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Current Cancer Therapy Reviews


ISSN (Print): 1573-3947
ISSN (Online): 1875-6301

Review Article

Treatment Strategies for Cervical Cancer in Older Women: Challenges and Advancements

Author(s): Arun Kumar Singh, Sonali Sundram, Hema Arya, Vandana and Rishabha Malviya*

Volume 20, Issue 2, 2024

Published on: 07 September, 2023

Page: [142 - 153] Pages: 12

DOI: 10.2174/1573394719666230707145133

Price: $65


Recent advances in brachytherapy (BT) and chemotherapy, as well as consensus statements from several different organizations, were examined in this study as they pertain to the treatment of locally advanced cervical cancer (LACC). Since patients undergoing intensive chemotherapy before, during, and after radiation therapy (RT) experienced significant toxicities, it was decided that no additional conventional therapeutic options should be pursued. The use of PET-CT and MRI in the assessment of pelvic lymph nodes and bone marrow metastases improved pelvic RT planning. It can be concluded from the findings of the study that by administering an integrated boost for metastatic pelvic lymph nodes in IMRT followed by MRI-guided adaptive beam therapy, patients with LACC may benefit from modern radiation therapy methods that treat bladder and rectum tissues while shortening treatment times.

Keywords: Cervical cancer, radiation therapy, comprehensive geriatric assessment, brachytherapy, chemotherapy, old age problems.

