Cervical cancer
Team members: Tropé, Kristensen, Sundfør, Sert, Lien, Rofstad, Knutstad, Abeler, Lyng, Stokke, Oksefjell
Ongoing clinical studies:
1. EORTC protocol 55994: Randomized phase III study of neoadjuvant chemotherapy followed by surgery vs. concommitant radiotherapy and chemotherapy in FIGO Ib2,IIa>4 cm or IIb cervical cancer.
2. Fertiliy preserving surgery (Tracheloctomi).
So far the treatment of cervical cancer has always led to infertility. There is a fertility saving surgical method that implies taht the tumor is treated with equal oncological results as with a conventional operation. The method gives the woman the opportunity to have children later on. Daniell Dargant performed in 1987 for the first tim radical trachelectomy through the combination of a laparascopic and a vaginal procedure. The technique was published in 1994. Laparascopic pelvic lymphadectomy, as described by Querley in 1991, is the first step in the basic technique ofr laparascopic and vaginal radial surgery. The first Norwegian cases of cervical cancer were treated using this method at the Norwegian Radium Hospital (Dnr). Dns's preliminary experiences were reported on the annual meeting for the Gynecological association in Tromsø in 2002. Four out of the ten women had children later on. The authors concluded that since the access on experts on radical trachelectomy is limited the treatment should be centralised to the hospital where the best experise and the best follow-up is located. The originataor of the method and the coworkers found that the treatment with trachelectomy does not imply an increased risk for relapse, which to a large degree is related to biologogical factos, and not to the surgical method.
Three factors are of major importance:
- the preoperative report
- the training of the surgeon
- that the pathologists give certain data
As it has become more common to have the first child at a relatively high age more women will get into the difficult situation of having cervical cancer before they have given birth.
3. Weekly Taxol by cisplatin resistant residue of cervical cancer.
4. Dynamic MRI of cancer cervicu uteri as method for prediction of residual, metastatic disease and radiation sensitivity.
5. Radiationinduced late effects in the pelvis region after combined external andintra cavitary radiation therapy by cancer cervicis uteri. A clinical study in radiation biology. Patients who receive curative radiation therapy are included in this study, where radiation biological data and data from dynamic MR are coupled against clinical data and follow-up with registration of radiation discomfort and quality of life.
6. Hyperbar oxygen treatment for injuries among gyneacological patients caused by radiaton
7. NSGO-CC-0304: CombretastatinPhase I-II-III studies of Cisplatin and Combretastatin (CA4P) in recurrent or advanced cervical cancer.
The primary objective (Phase I) is to establish the maximally tolerated dose (MTD) of Combretastatin combined with weekly Cisplatin in patients with advanced cervical cancer.
Translational research:
8. Molecular biological studies of radiation sensitivity
This protocol is coupled up against the study above (study nr. 5 - "Radiationinduced late effects in the pelvis region ...")
Molecular Biomarkers in Radiotherapy of Cervical Cancer (click to open Powerpoint presentation)
Completed studies where follow-up is still going on:
1. NOCECA. Protocol for the treatment of cervix cancer stage IIb-IVa.
Completed autumn 1999.
2. A feasibility study of cisplatin given concurrently with radio therapy in locally advanced cervical cancer. Completed 05.03.2001.
3. A phase I-II study of cisplatin and paclitaxel given concurrently with radiotherapy in locally advanced cervical cancer. A multi-center dose scalating study. Completed autumn 2002.
4. A phase II study of cisplatin, Ifosfamide, Mesna, 5-FU and Follinate as neoadjuvant chemotherapy before surgery in locally advanced cervical cancer. Completed summer 2003.
New protocols
1. GOG-0219: A phase III, randomized trial of weekly cisplatin and radiation versus Cisplatin and Tirapazamine and radiation in stage IB2, IIA, IIB, IIIB and IVA cervical carcinoma limited to the pelvis.
In this study, patients with clinical stages IB2, IIA, IIB, IIIB, IVA cervical carcinoma limited to the pelvis will be randomized to receive primary radiotherapy with cisplatin or cisplatin in combination with tirapazamine (TPZ)