From the Guidelines
The primary treatment for cervical cancer should be either surgery or radiation therapy (RT), with concurrent chemoradiation being the preferred treatment for stages IB2 to IVA disease, as recommended by the NCCN guidelines 1. The treatment approach for cervical cancer depends on the stage of the disease.
- For early-stage cervical cancer, surgery is often the primary treatment, which may involve a hysterectomy (removal of the uterus) or in some cases, a radical trachelectomy (removing the cervix while preserving the uterus) for women who wish to maintain fertility.
- For more advanced stages, concurrent chemoradiation is typically recommended, consisting of external beam radiation therapy, brachytherapy (internal radiation), and chemotherapy with cisplatin (40 mg/m² weekly) or cisplatin plus 5-fluorouracil, as outlined in the NCCN guidelines 1.
- It's also important to note that pelvic RT or chemoradiation will invariably lead to ovarian failure in premenopausal women, as stated in the NCCN guidelines 1. The NCCN guidelines provide a comprehensive approach to the treatment of cervical cancer, and concurrent chemoradiation is the primary treatment of choice for stages IB2 to IVA disease, based on the results of 5 randomized clinical trials 1.
- The treatment options for cervical cancer are effective because they target rapidly dividing cancer cells through different mechanisms: surgery physically removes the tumor, radiation damages cancer cell DNA, and chemotherapy interferes with cell division processes.
- Side effects vary by treatment but may include fatigue, nausea, hair loss, and fertility issues, as mentioned in the NCCN guidelines 1. Regular follow-up care is essential to monitor for recurrence and manage any long-term treatment effects, as recommended by the NCCN guidelines 1.
From the FDA Drug Label
Persistent, recurrent, or metastatic cervical cancer, in combination with paclitaxel and cisplatin, or paclitaxel and topotecan. ( 1.5) The recommended dose of Topotecan Injection is 0. 75 mg/m 2by intravenous infusion over 30 minutes daily on days 1,2, and 3; followed by cisplatin 50 mg/m 2by intravenous infusion on day 1 repeated every 21 days (a 21-day course).
Cervical Cancer Treatment: Bevacizumab (IV) in combination with paclitaxel and cisplatin, or paclitaxel and topotecan is indicated for the treatment of persistent, recurrent, or metastatic cervical cancer 2.
- The recommended dose of Topotecan Injection for cervical cancer is 0.75 mg/m2 by intravenous infusion over 30 minutes daily on days 1,2, and 3, followed by cisplatin 50 mg/m2 by intravenous infusion on day 1, repeated every 21 days 3.
- Dosage adjustments for subsequent courses of Topotecan Injection in combination with cisplatin are specific for each drug, and should be based on the manufacturer’s prescribing information for cisplatin administration and hydration guidelines, and for cisplatin dosage adjustment in the event of hematologic toxicity 3.
From the Research
Cervical Cancer Treatment Options
- Cervical cancer treatment may involve surgery, radiation therapy, or a combination of both, depending on the stage and extent of the disease 4.
- Radical hysterectomy with pelvic lymph node assessment is a standard initial therapy for early-stage cervical cancer 5.
- Adjuvant concurrent chemoradiation (CCRT) may be considered in surgically-treated patients with early-stage cervical cancer who exhibit pelvic lymph node metastasis 6.
Surgical Approaches
- Radical hysterectomy via laparotomy (an "open" approach) has been the standard for decades, but minimally invasive surgery (MIS) has been increasingly adopted due to its reported perioperative benefits 5.
- However, the Laparoscopic Approach to Cervical Cancer (LACC) trial reported that patients randomized to MIS had inferior oncologic outcomes, leading professional societies to state that open radical hysterectomy should remain the gold standard surgical approach 5.
Role of Chemotherapy and Radiation
- Platinum-based combination chemotherapy during adjuvant CCRT after surgery may promote better survival than a weekly cisplatin regimen in early-stage cervical cancer patients with pelvic lymph node metastasis 6.
- Adjuvant pelvic radiation following radical hysterectomy and pelvic lymph node dissection may be beneficial in patients with high-risk cervical cancer, including those with deep cervical stromal invasion, parametrial extension, or lymph node metastasis 7.