Radiation was until recently the key and only modality for the routine treatment of locally advanced cervical carcinoma. However after years of studying multi-modality treatments as an alternative to radiation alone in randomized phase III trials, the standard treatment has changed to chemo-radiation based on cisplatin. Three recent meta-analyses have confirmed that cisplatin-based chemo-radiation adds an absolute 12% benefit in five-year survival over radiation therapy alone. Neoadjuvant chemotherapy followed by radiation has not been of proven benefit, but when neoadjuvant chemotherapy is followed by surgery, an absolute increase of 15% in five-year survival over radiation alone is seen. This benefit in survival is comparable to that obtained with the current chemo-radiation schedules based on cisplatin. Despite these encouraging results there remains room for improvement as the five-year survival of patients treated with chemo-radiation ranges from nearly 80% in bulky IB tumours to only 25% in stage IVA disease. Other therapeutic approaches need to be fully evaluated including the use of chemo-radiation after neoadjuvant chemotherapy; the use of new drug combinations and the multi-modality combination of neoadjuvant chemotherapy followed by radical surgery plus adjuvant chemo-radiation. Likewise, the addition of radiosensitizers to cisplatin, preoperative chemo-radiation and/or adjuvant chemotherapy may eventually improve the currents results of cisplatin-based chemo-radiation. Nevertheless, it is hard to foresee a dramatic increase in cure rate, even with the most optimal combination of cytotoxic drugs, surgery and radiation, and thus the testing of molecular targeted therapies against cervical cancer is a logical step to follow.

中文翻译：

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局部晚期宫颈癌的现代管理。

直到最近，放射线治疗还是局部晚期宫颈癌常规治疗的关键和唯一方式。但是，在多年的随机III期研究中，对多模式疗法作为单独辐射的替代品进行研究之后，标准疗法已改为基于顺铂的化学辐射。最近的三项荟萃分析已证实，基于顺铂的化学放射治疗比单纯放射治疗的五年生存率绝对增加了12％。尚未证明新辅助化疗后放疗有益处，但是当新辅助化疗后进行手术时，五年生存率比单纯放疗绝对增加了15％。这种生存优势可与当前基于顺铂的化学放疗方案所获得的益处相媲美。尽管取得了这些令人鼓舞的结果，但由于接受化学放射治疗的患者的五年生存率从大块的IB肿瘤的近80％到IVA疾病的25％，仍存在改善的空间。其他治疗方法需要充分评估，包括在新辅助化疗后使用化学放疗；新药组合的使用和新辅助化疗的多模式组合，然后进行根治性手术加辅助化学放疗。同样，在顺铂中添加放射增敏剂，术前化学放疗和/或辅助化疗可能最终会改善当前基于顺铂的化学放疗的结果。不过，即使采用细胞毒药物，手术和放疗的最佳组合，也很难预见治愈率会急剧提高，