Graphical Abstract
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66(1): 7-30.
[] [PMID: 26742998]
Venkatesulu BP, Mallick S, Rath GK. Patterns of care of cervical cancer in the elderly: A qualitative literature review. J Geriatr Oncol 2017; 8(2): 108-16.
[] [PMID: 28169196]
Quaglia A, Tavilla A, Shack L, et al. The cancer survival gap between elderly and middle-aged patients in Europe is widening. Eur J Cancer 2009; 45(6): 1006-16.
[] [PMID: 19121578]
Duport DN. Epidemiological data on cervical cancer In: Chronic diseases and trauma.
Darlin L, Borgfeldt C, Widén E, Kannisto P. Elderly women above screening age diagnosed with cervical cancer have a worse prognosis. Anticancer Res 2014; 34(9): 5147-51.
[PMID: 25202106]
Berkman B, Rohan B, Sampson S. Myths and biases related to cancer in the elderly. Cancer 1994; 74(S7): 2004-8.
[<2004:AIDCNCR2820741703>3.0.CO;2-W] [PMID: 8087763]
Albert A, Lee A, Allbright R, Vijayakumar S. Impact of age on receipt of curative treatment for cervical cancer: an analysis of patterns of care and survival in a large, national cohort. J Geriatr Oncol 2019; 10(3): 465-74.
[] [PMID: 30361099]
Wright JD, Gibb RK, Geevarghese S, et al. Cervical carcinoma in the elderly. Cancer 2005; 103(1): 85-91.
[] [PMID: 15540239]
Eggemann H, Ignatov T, Geyken CH, Seitz S, Ignatov A. Management of elderly women with cervical cancer. J Cancer Res Clin Oncol 2018; 144(5): 961-7.
[] [PMID: 29500704]
Arbyn M, Anttila A, Jordan J, et al. European guidelines for quality assurance in cervical cancer screening. second edition-summary document. Ann Oncol 2010; 21(3): 448-58.
[] [PMID: 20176693]
Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and Amer-ican Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012; 137(4): 516-42.
[] [PMID: 22431528]
Cuzick J, Clavel C, Petry KU, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer 2006; 119(5): 1095-101.
[] [PMID: 16586444]
Gustafsson L, Sparén P, Gustafsson M, et al. Low efficiency of cytologic screening for cancer in situ of the cervix in older women. Int J Cancer 1995; 63(6): 804-9.
[] [PMID: 8847138]
INED. Espérance de vie; Ined- Institut national d’études démographiques 2010. Available from: mortalite_causes_deces/esperance_vie/ Available from:
Duport N. Screening for cancer of the cervix: The state of health of the population in France Monitoring of public health law indicators, 2008 report. Paris: National Institute for Health Surveillance 2009.
Andrae B, Kemetli L, Sparén P, et al. Screening-preventable cervical cancer risks: Evidence from a nationwide audit in Sweden. J Natl Cancer Inst 2008; 100(9): 622-9.
[] [PMID: 18445828]
Meyer R, Lemay A-L, Guy X, Giraud C, Mathevet P, Flori M. [Is there a benefit to continue pap smear screening for cervical cancer after 65 years of age? A retrospective study on 53,644 women]. Bull Cancer 2012; 99(4): 409-15.
[] [PMID: 22450525]
Castañón A, Landy R, Cuzick J, Sasieni P. Cervical screening at age 50-64 years and the risk of cervical cancer at age 65 years and older: Population-based case control study. PLoS Med 2014; 11(1): e1001585.
[] [PMID: 24453946]
Rodríguez AC, Schiffman M, Herrero R, et al. Longitudinal study of human papillomavirus persistence and cervical intraepithelial neoplasia grade 2/3: Critical role of duration of infection. J Natl Cancer Inst 2010; 102(5): 315-24.
[] [PMID: 20157096]
McCredie MRE, Sharples KJ, Paul C, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical in-traepithelial neoplasia 3: A retrospective cohort study. Lancet Oncol 2008; 9(5): 425-34.
[] [PMID: 18407790]
Strander B, Andersson-Ellström A, Milsom I, Sparén P. Long term risk of invasive cancer after treatment for cervical intraepithelial neo-plasia grade 3: Population based cohort study. BMJ 2007; 335(7629): 1077.
[] [PMID: 17959735]
Haute Autorité de Santé HAS. Evaluation of human papillomavirus (HPV) research in primary screening for precancerous and cancerous lesions of the cervix and the role of double p16/Ki67 immunostaining. Saint-Denis La Plaine 2019. Available from: rche-des-papillomavirus-humains-hpv-en-depistageprimaire-deslesions-precancereuses-et-cancereuses-du-col-de-l-uterus-et-de-laplace-du-double-immuno-marquage-p16/ki67
Lindell M, Sanner K, Wikström I, Wilander E. Self-sampling of vaginal fluid and high-risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening. BJOG 2012; 119(2): 245-8.
