Cervical cancer medical therapy: Difference between revisions
Jump to navigation
Jump to search
Nima Nasiri (talk | contribs) |
Nima Nasiri (talk | contribs) |
||
| Line 51: | Line 51: | ||
===In Situ Cervical Cancer<ref>http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_93</ref>=== | ===In Situ Cervical Cancer<ref>http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_93</ref>=== | ||
* Internal radiation therapy for medically inoperable patients | * Internal radiation therapy for medically inoperable patients | ||
:: For medically inoperable patients, a single intracavitary insertion with tandem and ovoids for 5,000 mg hours (80 Gy vaginal surface dose) may be used. | ::* For medically inoperable patients, a single intracavitary insertion with tandem and ovoids for 5,000 mg hours (80 Gy vaginal surface dose) may be used. | ||
===Stage IA Cervical Cancer=== | ===Stage IA Cervical Cancer=== | ||
* Intracavitary radiation therapy | * Intracavitary radiation therapy | ||
:: Intracavitary [[radiation therapy]] is a treatment option when [[palliative]] treatment is appropriate because of other medical conditions and for women who are not surgical candidates.If the depth of invasion is less than 3 mm and no capillary [[lymphatic]] space invasion is noted, and the frequency of lymph-node involvement is sufficiently low, external-beam radiation therapy is not required. One or two insertions with tandem and ovoids for 6,500 mg to 8,000 mg hours (100–125 Gy vaginal surface dose) are recommended. | ::* Intracavitary [[radiation therapy]] is a treatment option when [[palliative]] treatment is appropriate because of other medical conditions and for women who are not surgical candidates.If the depth of invasion is less than 3 mm and no capillary [[lymphatic]] space invasion is noted, and the frequency of lymph-node involvement is sufficiently low, external-beam radiation therapy is not required. One or two insertions with tandem and ovoids for 6,500 mg to 8,000 mg hours (100–125 Gy vaginal surface dose) are recommended. | ||
===Stages IB and IIA Cervical Cancer=== | ===Stages IB and IIA Cervical Cancer=== | ||
| Line 67: | Line 67: | ||
::** Improved outpatient management. | ::** Improved outpatient management. | ||
* Radical hysterectomy and bilateral pelvic lymphadenectomy with or without total pelvic radiation therapy plus chemotherapy | * Radical hysterectomy and bilateral pelvic lymphadenectomy with or without total pelvic radiation therapy plus chemotherapy | ||
:: The radiation therapy included EBRT and one Cs-137 LDR insertion, with a total dose to point A from 70 to 90 Gy (median 76 Gy) | ::* The radiation therapy included EBRT and one Cs-137 LDR insertion, with a total dose to point A from 70 to 90 Gy (median 76 Gy) | ||
* Other Treatment Options | * Other Treatment Options | ||
:* Adjuvant radiation therapy post surgery | :* Adjuvant radiation therapy post surgery | ||
::* Radiation therapy alone | ::* Radiation therapy alone | ||
:::: External-beam pelvic [[radiation therapy]] combined with two or more intracavitary [[brachytherapy]] applications is appropriate therapy for patients with stage IA2 and IB1 lesions. For patients with stage IB2 and larger lesions, radiosensitizing[[chemotherapy]] is indicated. The role of radiosensitizing [[chemotherapy]] in patients with stage IA2 and IB1 lesions is untested. However, it may prove beneficial in certain cases. | ::::* External-beam pelvic [[radiation therapy]] combined with two or more intracavitary [[brachytherapy]] applications is appropriate therapy for patients with stage IA2 and IB1 lesions. For patients with stage IB2 and larger lesions, radiosensitizing[[chemotherapy]] is indicated. The role of radiosensitizing [[chemotherapy]] in patients with stage IA2 and IB1 lesions is untested. However, it may prove beneficial in certain cases. | ||
::* Intensity-modulated radiation therapy (IMRT) | ::* Intensity-modulated radiation therapy (IMRT) | ||
