Functional imaging in treatment planning in radiation therapy: a review

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Modification of the Radiation Response of Patients With Carcinoma of the Uterine Cervix.

BACKGROUND: The purpose of this review is to summarize clinical trials for patients with cervical cancer treated with irradiation and modifiers of the irradiation response. METHODS: The MEDLINE database was used to identify clinical studies that evaluated modifiers of the irradiation response for patients with carcinoma of the uterine cervix from 1970 through 1998. The studies included were prospective, randomized phase III clinical trials comparing irradiation alone to irradiation plus a chemical modifier for carcinoma of the uterine cervix. RESULTS: Various chemical agents have been combined with irradiation in the treatment of patients with carcinoma of the uterine cervix. These agents include hyperbaric oxygen, hydroxyurea, nitroimidazoles, neoadjuvant chemotherapy, and concurrent chemotherapy. CONCLUSIONS: Many prospective, randomized studies evaluating the use of chemical agents to modify the irradiation response in patients with carcinoma of the uterine cervix indicate no improvement over radiation therapy alone. However, the February 1999 NCI clinical announcement describes a survival advantage for cisplatin-based therapy and concurrent irradiation.

Lack of Proven Efficacy of Chemotherapy for Patients With Carcinoma of the Uterine Cervix.

This article reviews prospective randomized phase III studies that use chemotherapy and irradiation for the treatment of patients with carcinoma of the uterine cervix. Neoadjuvant chemotherapy has been administered in four separate trials. None of these has shown a benefit to neoadjuvant therapy compared with irradiation alone. One study has been performed in which postoperative pelvic irradiation was adminsitered to all patients with positive pelvic nodes following radical hysterectomy. Those randomized to also receive chemotherapy failed to show an improvement in survival. Radiosensitization with hydroxyurea or misonidazole has shown little, if any, benefit. Only one concurrent chemotherapy and irradiation trial has been published and showed no benefit in the chemotherapy arm. Data are maturing or accruing in the Gynecological Oncology Group and the Radiation Therapy Oncology Group for concurrent chemotherapy studies. In conclusion, no prospective phase III studies have shown a survival advantage for the use of chemotherapy for patients with carcinoma of the uterine cervix.