Primary chemotherapy for high-risk recurrence cervix cancer

As has been discussed in previous chapters patients with lymph node positive, stages I and II and advanced stages III and IV cervix cancer have poor prognoses, regardless of local treatment type (Tables 1 and 2, respectively). For example, the 5-year survival rate has been reported to be as low as 54% in patients with lymph node positive, stage IB disease [1] and 30–40% in patients with bulky, stage III disease [2]. Recurrences in these high-risk groups occur both locally and distally in similar frequencies. The utilization of more aggressive regional therapy techniques in advanced disease as described by Aristizabal et al. in an earlier chapter has been associated with significantly higher control rates of local disease, but patients continue to die from systemic metastases. Clearly, new multimodality treatment programs must be directed toward the sterilization of both bulky, localized disease and distant, microscopic metastases.