::::* IMRT is 3D conformal radiotherapy, a technique that allows for focusing radiation beams on targeted cancer tissue precisely, while sparing adjacent organs. It is shown in studies that it decreases radiation therapy toxicity but it may decrease its efficacy. <ref name="LinChen2018">{{cite journal|last1=Lin|first1=Yanzhu|last2=Chen|first2=Kai|last3=Lu|first3=Zhiyuan|last4=Zhao|first4=Lei|last5=Tao|first5=Yalan|last6=Ouyang|first6=Yi|last7=Cao|first7=Xinping|title=Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis|journal=Radiation Oncology|volume=13|issue=1|year=2018|issn=1748-717X|doi=10.1186/s13014-018-1126-7}}</ref> | ::::* IMRT is 3D conformal radiotherapy, a technique that allows for focusing radiation beams on targeted cancer tissue precisely, while sparing adjacent organs. It is shown in studies that it decreases radiation therapy toxicity but it may decrease its efficacy. <ref name="LinChen2018">{{cite journal|last1=Lin|first1=Yanzhu|last2=Chen|first2=Kai|last3=Lu|first3=Zhiyuan|last4=Zhao|first4=Lei|last5=Tao|first5=Yalan|last6=Ouyang|first6=Yi|last7=Cao|first7=Xinping|title=Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis|journal=Radiation Oncology|volume=13|issue=1|year=2018|issn=1748-717X|doi=10.1186/s13014-018-1126-7}}</ref> | ||
| Line 77: | Line 77: | ||
===Stages IIB, III, and IVA Cervical Cancer=== | ===Stages IIB, III, and IVA Cervical Cancer=== | ||
* Radiation therapy with concomitant chemotherapy | * Radiation therapy with concomitant chemotherapy | ||
:: Strong consideration should be given to the use of intracavitary [[radiation therapy]] and external-beam [[radiation therapy]] (EBRT) to the pelvis combined with [[Cisplatin]] or [[Cisplatin]]/[[Fluorouracil]] (5FU). | ::* Strong consideration should be given to the use of intracavitary [[radiation therapy]] and external-beam [[radiation therapy]] (EBRT) to the pelvis combined with [[Cisplatin]] or [[Cisplatin]]/[[Fluorouracil]] (5FU). | ||
*Interstitial brachytherapy | *Interstitial brachytherapy | ||
:* For patients who complete EBRT and have bulky cervical disease such that standard [[brachytherapy]] cannot be placed anatomically, interstitial [[brachytherapy]] has been used to deliver adequate tumoricidal doses with an acceptable toxicity profile. | :* For patients who complete EBRT and have bulky cervical disease such that standard [[brachytherapy]] cannot be placed anatomically, interstitial [[brachytherapy]] has been used to deliver adequate tumoricidal doses with an acceptable toxicity profile. | ||
| Line 83: | Line 83: | ||
===Stage IVB Cervical Cancer=== | ===Stage IVB Cervical Cancer=== | ||
* Palliative radiation therapy | * Palliative radiation therapy | ||
:: Radiation therapy may be used to palliate central disease or distant metastases | ::* Radiation therapy may be used to palliate central disease or distant metastases | ||
===Recurrent Cervical Cancer=== | ===Recurrent Cervical Cancer=== | ||
*Radiation therapy and [[chemotherapy]] | *Radiation therapy and [[chemotherapy]] | ||
:: For recurrence in the pelvis after initial radical surgery, radiation therapy and [[chemotherapy]] ([[fluorouracil]] with or without [[mitomycin]]) may cure 40% to 50% of patients. | ::* For recurrence in the pelvis after initial radical surgery, radiation therapy and [[chemotherapy]] ([[fluorouracil]] with or without [[mitomycin]]) may cure 40% to 50% of patients. | ||
==Chemotherapy== | ==Chemotherapy== | ||
Revision as of 15:22, 19 February 2019
|
Cervical cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Cervical cancer medical therapy On the Web |
|
American Roentgen Ray Society Images of Cervical cancer medical therapy |
|
Risk calculators and risk factors for Cervical cancer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
The optimal therapy for cervical cancer depends on the stage at diagnosis, treatment of cervical neoplasia is mainly combination of radiation therapy and use of chemotherapeutic agents.
