A systematic review of randomised trials in the past two decades published in this week’s issue of THE LANCET concludes that women given concurrent chemotherapy and radiotherapy for cervical cancer could have an increased survival-rate of 12% compared with patients treated with radiotherapy alone.
Cervical cancer is the second most common cancer affecting women, and is the main cause of cancer mortality in less-developed countries. Around 80% of women are treated with radiotherapy alone; however, the chemotherapeutic agent cisplatin is effective for treating metastatic cervical cancer, and is thought to enhance the effects of radiotherapy. John Green and colleagues from Liverpool University, UK, reviewed the effects of combined chemotherapy and radiotherapy on overall and progression-free survival, local and distant disease control, and acute and late toxicity in patients with cervical cancer.
The investigators reviewed all known randomised controlled trials done between 1981 and 2000. Data for up to 3600 patients from 19 trials were analysed. The absolute benefit in progression-free and overall survival was 16% and 12% respectively. Combined chemotherapy and radiotherapy also reduced local and distant disease recurrence by around 40%; however, toxic side-effects were more common.
John Green comments: "We believe that evidence favours the use of chemoradiotherapy and, because our results are derived from trials of different populations, with different treatment regimens and supportive care facilities, they are potentially generalisable. Application to less-developed countries requires the regimen to be cheap and simple to administer, and we suggest that cisplatin once a week fits these criteria."
Contact: Dr John A Green, Clatterbridge Centre for Oncology, Clatterbridge Road, Bebington, Wirral, Merseyside, CH63 4JY, UK; T) 44-151-482-7743; F) 44-151-482-7675;e) J.A.Green@liverpool.ac.uk
Journal
The Lancet