Concomitant and neoadjuvant chemotherapy in conjunction with radiotherapy in the management of locally advanced cervical cancer.

Radiotherapy is standard treatment for women with locally advanced cervical cancer (stage IIB-IVA). Radiotherapy fails to control disease progression within the irradiated field in more than 40% of patients. The disease bulk is a major factor limiting the curative probability of pelvic radiotherapy. Chemotherapy has been integrated with pelvic radiotherapy with the goal of improving local tumor control and treating microscopic metastases outside the radiotherapy field. Simultaneous chemotherapy and radiotherapy, neoadjuvant chemotherapy followed by radiotherapy, and adjuvant chemotherapy after radiotherapy, have been investigated. Hydroxyurea during pelvic radiotherapy has been reported to be associated with an improved progression-free (P = .05) and survival (P = .066) advantage. Several randomized trials of concomitant radiotherapy with fluorouracil, mitomycin, or cisplatin have been completed, but no results are published. Neoadjuvant chemotherapy with cisplatin-containing regimens followed by radiotherapy has been studied in several randomized trials. Although tumor response after chemotherapy is reported in more than 50% of patients, no improvement in local disease control or in survival has been noted overall. In one large trial, neoadjuvant chemotherapy was inferior to standard pelvic radiotherapy in terms of local control and survival. Adjuvant chemotherapy after radiotherapy has been little studied, and no randomized trials have been reported. The results of trials in progress or completed but not yet reported will determine further clinical research directions. Chemotherapy during and after pelvic radiation therapy has been little studied.