Combined radiotherapy and chemotherapy for advanced carcinoma of the cervix

Until recently the use of cytotoxic drugs in the treatment of squamous carcinoma of the cervix has been limited to patients with local recurrence after primary therapy or with distant metastases. The effectiveness of some cytotoxic drugs, especially cisplatin, in producing tumour regression in this group of patients with a poor prognosis, has encouraged the use of chemotherapy at an earlier stage of the disease process. Since 1979 patients with FIGO IIb squamous carcinoma of the cervix extending more than half-way to the pelvic side-wall and Stages III and IV disease have been treated with a combination of cisplatin or methotrexate and radiotherapy. The complete remission rate of Stage III tumours was 89% with a local recurrence rate of only 8%. In patients with advanced Stage IIb disease only 44% achieved complete remission and three patients with Stage IV disease failed to respond. The projected 5-year survival rate is 66% for patients with Stage III disease and 49% for all patients. The results of this combined treatment are presented and discussed and the suggestion made that chemotherapy combined with radiotherapy can be safely used to advantage in patients at high risk of local relapse.