TRATAMIENTO ADYUVANTE DEL CÁNCER CÉRVICO UTERINO: FACTORES DE RIESGO, INDICACIONES Y TRATAMIENTO

Abstract

SUMMARY The identification of various pathologic risk factors and a better stratification of patients into risk groups, after primary surgical management of early stage cervical cancer, helps to define the best adjuvant treatment and improve outcomes. Two randomized clinical trials have greatly advanced our understanding of the role of adjuvant treatment in cervix cancer. In patients with clinical stage IA2, IB and IIA carcinoma of the cervix initially treated with radical hysterectomy and pelvic lymphadenectomy and who have positive pelvic lymph nodes, and/or positive surgical margins, and/or microscopic involvement of the parametrium the use of combined adjuvant radiation and chemotherapy significantly improves overall survival and progession-free survival compared with pelvic radiation therapy alone. For women with stage IB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy, with node-negative and at least two of the following risk factors: >1/3 stromal invasion, capillary lymphatic space involvement and large clinical tumor diameter adjuvant pelvic radiation therapy significantly improves relapse-free survival compared with no further therapy. Further improvement in outcomes for high risk, early stage cervical cancer patients will come from enhanced definition of prognostic factors and risk groups, better patient selection for primary treatment and better local and systemic therapies.