Therapeutic targets
- Improvement of the symptomatology
- Improvement of the prognosis
Therapy recommendations
- Chemotherapeutic agents are used. They are effective in both squamous cell carcinoma and adenocarcinoma.
- See also under “Further therapy“.
Indications to the following forms of chemotherapy:
Adjuvant chemotherapy
Adjuvant chemotherapy (supportive treatment measure to reduce the relapse rate and thus improve the chances of a cure) brings only in combination with a radiatio (radiotherapy) an advantage (radiochemotherapy, RCTX) on:
- The progression-free interval (period without progression of the tumor).
- The local recurrence rate (recurrence in the area of the operated breast or chest wall, skin, or axilla).
- The survival time
Standard is monotherapy with cisplatin. It increases the radiosensitivity of tumor cells (so-called radiosensitizer) (see further therapy: radiotherapy).
Neoadjuvant chemotherapy (NACT; chemotherapy prior to surgical treatment): platinum-containing, interval-shortened (< 14 days), dose-intensified may improve operability by tumor shrinkage and reduce metastases to lymph nodes:
- In stage FIGO IB2-IIB
- In case of pretherapeutically identified risk factors, e.g.:
- Bulky disease (tumor > 4 cm).
- Hemangiosis carcinomatosa
- Lymphangiosis carcinomatosa
- Suspected positive lymph nodes
Note: The benefit on disease-free interval and survival is currently controversial.
A 2013 meta-analysis failed to show any improvement in progression-free survival or overall survival with neoadjuvant chemotherapy (NACT) in stages IB1 to IIA. In another study of patients in stages B2, IIA, or IIB, the results of primary combined radiochemotherapy (RCTX) versus NACT for disease-free survival (DFS) showed no significant difference (median follow-up: 58.5 months): 69.3% for NACT versus 76.7% for RCTX (p = 0.038).
Palliative chemotherapy
Palliative chemotherapy (various single and/or combination therapies) is indicated for recurrences (tumor recurrence) that cannot be treated either surgically or with radiotherapy. However, cervical carcinoma is relatively insensitive to chemotherapeutic agents. Success rates of approximately 20% can be expected with monotherapy, and approximately 40% with polychemotherapy.
