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Adding chemotherapy to radiation therapy given after surgery may reduce recurrences of cancer and improve survival in women with early-stage cervical cancer, according to researchers from the Southwest Oncology Group.

Cancer of the cervix, the opening of the uterus (womb) that connects the uterus to the vagina (birth canal), is a common cancer in women. Treatment options depend on the stage of disease (extent of cancer at diagnosis) and may include surgery, radiation therapy, and/or chemotherapy. Stage IA cervical cancer consists of a small amount of cancer confined to the tissues of the cervix, while stage IB cervical cancer is characterized by a larger amount of cancer confined to the tissues of the cervix. Stage IIA cervical cancer entails disease that began in the cervix, but has spread to the upper vagina. Women who have these stages of cervical cancer often undergo surgery as primary treatment. One of the most common types of surgeries performed is a radical hysterectomy, which involves the removal of the cervix, uterus, and part of the vagina. Surgical removal of the nearby lymph nodes, called a lymph node dissection or pelvic lymphadenectomy, is also done to determine whether cancer cells have spread to these lymph nodes. After surgery, some women may still have residual disease outside the cervix in amounts so small that they cannot be detected (called micrometasases). To help prevent any potentially remaining micrometastases from growing and causing a recurrence (return) of cancer after surgery, additional therapy is often administered (called adjuvant therapy). The role of adjuvant therapy for women with stage IA to IIA cervical cancer is not yet entirely clear; however, many women are treated with radiation therapy after their surgery. Researchers recently sought to determine whether using both radiation therapy and chemotherapy after surgery would prove to be even more effective for women with this type of disease.

Researchers from the Southwest Oncology Group evaluated the use of adjuvant therapy with both chemotherapy and radiation therapy in 268 women with stage IA, IB, or IIA cervical cancer. All patients underwent a radical hysterectomy with pelvic lymphadenectomy. After the surgery, the researchers assigned the women to receive either radiation therapy alone or radiation therapy plus chemotherapy with cisplatin and fluorouracil. The results showed that 37% of patients receiving radiation therapy alone suffered recurrences, compared with only 20% of those receiving both radiation therapy and chemotherapy. After 4 years, the survival rate of those receiving radiation therapy alone was 71%, compared with 81% of those also receiving the chemotherapy.

From these findings, it appears that the use of both chemotherapy and radiation therapy, given after radical hysterectomy, should be considered a standard therapy for women with stage IA, IB, and IIA cancer of the cervix. Women who have cervical cancer may wish to talk with their doctor about the risks and benefits of receiving both radiation therapy and chemotherapy after surgery or of participating in a clinical trial in which promising new therapies are being studied.

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Journal of Clinical Oncology, Vol 18, No 8, pp 1606-1613, 2000)