Treatment options in recurrent cervical cancer (Review)

The management of recurrent cervical cancer depends mainly on previous treatment and on the site and extent of recurrence Concurrent cisplatin-based chemo-radiation is the treatment of choice for patients with pelvic failure after radical hysterectomy alone However the safe delivery of high doses of radiotherapy is much more difficult in this clinical setting compared with primary radiotherapy Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation In a recent series, the 5-year overall survival and operative mortality after pelvic exenteration ranged from 21 to 61% and from 1 to 10%, respectively Free surgical margins, negative lymph nodes, small tumour size and long disease-free interval were associated with a more favourable prognosis Currently, pelvic reconstructive procedures (continent urinary conduit low colorectal anastomosis, vaginal reconstruction with myocutaneous flaps) ate strongly recommended after exenteration Concurrent cisplatin-based chemo-radiation is the treatment of choice for isolated para-aortic lymph node failure, with satisfactory chances of a cure in asymptomatic patients Chemotherapy is administered with palliative intent to women with distant or loco-regional recurrences not amenable by surgery or radiotherapy Cisplatin is the most widely used drug, with a response rate of 17-38% and a median overall survival of 6 1-7 1 months Cisplatin-based combination chemotherapy achieves higher response rates ('2-68%) when compared with single-agent cisplatin, but median overall survival is usually less than one year In a recent Gynecologic Oncology Group (GOG) trial the combination topotecan + cisplatin obtained a significantly longer overall survival than single-agent cisplatin in patients with metastatic or recurrent or persistent cervical cancer A subsequent GOG study showed a trend in terms of longer overall survival and better quality of life for the doublet cisplatin + paclitaxel vs the doublets cisplatin + topotecan cisplatin + vinorelbine and cisplatin + gemcitabine Molecularly targeted thetapy may represent a novel therapeutic tool, but its use alone or in combination with chemotherapy is still investigational