Cervical cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Women with cervical cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods. The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.
- Standard Treatment Options for cervical cancer
In situ carcinoma of the cervix (this stage is not recognized by FIGO)
- Conization
- Hysterectomy for postreproductive patients
- Internal radiation therapy for medically inoperable patients
Stage IA cervical cancer
- Conization
- Total hysterectomy
- Modified radical hysterectomy with lymphadenectomy
- Radical trachelectomy
- Intracavitary radiation therapy
- Radiation therapy with concomitant chemotherapy
Stages IB, IIA cervical cancer
- Radiation therapy with concomitant chemotherapy
- Radical hysterectomy and bilateral pelvic lymphadenectomy with or without total pelvic radiation therapy plus chemotherapy
- Radical trachelectomy
- Neoadjuvant chemotherapy
- Radiation therapy alone
- Intensity Modulated Radiation Therapy (IMRT)
Stages IIB, III, and IVA cervical cancer
- Radiation therapy with concomitant chemotherapy
- Neoadjuvant chemotherapy
- Interstitial brachytherapy
Stage IVB cervical cancer
- Palliative radiation therapy
- Palliative chemotherapy
Recurrent cervical cancer
- Radiation therapy and chemotherapy
- Palliative chemotherapy
- Pelvic exenteration
Radiation therapy
- In Situ Cervical Cancer
- Internal radiation therapy for medically inoperable patients
For medically inoperable patients, a single intracavitary insertion with tandem and ovoids for 5,000 mg hours (80 Gy vaginal surface dose) may be used.
- Stage IA Cervical Cancer
- Intracavitary radiation therapy
Intracavitary radiation therapy is a treatment option when palliative treatment is appropriate because of other medical conditions and for women who are not surgical candidates. If the depth of invasion is less than 3 mm and no capillary lymphatic space invasion is noted, and the frequency of lymph-node involvement is sufficiently low, external-beam radiation therapy is not required. One or two insertions with tandem and ovoids for 6,500 mg to 8,000 mg hours (100–125 Gy vaginal surface dose) are recommended.
- Stages IB and IIA Cervical Cancer
- Radiation therapy with concomitant chemotherapy
Concurrent, cisplatin-based chemotherapy with radiation therapy is the standard of care for women who require radiation therapy for treatment of cervical cancer. Radiation therapy protocols for patients with cervical cancer have historically used dosing at two anatomical points, termed point A and point B, to standardize the doses received. Point A is defined as 2 cm from the external os, and 2 cm lateral, relative to the endocervical canal. Point B is also 2 cm from the external os, and 5 cm lateral from the patient midline, relative to the bony pelvis. In general, for smaller tumors, the curative-intent dose for point A is around 70 Gy, whereas for larger tumors, the point A dose may approach 90 Gy.
- Brachytherapy
Standard radiation therapy for cervical cancer includes brachytherapy after external-beam radiation therapy (EBRT). Although low-dose rate (LDR) brachytherapy, typically with cesium Cs 137, has been the traditional approach, the use of high-dose rate (HDR) therapy, typically with iridium Ir 192, is rapidly increasing. HDR brachytherapy provides the advantage of eliminating radiation exposure to medical personnel, a shorter treatment time, patient convenience, and improved outpatient management.