ABSTRACT
Until 1983, cervical carcinoma was considered a chemo-resistant cancer, and as such, was treated with chemotherapy only after all other treatments have failed. This group of patients are most likely to be nonresponders, therefore, it is not surprising that results were disappointing. Studies carried out in these conditions have several inherited problems. First of all, most patients will have local recurrence, and this condition is frequently associated with ureteral obstruction and consequent impaired renal function, which alters drug excretion. Second, most patients with recurrent cervical cancer will have undergone radiotherapy and will have reduced tolerance to chemotherapy because of impaired marrow reserve. In addition, tissue vascularization in the pelvis may be altered by radiation and may result in drugs not reaching the recurrent tumor. Finally, radiation-induced fibrosis is difficult to distinguish from tumor and this creates problems in both diagnosis of recurrence and evaluation of response to therapy (1).
