Scambia G. Anemia in patients with locally advanced cervical carcinoma administered preoperative radiochemotherapy: association with pathological response to treatment and clinical outcome. Gynecol Oncol 2006. 103500–505.
44. Kapp KS, Poschauko J, Geyer E, Berghold A, Oechs AC, Petru E, Lahousen M, Kapp DS. Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 2002. 5458–66.
45. Grogan M, Thomas GM, Melamed I, Wong FL, Pearcey RG, Joseph PK, Portelance L, Crook J, Jones KD. The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999. 861528–1536.
46. Lavey RS, Liu PY, Greer BE, Robinson WR 3rd, Chang PC, Wynn RB, Conrad ME, Jiang C, Markman M, Alberts DS. Recombinant human erythropoietin as an adjunct to radiation therapy and cisplatin for stage IIB-IVA carcinoma of the cervix: a Southwest Oncology Group study. Gynecol Oncol 2004. 95145–151.
47. Henke M, Laszig R, Rübe C, Schäfer U, Haase KD, Schilcher B, Mose S, Beer KT, Burger U, Dougherty C, Frommhold H. Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet 2003. 3621255–1260.
48. Leyland-Jones B, Semiglazov V, Pawlicki M, Pienkowski T, Tjulandin S, Manikhas G, Makhson A, Roth A, Dodwell D, Baselga J, Biakhov M, Valuckas K, Voznyi E, Liu X, Vercammen E. Maintaining normal hemoglobin levels with epoetin alfa in mainly nonanemic patients with metastatic breast cancer receiving first-line chemotherapy: a survival study. J Clin Oncol 2005. 235960–5972.
49. Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, Trelle S, Weingart O, Bayliss S, Djulbegovic B, Bennett CL, Langensiepen S, Hyde C, Engert A. Recombinant human erythropoietins and cancer patients: updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst 2006. 98708–714.
50. Duggan B, Muderspach LI, Roman LD, Curtin JP, d' Ablaing G 3rd, Morrow CP. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 1993. 82598–602.
51. Sood AK, Sorosky JI, Krogman S, Anderson B, Benda J, Buller RE. Surgical management of cervical cancer complicating pregnancy: a case-control study. Gynecol Oncol 1996. 63294–298.
52. van der Vange N, Weverling GJ, Ketting BW, Ankum WM, Samlal R, Lammes FB. The prognosis of cervical cancer associated with pregnancy: a matched cohort study. Obstet Gynecol 1995. 851022–1026.
53. Economos K, Perez Veridiano N, Delke I, Collado ML, Tancer ML. Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 1993. 81915–918.
54. Hannigan EV, Whitehouse HH 3rd, Atkinson WD, Becker SN. Cone biopsy during pregnancy. Obstet Gynecol 1982. 60450–455.
55. Copeland LJ, Saul PB, Sneige N. Cervical adenocarcinoma: tumor implantation in the episiotomy sites of two patients. Gynecol Oncol 1987. 28230–235.
56. Gordon AN, Jensen R, Jones HW 3rd. Squamous carcinoma of the cervix complicating pregnancy: recurrence in episiotomy after vaginal delivery. Obstet Gynecol 1989. 73850–852.
57. Giacalone PL, Laffargue F. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy. A report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer 1999. 851203–1204.
58. Tewari K, Cappuccini F, Gambino A, Kohler MF, Pecorelli S, DiSaia PJ. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy: a report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer 1998. 821529–1534.
59. Grigsby PW, Perez CA, Kuske RR, Camel HM, Kao MS, Galakatos AE, Hederman MA. Adenocarcinoma of the uterine cervix: lack of evidence for a poor prognosis. Radiother Oncol 1988. 12289–296.
60. Covens A, Kirby J, Shaw P, Chapman W, Franseen E. Prognostic factors for relapse and pelvic lymph node metastases in early stage I adenocarcinoma of the cervix. Gynecol Oncol 1999. 74423–427.
61. Schorge JO, Lee KR, Sheets EE. Prospective management of stage IA(1) cervical adenocarcinoma by conization alone to preserve fertility: a preliminary report. Gynecol Oncol 2000. 78217–220.
62. de Hullu JA, Pras E, Hollema H, van der Zee AG, Bogchelman DH, Mourits MJ. Presentations of endometrial activity after curative radiotherapy for cervical cancer. Maturitas 2005. 51172–176.
63. Chan YM, Ng TY, Ngan HY, Wong LC. Monitoring of serum squamous cell carcinoma antigen levels in invasive cervical cancer: is it cost-effective? Gynecol Oncol 2002. 847–11.
64. Maiman M. The clinical application of serum squamous cell carcinoma antigen level monitoring in invasive cervical carcinoma. Gynecol Oncol 2002. 844–6.
65. Chung HH, Kim SK, Kim TH, Lee S, Kang KW, Kim JY, Park SY. Clinical impact of FDG-PET imaging in post-therapy surveillance of uterine cervical cancer: From diagnosis to prognosis. Gynecol Oncol 2006. 103165–170.
66. Chung HH, Jo H, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, Kang SB, Lee HP. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol 2007. 104529–534.
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