Does the evidence support the use of concurrent chemoradiotherapy as a standard in the management of locally advanced cancer of the cervix, especially in developing countries?

Locally advanced cancer of the cervix (FIGO stages III and IVA) is one of the most common malignancies in developing countries. Conventional treatment has been a judicious combination of external radiotherapy and intracavitary brachytherapy. However, prompted by the results of five randomised-controlled trials (RCTs) published in close succession, The National Cancer Institute (NCI) alert in 1999, and two meta-analyses, the management of cancer of the cervix has gradually changed. Concurrent chemoradiotherapy with cisplatin alone, or in combination, is gradually being favoured for the treatment of cancer of the cervix. This overview examines whether the published evidence is sufficiently adequate to justify the use of chemoradiotherapy using cisplatin as standard care in the management of cancer of the cervix, especially in developing countries, where most women present with locally advanced cancer of the cervix. A critical review of the various phase III randomised trials and meta-analyses indicates that, although chemoradiotherapy could be a standard form of treatment for early cancer of the cervix, its role in advanced stages needs further exploration before this could be incorporated into routine clinical care.