[] [PMID: 22017806]
Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28(S4): iv72-83.
[] [PMID: 28881916]
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146-57.
[] [PMID: 11253156]
Balducci L, Extermann M. Management of cancer in the older person: A practical approach. Oncologist 2000; 5(3): 224-37.
[] [PMID: 10884501]
Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol 2000; 35(3): 147-54.
[] [PMID: 10960797]
Girre V, Falcou MC, Gisselbrecht M, et al. Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients? J Gerontol A Biol Sci Med Sci 2008; 63(7): 724-30.
[] [PMID: 18693227]
Caillet P, Canoui-Poitrine F, Vouriot J, et al. Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study. J Clin Oncol 2011; 29(27): 3636-42.
[] [PMID: 21709194]
Soubeyran P, Bellera C, Goyard J, et al. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One 2014; 9(12): e115060.
[] [PMID: 25503576]
Stuck AE, Siu AL, Wieland GD, Rubenstein LZ, Adams J. Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet 1993; 342(8878): 1032-6.
[] [PMID: 8105269]
Soubeyran P, Bellera C, Goyard J, et al. Validation of the G8 screening tool in geriatric oncology: The ONCODAGE project. J Clin Oncol 2011; 29(S15): 9001.
Martinez-Tapia C, Canoui-Poitrine F, Bastuji-Garin S, et al. Optimizing the G8 screening tool for older patients with cancer: Diagnostic performance and validation of a six-item version. Oncologist 2016; 21(2): 188-95.
[] [PMID: 26764250]
Choi YS, Kim YH, Kang S, et al. Feasibility of radical surgery in the management of elderly patients with uterine cervical cancer in Korea. Gynecol Obstet Invest 2005; 59(3): 165-70.
[] [PMID: 15677871]
Mousavi A, Zarchi MK, Modares Gilani M, et al. Radical hysterectomy in the elderly. World J Surg Oncol 2008; 6(1): 38.
[] [PMID: 18394193]
George EM, Tergas AI, Ananth CV, et al. Safety and tolerance of radical hysterectomy for cervical cancer in the elderly. Gynecol Oncol 2014; 134(1): 36-41.
[] [PMID: 24768851]
Zhao Y, Hang B, Xiong GW, Zhang XW. Laparoscopic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2017; 27(11): 1132-44.
[] [PMID: 28300465]
Diver E, Hinchcliff E, Gockley A, et al. Minimally invasive radical hysterectomy for cervical cancer is associated with reduced morbidity and similar survival outcomes compared with laparotomy. J Minim Invasive Gynecol 2017; 24(3): 402-6.
[] [PMID: 28011096]
Koh W-J, Dorigo O, Mutch DNCCN. Guidelines index table of contents discussion. Cervical Cancer 2017; p. 84.
Cibula D, Pötter R, Planchamp F, et al. The European Society of gynaecological oncology/european society for radiotherapy and oncology/european society of pathology guidelines for the management of patients with cervical cancer. Radiother Oncol 2018; 127(3): 404-16.
[] [PMID: 29728273]
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018; 379(20): 1895-904.
[] [PMID: 30380365]
Köhler C, Hertel H, Herrmann J, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analy-sis. Int J Gynecol Cancer 2019; 29(5): 845-50.
[] [PMID: 31155516]
Lécuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: Results of the SENTICOL study. J Clin Oncol 2011; 29(13): 1686-91.
[] [PMID: 21444878]
Lecuru FR, McCormack M, Hillemanns P, et al. SENTICOL III: An international validation study of sentinel node biopsy in early cervical cancer. A GINECO, ENGOT, GCIG and multicenter study. Int J Gynecol Cancer 2019; 29(4): 829-34.
[] [PMID: 30898938]
Lu Q, Zhang Y, Liu C, Wang S, Guo S, Zhang Z. Total laparoscopic radical trachelectomy in the treatment of early squamous cell cervical cancer: A retrospective study with 8-year follow-up. Gynecol Oncol 2013; 130(2): 275-9.
[] [PMID: 23648468]
Biliatis I, Kucukmetin A, Patel A, et al. Small volume stage 1B1 cervical cancer. Gynecol Oncol 2012; 126(1): 73-7.
[] [PMID: 22465521]
Maneo A, Sideri M, Scambia G, et al. Simple conization and lymphadenectomy for the conservative treatment of stage IB1 cervical cancer. An Italian experience. Gynecol Oncol 2011; 123(3): 557-60.
[] [PMID: 21907396]
Ramirez PT, Pareja R, Rendón GJ, Millan C, Frumovitz M, Schmeler KM. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? Gynecol Oncol 2014; 132(1): 254-9.
[] [PMID: 24041877]
Landoni F, Colombo A, Milani R, Placa F, Zanagnolo V, Mangioni C. Randomized study between radical surgery and radiotherapy for the treatment of stage IB–IIA cervical cancer: 20-year update. J Gynecol Oncol 2017; 28(3): e34.
