New trends on chemotherapy in the treatment of invasive cancer of the cervix

The survival of patients with 'large volume' stage Ib and II and advanced stage (III and IV) cervical cancer is still unsatisfactory. Chemotherapy has proved to be active in patients with relapse following conventional treatment and in 'fresh', initially extended cases. But generally it cannot modify the prognosis when used as a second line treatment. The systemic treatment is now proposed as a first treatment. The aim of primary (neoadjuvant) chemotherapy is to reduce the tumor volume, bringing the case within the limits of radical surgery and/or radiotherapy, and reducing the risk of local relapses and/or distant metastasis. Aims of concomitant chemo-radiotherapy are the same. Moreover several antiblastic drugs offer an evident radiosensitizing effect. The results of several preliminary pilot studies have shown the feasibility of neoadjuvant and concomitant chemotherapy, and reported partial plus complete clinical responses in a high percentage of cases treated. These studies confirm the efficacy and the good prospects of the new approaches on the combined systemic plus conventional treatments.