Medical Therapy
Patterns-of-care studies clearly demonstrate the negative prognostic effect of increasing tumor volume and spread pattern. Treatment, therefore, may vary within each stage as the individual stages are currently defined by International federation of gynaecology and obstetrics(FIGO).[1][2]
In situ carcinoma of the cervix:
Treatment options for squamous cell carcinoma in situ include:
- Cryosurgery
- Laser surgery
- Loop electrosurgical excision procedure (LEEP)
- Cold knife conization
- Simple hysterectomy
Treatment options for adenocarcinoma in situ include:
- Conization
- Hysterectomy for postreproductive patients
Stage IA cervical cancer
- Conization
- Total hysterectomy
- Modified radical hysterectomy with lymphadenectomy
- Radical trachelectomy
- Intracavitary radiation therapy
- Radiation therapy with concomitant chemotherapy
Stages IB, IIA cervical cancer
- Radiation therapy with concomitant chemotherapy
- Radical hysterectomy and bilateral pelvic lymphadenectomy with or without total pelvic radiation therapy plus chemotherapy
- Radical trachelectomy
- Neoadjuvant chemotherapy
- Radiation therapy alone
- Intensity Modulated Radiation Therapy (IMRT)
Stages IIB, III, and IVA cervical cancer
- Radiation therapy with concomitant chemotherapy
- Neoadjuvant chemotherapy
- Interstitial brachytherapy
Stage IVB cervical cancer
- Palliative radiation therapy
- Palliative chemotherapy
Recurrent cervical cancer
- Radiation therapy and chemotherapy
- Palliative chemotherapy
- Pelvic exenteration
Radiation therapy
In Situ Cervical Cancer[3]
- Internal radiation therapy for medically inoperable patients
- For medically inoperable patients, a single intracavitary insertion with tandem and ovoids for 5,000 mg hours (80 Gy vaginal surface dose) may be used.
Stage IA Cervical Cancer
- Intracavitary radiation therapy
- Intracavitary radiation therapy is a treatment option when palliative treatment is appropriate because of other medical conditions and for women who are not surgical candidates.If the depth of invasion is less than 3 mm and no capillary lymphatic space invasion is noted, and the frequency of lymph-node involvement is sufficiently low, external-beam radiation therapy is not required. One or two insertions with tandem and ovoids for 6,500 mg to 8,000 mg hours (100–125 Gy vaginal surface dose) are recommended.
Stages IB and IIA Cervical Cancer
- cisplatin-based chemotherapy with radiation therapy is the standard of care for women who require radiation therapy. Radiation therapy protocols for patients with cervical cancer have historically used dosing at two anatomical points, termed point A and point B, to standardize the doses received. Point A is defined as 2 cm from the external os, and 2 cm lateral, relative to the endocervical canal. Point B is also 2 cm from the external os, and 5 cm lateral from the patient midline, relative to the bony pelvis. In general, for smaller tumors, the curative-intent dose for point A is around 70 Gy, whereas for larger tumors, the point A dose may approach 90 Gy.
- Brachytherapy
- brachytherapy after external-beam radiation therapy (EBRT) is the standard of care for women with cervical cancer. The use of high-dose rate (HDR) brachytherapy provides the advantage of the following:
- Eliminating radiation exposure to medical personnel
- Shorter treatment time
- Patient convenience
- Improved outpatient management.
- brachytherapy after external-beam radiation therapy (EBRT) is the standard of care for women with cervical cancer. The use of high-dose rate (HDR) brachytherapy provides the advantage of the following:
- Radical hysterectomy and bilateral pelvic lymphadenectomy with or without total pelvic radiation therapy plus chemotherapy
- The radiation therapy included EBRT and one Cs-137 LDR insertion, with a total dose to point A from 70 to 90 Gy (median 76 Gy)
- Other Treatment Options
- Adjuvant radiation therapy post surgery
- Radiation therapy alone
- External-beam pelvic radiation therapy combined with two or more intracavitary brachytherapy applications is appropriate therapy for patients with stage IA2 and IB1 lesions. For patients with stage IB2 and larger lesions, radiosensitizingchemotherapy is indicated. The role of radiosensitizing chemotherapy in patients with stage IA2 and IB1 lesions is untested. However, it may prove beneficial in certain cases.
- Intensity-modulated radiation therapy (IMRT)
- IMRT is 3D conformal radiotherapy, a technique that allows for focusing radiation beams on targeted cancer tissue precisely, while sparing adjacent organs. It is shown in studies that it decreases radiation therapy toxicity but it may decrease its efficacy. [7]
Stages IIB, III, and IVA Cervical Cancer
- Radiation therapy with concomitant chemotherapy
- Strong consideration should be given to the use of intracavitary radiation therapy and external-beam radiation therapy (EBRT) to the pelvis combined with Cisplatin or Cisplatin/Fluorouracil (5FU).
