Book contents
- 50 Big Debates in Gynecologic Oncology
- 50 Big Debates in Gynecologic Oncology
- Copyright page
- Contents
- Contributors
- Section I Perioperative Management
- Section II Screening, Prevention, and Early Diagnosis
- Section III Ovarian Cancer
- Section IV Endometrial Cancer
- Section V Cervical Cancer
- Debate 42A Is there a Role for Minimally Invasive Radical Hysterectomy for Management of Cervical Cancer?
- Debate 42B Is there a Role for Minimally Invasive Radical Hysterectomy for Management of Cervical Cancer?
- Debate 43A Is Radical Surgery or Parametrectomy Needed for Early-stage FIGO IA2 and Microscopic IB1 Cervical Cancer?
- Debate 43B Is Radical Surgery or Parametrectomy Needed for Early-stage FIGO IA2 and Microscopic IB1 Cervical Cancer?
- Debate 44A What is the Best Management Option for Young Women with Stage IB2 Cervical Cancer Who Wish to Preserve Fertility?
- Debate 44B What is the Best Management Option for Young Women with Stage IB2 Cervical Cancer Who Wish to Preserve Fertility?
- Debate 45A Should Adjuvant Hysterectomy be Performed for Patients with Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy?
- Debate 45B Should Adjuvant Hysterectomy be Performed for Patients with Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy?
- Debate 46A What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?
- Debate 46B What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?
- Debate 47A Is there a Role for Immunotherapy in Treatment of Cervical Cancer?
- Debate 47B Is there a Role for Immunotherapy in Treatment of Cervical Cancer?
- Section VI Vaginal and Vulvar Cancer
- Index
- References
Debate 46B - What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?
Primary Chemoradiation
from Section V - Cervical Cancer
Published online by Cambridge University Press: 20 July 2023
Book contents
- 50 Big Debates in Gynecologic Oncology
- 50 Big Debates in Gynecologic Oncology
- Copyright page
- Contents
- Contributors
- Section I Perioperative Management
- Section II Screening, Prevention, and Early Diagnosis
- Section III Ovarian Cancer
- Section IV Endometrial Cancer
- Section V Cervical Cancer
- Debate 42A Is there a Role for Minimally Invasive Radical Hysterectomy for Management of Cervical Cancer?
- Debate 42B Is there a Role for Minimally Invasive Radical Hysterectomy for Management of Cervical Cancer?
- Debate 43A Is Radical Surgery or Parametrectomy Needed for Early-stage FIGO IA2 and Microscopic IB1 Cervical Cancer?
- Debate 43B Is Radical Surgery or Parametrectomy Needed for Early-stage FIGO IA2 and Microscopic IB1 Cervical Cancer?
- Debate 44A What is the Best Management Option for Young Women with Stage IB2 Cervical Cancer Who Wish to Preserve Fertility?
- Debate 44B What is the Best Management Option for Young Women with Stage IB2 Cervical Cancer Who Wish to Preserve Fertility?
- Debate 45A Should Adjuvant Hysterectomy be Performed for Patients with Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy?
- Debate 45B Should Adjuvant Hysterectomy be Performed for Patients with Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy?
- Debate 46A What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?
- Debate 46B What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?
- Debate 47A Is there a Role for Immunotherapy in Treatment of Cervical Cancer?
- Debate 47B Is there a Role for Immunotherapy in Treatment of Cervical Cancer?
- Section VI Vaginal and Vulvar Cancer
- Index
- References
Summary
The standard treatment in patients with stage IB3–IIB cervical cancer is concomitant chemoradiation (CTRT). Neoadjuvant chemotherapy followed by surgery (NACT-surgery), recently reported in comparison with CTRT in two phase III randomized trials, has been proposed as an alternative treatment in these patients. The two studies were similarly designed with a few differences. Their results, in aggregate, show that disease-free survival (DFS) is significantly superior with CTRT compared to NACT-surgery while overall survival (OS) is not significantly different with these two treatments. In the NACT-surgery arms of TMH and EORTC studies, 28% and 24% patients could not undergo surgery, respectively, and 44.6% and 27% patients received radiotherapy, respectively. Although the benefit of CTRT seemed to be concentrated in patients with stage IIB, there is no suggestion that NACT-surgery results in better outcome in any stage. Therefore, CTRT should be the standard of care in patients with locally advanced cervical cancer.
- Type
- Chapter
- Information
- 50 Big Debates in Gynecologic Oncology , pp. 280 - 284Publisher: Cambridge University PressPrint publication year: 2023
References
Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008;26:5802–5812.CrossRefGoogle Scholar
Koh, WJ, et al. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019;17(1):64–84.CrossRefGoogle ScholarPubMed
Gupta, S, et al. Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol 2018;36(16):1548–1555.CrossRefGoogle ScholarPubMed
Kenter, G, et al. Results from neoadjuvant chemotherapy followed by surgery compared to chemoradiation for stage Ib2–IIb cervical cancer, EORTC 55994. 2019 ASCO Annual Meeting; May 31 to June 4, 2019; Chicago, IL: American Society of Clinical Oncology. Abstract 5503.Google Scholar
Tan, LT, et al. Image-guided adaptive radiotherapy in cervical cancer. Semin Radiat Oncol 2019;29(3):284–298.Google Scholar