Chemotherapy Plus Radiation Therapy Improves Survival For Patients with Invasive Cervical Cancer

A landmark national study led by researchers at The University of Texas M. D. Anderson Cancer Center has found that women with locally advanced cervical cancer live significantly longer when treated with radiation therapy and chemotherapy simultaneously.

Based on the Radiation Therapy Oncology Group (RTOG) study data, as well as data from two similar studies published in the same upcoming issue of the New England Journal of Medicine and two other studies soon to be published, the National Cancer Institute issued a rare clinical announcement on February 22 stating that "strong consideration should be given to adding chemotherapy to radiation therapy in the treatment of invasive cervical cancer."

In a statement, NCI director Dr. Richard Klausner says, "The findings of these five trials are remarkably consistent. They are likely to change the standard of care for invasive cervical cancer."

The NCI has issued only four other clinical announcements in its history.

Because of their potential implications for public health, the articles have been released in advance of their publication date and may be accessed on the Journal's Web site at www.nejm.org.

"This is the first fundamental advance in the treatment of cervical cancer in more than 40 years," says Dr. Mitchell Morris, principal investigator of the RTOG study and professor of gynecologic oncology at M. D. Anderson. "Now that we have the data, it is vital to make chemotherapy a part of standard care for women with advanced cervical cancer. Every day that we wait to make it a part of treatment, fewer women have the opportunity to benefit."

According to the study by the RTOG, to be published in the April 15 issue of the New England Journal of Medicine, combining chemotherapy with radiation treatment dramatically reduced recurrences of cervical cancer, leading to improved survival rates.

Traditionally, women with advanced cervical cancer have been treated with radical surgery or radiation, using external beams and internal implants to control the disease and its microscopic spread to other parts of the body.

The RTOG study reports that the overall survival rate at five years for patients who had been given both chemotherapy and radiation to the abdomen was 73 percent, compared to a 68 percent survival rate for patients who were given only radiation to the abdomen and pelvis.

The disease-free survival rates were 66 percent for patients who were given both chemotherapy and radiation, and 40 percent for those receiving only radiation. Disease-free survival was determined from the date of the patient's entry in the study to the date of the first occurrence of disease progression, second cancer diagnosis or death or the date of the last follow up if none of these events occurred.

The study followed 403 patients from 1990 to 1998. Of the randomized group, 195 patients were concurrently treated with both radiation to the pelvis and a chemotherapy regimen of cisplatin and 5-flourouracil (5-FU). The other group comprised of 193 patients received extended-field radiotherapy, or radiation beams to the pelvis and abdomen.

The addition of chemotherapy to the patients' treatments resulted in only a modest increase in side effects compared to standard radiation, Dr. Morris says. He added that the nausea, fatigue and lowered blood counts experienced by some patients were side effects often experienced with chemotherapy, and were treatable with medication.

"The study of the RTOG is not the first to study chemoradiation, but we believe this is the definitive study showing chemotherapy and radiation used together can improve survival of invasive cervical cancer," Dr. Morris says.

The study conducted by the RTOG was funded by grants provided by the National Cancer Institute. The study was conducted primarily at M. D. Anderson Cancer Center, Washington University School of Medicine in St. Louis, New York University and the State University of New York Health Science Center.

In the United States, more than 13,700 women were diagnosed with invasive cervical cancer last year. Nearly 5,000 patients died because treatment did not control the disease or its spread to other parts of the body, Dr. Morris says. Worldwide, about a half million new cases are diagnosed annually, according to the World Health Organization.

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©2006 Texas Medical Center

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