Cervical cancer treatment

Treating nicotine and tobacco dependence can prevent a variety of costly chronic diseases, including heart disease, cancer, and chronic lung disease. It is estimated that smoking cessation efforts are more cost effective than other commonly provided preventive services such as screening for breast, colon, and cervical cancer, treatment of mildly elevated blood pressure, and treatment of high cholesterol. 

Bruzzone M, Franzone P, Ghione G, et al. Combined Treatment with Paclitaxel (P) and Radiotherapy (RT) in Patients (Pts) with Advanced Cervical Cancer (ACC) (abstract 1592). Pro Am Soc Clin Oncol 2000 19. 

This chapter will review trials of chemoradiation in cervical cancer, including the recent trials that established the value of this approach, and will discuss several questions that remain to be resolved regarding this treatment, including the ideal dose and schedule, and the effect of chemoradiation on compliance and complications. The last section of this chapter will briefly discuss the use of chemoradiation in the treatment of other gynecologic malignancies. 

Citing the success of mitomycin-C in the treatment of anal cancer, a number of investigators have explored the use of this drug, usually in combination with fluorouracil, in patients treated with radiation for cervical and vulvar carcinomas (23-27). Roberts et al. (27) recently reported results of an interim analysis of a randomized trial, conducted in Venezuela, in which women with locally advanced cervical cancer were treated with radiation therapy with or without mitomycin. At the time of this interim analysis (published while the authors were continuing to accrue patients to the study), the authors noted a significant improvement in disease-free survival (p - 0.01) with chemotherapy but no significant difference in overall survival (p = 0.1). 

Vaginal cancers are so similar to cervical cancers with respect to epidemiology, behavior, and treatment response that many clinicians have chosen to treat vaginal cancers of stage II or greater with chemoradiation on the basis of results from cervical cancer trials. Unfortunately, only scattered published reports of chemoradiation are available for this rare tumor. 

Boice, J.D., Jr., Day, N.E., Andersen, A., Brinton, L.A., Brown, R, Choi, N.W., Clarke, E.A., Coleman, M.R, Curtis, R.E., and Flannery, J.T. (1985b). Second cancers following radiation treatment for cervical cancer. An international collaboration among cancer registries, J. NatL Cancer Inst. 74,955. 

Another important anticancer natural product is camptothecin, an alkaloid derived from the Chinese tree Camptotheca acuminata Descne. A semisynthetic water-soluble derivative of camptothecin known as ironotecan (Topotecin , Campto ) was introduced in Japan in 1994 for the treatment of lung, ovarian, and cervical cancers. Unlike Taxol, camptothecin acts by inhibition of the enzyme topoisomerase I. 

Motexafin lutetium is also in clinical trials, having completed several Phase I and II studies. The completed trials are for the photodynamic treatment of recurrent breast cancer [41,42], light-based treatment of choroidal neovascularization, [43] and the photoangioplastic reduction of atherosclerotic plaque in peripheral [19,44] and coronary arterial disease [20,45], On the basis of these studies, MLu (Antrin Phototherapy) is currently being developed for the treatment of atherosclerotic plaque. Additionally, the National Cancer Institute is testing MLu for the PDT based treatment of prostate [46,47] and cervical cancers. 

Cervical and Endometrial Cancer. Cisplatin is one of the most active agents available for the treatment of squamous-cell cancers of the cervix. Single-agent trials have indicated response rates of up to 31% in patients with advanced disease, with nearly one-third being complete responses [186], The GOG reported the results of a large (394 patients) randomized trial in 1989 comparing carboplatin and iproplatin monotherapy and noted a 15% response rate with carboplatin, suggesting that its activity may not be comparable to cisplatin in cervical cancer [187]. 

Lee KH, Yim EK, Kim CJ, Namkoong SE, Um SJ, Park JS. Proteomic analysis of anticancer effects by paclitaxel treatment in cervical cancer cells. Gynecol Oncol 2005 98(1) 45-53. 

Phenoxodiol 64 (Marshall Edwards) is being evaluated in a Phase III trial for the treatment of ovarian cancer in combination with carboplatin, as well as in earlier stage trials as a monotherapy and in combination with docetaxel for the treatment of prostate and cervical cancer.145 Phenoxodiol 64146 149 is a synthetic analogue of genistein 65,150 an isoflavone present in many plants... 

Californium-252 is also used in medicine. When injected into the body, it tends to be deposited in bones. The radiation it gives off can be used to determine the health of the bone. Californium-252 is also used to treat ovarian and cervical cancer. Some experts see a number of important medical uses for californium-252 in the future, especially in radiotherapy (medical treatment using radiation). 

Paclitaxel (Taxol ) and its semisynthetic analogue docetaxel (see Figure 5.1) are two of the most important chemotherapeutic drugs, currently used for the treatment of advanced ovarian cancer, metastatic breast cancer, melanoma, non-small-cell lung cancer, and Kar-posi s sarcoma [8,9], More recently, these drugs have been used for the treatment of neck, prostate, and cervical cancers [8, 9],... 

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