RESUMO
PURPOSE OF REVIEW: Although there is effective screening for cervical cancer, it continues to be a healthcare problem in developing countries. To increase survival rates, different strategies with neoadjuvant chemotherapy have been developed. Nearly all trials that analysed neoadjuvant chemotherapy plus surgery demonstrated an improved outcome, but most phase III trials that compared neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone have failed to show further benefit. Recent data on neoadjuvant chemotherapy could change that assumption, so revision is needed. RECENT FINDINGS: A meta-analysis by the Medical Research Council (UK) based on individual patient data (2074 patients, median follow-up 5.7 years) showed that there was no benefit of survival in patients treated with radiotherapy. Some interesting results were obtained when the trials were grouped together according to cycle length and dose intensity. Trials that gave more intensive chemotherapy in terms of a shorter cycle or a higher dose intensity tended to show an advantage for neoadjuvant chemotherapy. When analysing neoadjuvant chemotherapy followed by surgery, data from meta-analysis showed a reduction in the risk of death of 35% and an absolute gain of 14% in the 5-year survival. The reasons for this could be that short cycle length chemotherapy was used in this subgroup or the surgery may have removed radioresistant cell clones. SUMMARY: Neoadjuvant chemotherapy may play a role in the treatment of women with cervical cancer. In future, it may be reasonable to compare it with concomitant chemoradiotherapy in terms of efficacy and toxicity.
Assuntos
Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Neoadjuvante , Neoplasias do Colo do Útero/terapia , Quimioterapia Adjuvante , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/mortalidadeRESUMO
In February 1999, the National Cancer Institute of the US National Institutes of Health issued a communication stating that concurrent chemoradiotherapy should be considered as standard treatment for cervical cancer. This statement was based on the publication of five randomized prospective trials. On the basis of a critical review of these papers and others that identified different results, questions, doubts, and concerns have arisen about this therapeutic method. We analyzed the quality of the control groups managed with the standard treatment, noting data that may have altered these results, as well as analyzing the quality of chemotherapy, radiotherapy, and treatment compliance. In light of this analysis, we believe that further trials should be carried out with fairly balanced prognostic factors to demonstrate beyond a doubt that concurrent chemoradiotherapy is superior to radiotherapy alone. In developing countries where resources are scarce, this type of tumor is found frequently. Concurrent chemoradiotherapy would involve increased costs and supportive care, taking away resources from other vital areas.