16 - Clinical trials in cervical cancer

Summary

Introduction

The introduction in 1987 of a national cervical screening programme in the UK led, in little more than a decade, to a halving in the incidence of cervical cancer from 16 per 100000 to 8 per 100 000 by the year 2000. Despite similar success in other developed countries, cervical cancer remains a major international problem. It is the second most common female cancer worldwide, with almost 500 000 new cases diagnosed annually and 250 000 deaths each year.

The standard ofcare for early-stage disease (International Federation of Gynecology and Obstetrics [FIGO] stage IA, IB1) remains surgery. For more advanced disease chemoradiotherapy is preferred. Despite recent improvements in survival, due in the main to the introduction of chemoradiotherapy, the overall pelvic relapse rate remains significant, with the disease recurring in the pelvis in over a quarter of women. This highlights the need for continued effort to improve outcome in this disease. Five year survival rates are around 90%, 75%, 50% and 20% for FIGO stages I, IB2/II, III and IV, respectively.

The challenges in treating cervical cancer are centred on improvements in survival and local control and minimising treatment-related morbidity. This chapter focuses on the evidence for current practice and highlights future research issues.

The role of surgery

Surgery remains the treatment ofchoice in early-stage disease. The most widely quoted data to support this come from an article published in 1997.