The document discusses the treatment of cervical cancer. It recommends that concurrent chemoradiation with cisplatin is the standard treatment for locally advanced cervical cancer based on evidence from randomized trials showing improved survival. Neoadjuvant chemotherapy followed by surgery may be an alternative approach currently being tested in clinical trials. Bevacizumab is being studied as a potential targeted therapy in advanced or recurrent cervical cancer.

1. Clinical session Gynecological cancers Cervical and endometrial cancers Prof. C. Sessa IOSI - Bellinzona 10° ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY Ermatingen, 4.4.2011

4. Cervical Cancer The FIGO staging Difficulties in clinical/radiological evaluation local extension (corpus, parametrium, pelvic wall) nodal involvement

5. Survival by FIGO stage Cervical Cancer

6. Survival by nodal status Cervical Cancer

8. NIH Consensus Statement on Cervical Cancer Bethesda 1996 “ patients with stage IB and IIA cervical cancer are appropriately treated with either radical hysterectomy with pelvic lymphadenectomy or radiation therapy with equivalent result. To minimize morbidity, primary therapy should avoid the routine use of both radical surgery and radiation therapy.The combined use of radical surgery and radical radiation therapy results in high morbidity and cost.” Cervical Cancer

14. CONCLUSIONS CT/RT is considered the world standard treatment for LACC Neoadjuvant CT followed by surgery may represent an alternative: in two randomized trials TIP demonstrated a superior activity compared to IP and TP but was associated with significantly higher toxicity The cost-effectiveness of neoadjuvant CT followed by surgery will be tested in a randomized trial against CT/RT (EORTC 55994) .

15. 55994 EORTC Treatment scheme