[Concomitant radiochemotherapy in cancer of the cervix uteri: modifications of the standards].
For a long time, combined external irradiation and brachytherapy has been considered as the standard treatment in patients with advanced cervical cancers. Recently, five clinical randomized trials assessing the role of cis-platin-based chemotherapy delivered concomitantly to radiotherapy have been conducted in the United States. Another clinical randomized trial assessing the role of epirubicin was conducted by the Queen Mary Hospital in Hong Kong. With more than 2,000 enrolled patients, these studies showed converging results with an overall and disease-free survival improvement in the arms combining cis-platin and epirubicin-based chemotherapy and irradiation. These combinations led to a significant decrease in loco-regional evolution or recurrence rates, or even in pulmonary metastases rates. The relative risk of recurrences was decreased by 50%. The relative risk of death was decreased by 40%. The differences, however, were less significant in patients with advanced stages III or IVA. Hematological and digestive acute toxicity was significantly higher in the radiochemotherapy groups, but long-term complications were comparable. The results of these randomized trials have led to a modification in the standard of treatment in these poor prognosis cervix cancers. Five of the randomized trials evidenced the superiority of cis-platin-based chemotherapy, but the optimal chemotherapeutic regimens remain to be defined.
Haie-Meder
C
C
Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France. haie@igr.fr
Lhommé
C
C
de Crevoisier
R
R
Morice
P
P
Resbeut
M
M
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007044:Hysterectomy; D008679:Metaplasia; D009367:Neoplasm Staging; D018579:Patient Selection; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D002945:Cisplatin; D005472:Fluorouracil; D006918:Hydroxyurea
Radiochimiothérapie concomitante dans les cancers du col de l'utérus: modifications des standards.