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Chemo Cuts Cervical Cancer Deaths
By DANIEL Q. HANEY
AP Medical
Editor
BOSTON (AP) — The government is urging doctors to immediately begin treating victims of spreading cervical cancer with a combination of chemotherapy and radiation, a change studies show can cut the death rate in half.
The National Cancer Institute issued its alert on Monday, sending letters to thousands of physicians about the first breakthrough in cervical cancer therapy since the introduction of radiation treatment in the 1950s.
``We think this will change the way we treat women with cervical cancer,'' said Dr. Edward Trimble, head of surgery in the institute's therapy evaluation program.
Surgery is the standard treatment for cervical cancer caught early, but doctors have long relied on radiation when it starts to spread within the pelvis.
Until now, there was no evidence that adding chemotherapy would improve the outcome, ``so you always go with the simpler approach,'' said Dr. Harrison G. Ball of the University of Massachusetts Medical School.
The change in thinking results from five still-unpublished studies sponsored by the cancer institute. All compared a combination of simultaneous chemotherapy and radiation against radiation alone.
The results were remarkably consistent: During follow ups from three to eight years, the combination resulted in a 30 percent to 50 percent lower death rate.
The research found that a common chemotherapy drug called cisplatin appears to be the most effective when combined with radiation.
Three of the studies will appear in the April 15 issue of the New England Journal of Medicine. One will be published in the spring in the Journal of Clinical Oncology, while the fifth will be presented March 22 in San Francisco at a meeting of the Society of Gynecologic Oncologists.
All of the studies involved several hundred women. Their cancer had begun to spread beyond the cervix but was still confined to the pelvis.
``While many have previously been cured by radiotherapy, we believe that the opportunity to substantially increase the cure rate for these women has really been demonstrated through this collection of studies,'' said Dr. Walter Curran Jr. of Thomas Jefferson University in Philadelphia, who did not take part in the research.
Why the combination works better than either radiation or chemotherapy alone is not clear. Researchers suspect the drugs may make cancer more sensitive to radiation and make it less able to repair radiation's damage.
Cervical cancer is expected to kill about 4,800 women in the United States this year. It usually affects women between 35 and 55.
The incidence of cervical cancer has dropped by half since the 1970s, largely because of widespread screening with the Pap test, which is 90 percent effective in detecting the disease, even before symptoms appear. About 40 percent of U.S. women are not tested regularly.
Dr. Henry M. Keys of Albany Medical College in Albany, N.Y., said researchers are testing similar combinations on cancer of the lungs, head and neck, but ``in none of those areas have we seen anything as dramatic as the impact in these studies.''
Side effects of the combination included nausea, vomiting and low blood counts. These were more common and severe than women experienced with radiation alone.
Dr. Carolyn Runowicz of Albert Einstein College of Medicine in New York City said doctors are still trying to learn the best chemotherapy regimen.
``It's an evolving field, and this by no means settles it,'' she said. ``But it has improved treatment for many women.''
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