- Interstitial brachytherapy
- For patients who complete EBRT and have bulky cervical disease such that standard brachytherapy cannot be placed anatomically, interstitial brachytherapy has been used to deliver adequate tumoricidal doses with an acceptable toxicity profile.
Stage IVB Cervical Cancer
- Palliative radiation therapy
- Radiation therapy may be used to palliate central disease or distant metastases
Recurrent Cervical Cancer
- Radiation therapy and chemotherapy
- For recurrence in the pelvis after initial radical surgery, radiation therapy and chemotherapy (fluorouracil with or without mitomycin) may cure 40% to 50% of patients.
Chemotherapy
Stages IB and IIA Cervical Cancer[8]
- Radiation therapy with concomitant chemotherapy
- Concurrent, cisplatin-based chemotherapy with radiation therapy is the standard of care for women who require radiation therapy for treatment of cervical cancer
- Neoadjuvant chemotherapy
Stages IIB, III, and IVA Cervical Cancer
- Radiation therapy with concomitant chemotherapy
- Strong consideration should be given to the use of intracavitary radiation therapy and external-beam radiation therapy (EBRT) to the pelvis combined with cisplatin or cisplatin/fluorouracil (5FU)
Stage IVB Cervical Cancer[9]
- Palliative chemotherapy
Drugs used in stage IVB cervical cancer treatment are shown in table below[10]
| Drug Name | Response Rate |
| Cisplatin | 15%–25% |
| Ifosfamide | 31% |
| Paclitaxel | 17% |
| Ifosfamide/cisplatin | 31% |
| Irinotecan | 21% in patients previously treated with chemotherapy |
| Paclitaxel/cisplatin | 46% |
| Cisplatin/gemcitabine | 41% |
| Cisplatin/topotecan | 27% |
Recurrent Cervical Cancer[11]
- Palliative chemotherapy
Drugs used in Recurrent Cervical Cancer treatment are shown in table below[12]
| Drug Name | Response Rate |
| Cisplatin | 15%–25% |
| Ifosfamide | 31% |
| Paclitaxel | 17% |
| Ifosfamide/cisplatin | 31% |
| Irinotecan | 21% in patients previously treated with chemotherapy |
| Paclitaxel/cisplatin | 46% |
| Cisplatin/gemcitabine | 41% |
| Cisplatin/topotecan | 27% |
| Cisplatin/vinorelbine | 30% |
| Bevacizumab | 11%; 24% survived progression free for at least 6 months, as seen in GOG-0227C(NCT00025233) |
References
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq/#section/_85
- ↑ Hazell, Sarah Z.; Stone, Rebecca L.; Lin, Jeffrey Y.; Viswanathan, Akila N. (2018). "Adjuvant therapy after radical trachelectomy for stage I cervical cancer". Gynecologic Oncology Reports. 25: 15–18. doi:10.1016/j.gore.2018.05.001. ISSN 2352-5789.
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_93
- ↑ Eifel, Patricia J (2006). "Concurrent chemotherapy and radiation therapy as the standard of care for cervical cancer". Nature Clinical Practice Oncology. 3 (5): 248–255. doi:10.1038/ncponc0486. ISSN 1743-4254.
- ↑ Kamrava, Mitchell; Banerjee, Robyn (2014). "Brachytherapy in the treatment of cervical cancer: a review". International Journal of Women's Health: 555. doi:10.2147/IJWH.S46247. ISSN 1179-1411.
- ↑ Kamrava, Mitchell; Banerjee, Robyn (2014). "Brachytherapy in the treatment of cervical cancer: a review". International Journal of Women's Health: 555. doi:10.2147/IJWH.S46247. ISSN 1179-1411.
- ↑ Lin, Yanzhu; Chen, Kai; Lu, Zhiyuan; Zhao, Lei; Tao, Yalan; Ouyang, Yi; Cao, Xinping (2018). "Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis". Radiation Oncology. 13 (1). doi:10.1186/s13014-018-1126-7. ISSN 1748-717X.
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_110
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_141
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_141
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_147
- ↑ http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_147