Cervical Cancer Treatment Protocols 

Updated: Aug 18, 2014
  • Author: Cecelia H Boardman, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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Treatment Protocols

Treatment protocols for cervical cancer are provided below, including treatment by stage, chemoradiation therapy, and chemotherapy.

Treatment recommendations for early stage disease

Stage IA1 disease:

  • Primary treatment of early stage cervical cancer is surgery or radiation therapy [1, 2, 3, 4, 5, 6, 7, 8]
  • Treatment recommendations include extrafascial hysterectomy, modified radical trachelectomy, or hysterectomy with pelvic node dissection [9]

Treatment recommendations for stage IA2

Stage IA2 disease:

  • Patients with stage IA2 tumors are treated with radical hysterectomy or radical trachelectomy with pelvic lymph node dissection
  • Alternative options include brachytherapy with or without pelvic radiation therapy (total point A dose: 75-80 Gy) [10]

Treatment recommendations for stage IB and IIA

Stage IB and IIA:

  • Patients with stage IB or IIA disease can be treated with surgery (radical trachelectomy, pelvic lymphadenectomy, radical hysterectomy plus bilateral pelvic lymph nodes dissection), pelvic radiotherapy or chemoradiation [11, 12, 13, 14, 15, 16, 17, 18, 19, 20]
  • If lymph nodes are positive, then a hysterectomy is not recommended; instead patient should receive chemoradiation
  • Patients with stage IB or IIA may also be given pelvic radiotherapy and brachytherapy with or without concurrent cisplatin-based chemotherapy [1, 21, 22, 7, 23, 24, 25, 26, 27, 28, 29, 10]
  • Cisplatin 40 mg/m 2 IV once weekly (not to exceed 70 mg/wk) plus  radiation therapy 1.8-2 Gy per fraction (minimum 4 cycles; maximum 6 cycles) or
  • Cisplatin 50-75 mg/m 2 IV on day 1 plus  5-fluorouracil (5-FU) 1000 mg/m 2 continuous IV infusion on days 2-5 and days 30-33 (total dose 4000 mg/m 2 each course)
  • Cisplatin 50-75 mg/m 2 IV on day 1 plus  5-FU 1000 mg/m 2 continuous IV infusion over 24 h on days 1-4 (total dose 4000 mg/m 2 each cycle) every 3wk for a total of 3-4 cycles

Treatment recommendations for advanced stage disease

Stage IIB, IIIA, IIIB, and IVA:

  • Traditionally, advanced disease includes stages IIB-IVA; however, many oncologists now also include patients with IB2 and IIA2 in the advanced disease category [10]
  • Treatment recommendations for advanced disease include concomitant chemoradiation and brachytherapy [10, 21, 22, 23, 24, 25, 26, 27, 28, 29]
  • Cisplatin 40 mg/m 2 IV once weekly (not to exceed 70 mg/wk) plus  radiation therapy 1.8-2 Gy per fraction (minimum 4 cycles; maximum 6 cycles) or
  • Cisplatin 50-75 mg/m 2 IV on day 1 plus  5-fluorouracil (5-FU) 1000 mg/m 2 continuous IV infusion on days 2-5 and Days 30-33 (total dose 4000 mg/m 2 each course)
  • Cisplatin 50-75 mg/m 2 IV on day 1 plus  5-FU 1000 mg/m 2 continuous IV infusion over 24 h on days 1-4 (total dose 4000 mg/m 2 each cycle) every 3wk for a total of 3-4 cycles

Treatment recommendations for metastatic disease

Stage IVB:

  • Patients with metastatic disease are primarily treated with cisplatin-based chemotherapy
  • In addition, individualized radiation therapy should be considered for control of pelvic disease and other symptoms [1, 7, 10]

First-line therapy for stage IV recurrent or metastatic disease [10] [30] 30, [31] 31, [32] 32, [33] 33, [34] 34] :

  • Bevacizumab 15 mg/kg IV over 30-90 min plus  cisplatin 50 mg/m 2 IV over 30-90 min on days 1 or 2 plus  paclitaxel 135 or 175 mg/m 2 IV over 3 or 24 h on day 1 every 3 wk or
  • Bevacizumab 15 mg/kg IV over 30-90 min plus  paclitaxel 175 mg/m 2 IV over 3 h on day 1 plus  topotecan 0.75 mg/m 2 IV over 30 min on days 1-3 every 3 wk or
  • Paclitaxel 135 mg/m 2 IV over 24h (dosing at 175 mg/m 2 IV over 3h is also acceptable) followed by  cisplatin 50 mg/m 2 IV on day 1 every 3wk or
  • Topotecan 0.75 mg/m 2 IV (or 0.6 mg/m 2 IV if prior radiation therapy) on days 1-3 followed by  cisplatin 50 mg/m 2 IV on day 1 every 3wk or
  • Paclitaxel 175 mg/m 2 IV over 3h on day 1 every 3 wk

Second-line therapy for stage IV recurrent or metastatic disease: