Work by a faculty member at Case Western Reserve University has contributed to the National Cancer Institute announcing that, for the first time in 20 years of ongoing research, investigators have found a weapon that actually improves the survival rate of cervical cancer patients.
Upon reviewing the impressive results of five nationwide clinical trials involving more than 1,700 women from 1992-97, NCI is urging the medical community to improve the treatment of cervical cancer by combining radiation and chemotherapy. Until now, the standard treatment has been surgery or radiation for early stages of invasive cervical cancer and radiation alone for advanced stages of the disease.
Peter G. Rose, chief of gynecologic oncology at University Hospitals of Cleveland and associate professor of reproductive biology at CWRU's School of Medicine, led the largest of the five studies, involving more than 50 institutions nationwide.
NCI has designated the Ireland Cancer Center at University Hospitals of Cleveland and CWRU as a Comprehensive Cancer Center.
Rose said that this new combination therapy -- called chemoradiation -- will have a sweeping impact on women's health, and has the real potential to cut the number of cervical cancer deaths in half.
By combining radiation with chemotherapy agents, Rose said, "Collectively, you are killing more cancer cells together than if you use those treatments by themselves." In these trials, the simultaneous use of platinum-based chemotherapy and radiation increased survival rates by 50 percent.
Rose also noted that side effects from the treatments were acceptable, and that hair loss did not occur as a result of the chemotherapy drugs.
NCI felt so strongly about the findings that the agency mailed an alert
to thousands of physicians who treat cancer. This clinical announcement appears
on NCI's Web site at
http://cancertrials.nci.nih.gov/NCI_CANCER_TRIALS/zones/TrialInfo/News/cervcan/index.html
The page also offers descriptions of the five studies' findings,
along with other information related to cervical cancer.
The New England Journal of Medicine published three of the studies -- including the one conducted at CWRU and UHC -- in its April 15 issue. Full-text versions of these studies are available on the journal's Web site at www.nejm.org/content/1999/0340/0015/TOC.aspThe other two studies will appear in the other journal issues this year.
Each year in the United States, almost 15,000 women are diagnosed with cervical cancer, and 5,000 women die of the disease, according to NCI.
"This is a disease that affects young women," Rose said. "When a woman dies at the age of 30, the impact is devastating to her family and society in general.
In three of the studies, women were randomly divided into groups that received either radiation alone or radiation plus chemotherapy at the same time. The chemotherapy agents were a platinum-based combination of cisplatin and 5-fluorouracil, which were used together in two studies.
In the two other trials, all patients received both radiation and chemotherapy, but the chemotherapy drugs differed between the two studies. The trials involved the use of cisplatin, 5- fluorouracil, or hydroxyurea. Cisplatin-containing therapy was more effective than hydroxyurea.
The exact cause of cervical cancer is unknown, but the incidence of the disease has decreased in the United States by 75 percent since the development of the Pap smear 45 years ago. Cervical cancer remains the second most common cancer for women in the world, and the top cancer-killer of women in Asia, Africa, and South America.
There are believed to be multiple causes. Chief among the risk factors are the Human Papilloma (or wart) virus, sexual activity during adolescence, and cigarette smoking. However, many women without these risk factors develop cervical cancer, and most women who carry Human Papilloma never develop cervical cancer.
The other four studies were coordinated by researchers at Christiana Hospital in Newark, Delaware; the University of Texas M.D. Anderson Cancer Center in Houston; the University of Washington in Seattle; and the Albany Medical College in Albany, New York.
Journal
New England Journal of Medicine