ABSTRACT
Cervical cancer is probably themost common female cancer in theworld. Although the international statistics for cervical cancer rank it as the third most common cancer (1,2), the disease primarily occurs in countries without comprehensive or durable tumor registries. In these countries cervical cancer occurs at an epidemic proportion. Unfortunately, cervical cancer affects woman at a younger age than any other cancer that affects adult women (3). This results in an average of 28 years of life lost for every case (4). Cervical cancer usually occurs in patients who have not had regular Pap smear screenings.Due to the lack of screening, patientswith cervical cancer often presentwith locally advanced stage disease. This extent of disease is beyond what can often be controlled with surgery alone. Radiation therapy is typically used in this setting. However as tumor size increases, reflected grossly in FIGO staging, survival decreases precipitously. In his classic paper, Fletcher described the relationship between the radiation dose required to control squamous cell cervical cancer based on the size of the primary tumor (5). When tumors exceed 6 cm, the dose of radiation required exceeds the tolerance of normal pelvic tissues. Because of the limitation on the dose that can be delivered, survivals with larger tumors are suboptimal. To overcome this a number of adjunctive therapies have been utilized. Three primary types of adjunctive therapies have included chemotherapy, hyperthermia and large particle radiation (6,7). However, because of the technical difficulties of cervical hyperthermia as well as the limited availability of large particle radiation therapy equipment, chemotherapy has emerged as the most common adjunct therapy to radiation.
