医学交流课件：Professor Sharma-final cancer cervix IA chemotherapy.ppt

Current Status of Bland & Chemo-embolization in advanced Cancer of Cervix- Impact on Clinical Outcomes & Survival Rates
Carcinoma of Cervix
Cervical cancer remains a major threat to women’s health, accounts for >1,50,000 deaths annually worldwide 
2nd most common cancer among women, most common female genital cancer in developing countries 
75% of deaths from cervical cancer are from developing countries, also occurs at a younger age in this region 
Bleeding is a common symptom & major cause of morbidity & mortality, its management represents a challenge
Whereas treatment strategies for Stage 1 & 2 are effective with reasonable cure rates, outcomes in stage 3 & 4 are not so good and less well defined
There is a need to think beyond the current treatment
Treatment of locally advanced Cancer Cervix
For nearly 80 years exclusive radiation was considered the standard of care
5-year survival for stages IB2, IIB, IIIB, and IVA are , , , and %, respectively
5 randomized studies including nearly 2,000 patients demonstrated that survival rate with concomitant chemotherapy (RT/CT) based on Cisplatin was superior to that obtained with radiation alone
New Engl J Med 1999 Aug 26;341(9):708
Annual Report on the results of treatment in Gynaecological Cancer. J Epidemiol statist 1998, 3:5-34
Principles of chemo-radiation
Three clinical rationales support use of chemotherapy delivered concurrently with radiation 
Concomitant chemo-radiotherapy can be used with organ-preserving intent, resulting in improved cosmetic & function compared with surgical resection with or without adjuvant treatment.
Chemotherapy can act as a radio-sensitizer, improving probability of local control &, in some cases, survival, by aiding destruction of radio-resistant clones ( SYNERGESTIC EFFECT)
Chemotherapy given as part of concurrent chemo-radiation may act systemically & potentially eradicate distant micro metastases (SPATIAL ADDIVITIVY)
Nat Clin Pract Oncol 2