Randall Leslie M, Walker Amanda J, Jia Angela Y, Miller Devin T, Zamarin Dmitriy
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:252-263. doi: 10.1200/EDBK_320411.
Cervical cancer is a socially and scientifically distinguishable disease. Its pathogenesis, sexual transmission of high-risk HPV to a metaplastic portion of the uterine cervix, makes cervical cancer preventable by safe and effective HPV vaccines commercially available since 2006. Despite this, cervical cancer remains the deadliest gynecologic cancer in the world. Regrettably, global incidence and mortality rates disproportionately affect populations where women are marginalized, where HIV infection is endemic, and where access to preventive vaccination and screening for preinvasive disease are limited. In the United States, cervical cancer incidence has gradually declined over the last 25 years, but mortality rates remain both constant and disparately higher among communities of color because of the adverse roles that racism and poverty play in outcome. Until these conditions improve and widespread prevention is possible, treatment innovations are warranted. The last standard-of-care treatment changes occurred in 1999 for locally advanced disease and in 2014 for metastatic and recurrent disease. The viral and immunologic nature of HPV-induced cervical cancer creates opportunities for both radiation and immunotherapy to improve outcomes. With the advent of T cell-directed therapy, immune checkpoint inhibition, and techniques to increase the therapeutic window of radiation treatment, an overdue wave of innovation is currently emerging in cervical cancer treatment. The purpose of this review is to describe the contemporary developmental therapeutic landscape for cervical cancer that applies to most tumors and to discuss notable rare histologic subtypes that will not be adequately addressed with these treatment innovations.
宫颈癌是一种在社会和科学上具有显著特征的疾病。其发病机制是高危型人乳头瘤病毒（HPV）通过性传播至子宫颈的化生部位，这使得自2006年以来可商购的安全有效的HPV疫苗能够预防宫颈癌。尽管如此，宫颈癌仍是全球最致命的妇科癌症。遗憾的是，全球发病率和死亡率对妇女被边缘化、HIV感染呈地方性流行以及预防性疫苗接种和癌前病变筛查受限的人群影响尤为严重。在美国，过去25年宫颈癌发病率逐渐下降，但由于种族主义和贫困对治疗结果产生的不利影响，有色人种社区的死亡率仍居高不下且差异显著。在这些情况得到改善并实现广泛预防之前，治疗创新是必要的。上一次标准治疗方案的改变发生在1999年（针对局部晚期疾病）和2014年（针对转移性和复发性疾病）。HPV诱导的宫颈癌的病毒学和免疫学特性为放疗和免疫治疗改善治疗结果创造了机会。随着T细胞导向疗法、免疫检查点抑制以及扩大放射治疗治疗窗技术的出现，宫颈癌治疗领域目前正迎来一波姗姗来迟的创新浪潮。本综述的目的是描述适用于大多数肿瘤的宫颈癌当代发展性治疗格局，并讨论这些治疗创新无法充分应对的显著罕见组织学亚型。