a) Cibula D, Pötter R, Planchamp F, et al. The European society of gynaecological oncology/european society for radiotherapy and oncology/european society of pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 2018; 28(4): 641-55.
[] [PMID: 29688967];
b) Naga CHP, Gurram L, Chopra S, Mahantshetty U. The management of locally advanced cervical cancer. Curr Opin Oncol 2018; 30(5): 323-9.
[] [PMID: 29994902];
c) Lehman M, Thomas G. Is concurrent chemotherapy and radiotherapy the new standard of care for locally advanced cervical cancer? Int J Gynecol Cancer 2001; 11(2): 87-99.
[] [PMID: 11328406]
Bourgin C, Lambaudie E, Houvenaeghel G, Foucher F, Levêque J, Lavoué V. Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management. Eur J Surg Oncol 2017; 43(4): 703-9.
[] [PMID: 27955835]
Kim KS, Yi SM, Jun JH, Cheong MA, Koo MS. The hemodynamic effects of a reversed Trendelenburg in elderly patients with increased cardiac risk during laparoscopic cholecystectomy. Korean J Anesthesiol 2009; 56(4): 398-402.
[] [PMID: 30625760]
Gouy S, Morice P, Narducci F, et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012; 13(5): e212-20.
[] [PMID: 22554549]
Eifel PJ, Winter K, Morris M, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol 2004; 22(5): 872-80.
[] [PMID: 14990643]
Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9: 48-60.
[] [PMID: 29594251]
Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradio therapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev 2010; 2010(1): CD008285.
[PMID: 20091664]
Aparicio T, Jouve JL, Teillet L, et al. Geriatric factors predict chemotherapy feasibility: Ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol 2013; 31(11): 1464-70.
[] [PMID: 23460711]
Duan ZY, Liu JQ, Yin P, Li JJ, Cai GY, Chen XM. Impact of aging on the risk of platinum-related renal toxicity: A systematic review and meta-analysis. Cancer Treat Rev 2018; 69(69): 243-53.
[] [PMID: 30121504]
Cetina L, Garcia-Arias A, Uribe M de J, Candelaria M, Rivera L, Oñate-Ocaña L. Concurrent chemoradiation with carboplatin for elderly, diabetic and hypertensive patients with locally advanced cervical cancer. Eur J Gynaecol Oncol 2020; 29(6): 608-12.
Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: The chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer 2012; 118(13): 3377-86.
[] [PMID: 22072065]
Wang W, Hou X, Yan J, et al. Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 2017; 17(1): 510.
[] [PMID: 28764676]
Hata M, Koike I, Miyagi E, et al. Radiation therapy for pelvic lymph node metastasis from uterine cervical cancer. Gynecol Oncol 2013; 131(1): 99-102.
[] [PMID: 23877014]
Mell LK, Kochanski JD, Roeske JC, et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with con-current cisplatin and intensity-modulated pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2006; 66(5): 1356-65.
[] [PMID: 16757127]
Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005; 294(20): 2587-93.
[] [PMID: 16304072]
Lindegaard JC, Thranov IR, Engelholm SA. Radiotherapy in the management of cervical cancer in elderly patients. Radiother Oncol 2000; 56(1): 9-15.
[] [PMID: 10869749]
Gandhi AK, Sharma DN, Rath GK, et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: A prospective randomized study. Int J Radiat Oncol Biol Phys 2013; 87(3): 542-8.
[] [PMID: 24074927]
Albuquerque K, Giangreco D, Morrison C, et al. Radiation-related predictors of hematologic toxicity after concurrent chemoradiation for cervical cancer and implications for bone marrow-sparing Pelvic IMRT. Int J Radiat Oncol Biol Phys 2011; 79(4): 1043-7.
Chakraborty S, Geetha M, Dessai S, Patil VM. How well do elderly patients with cervical cancer tolerate definitive. Ecancermedicalscience 2014; 8: 484.
[] [PMID: 25525462]
Halkett G, O’Connor M, Jefford M, et al. RT Prepare: A radiation therapist-delivered intervention reduces psychological distress in wom-en with breast cancer referred for radiotherapy. Br J Cancer 2018; 118(12): 1549-58.
[] [PMID: 29855611]
Lim K, Small W, Portelance L, Creutzberg C, Jürgenliemk-Schulz IM, Mundt A. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys 2011; 79(2): 348-55.
Mazeron R, Petit C, Rivin E, et al. 45 or 50 Gy, which is the optimal radiotherapy pelvic dose in locally advanced cervical cancer in the perspective of reaching magnetic resonance image-guided adaptive brachytherapy planning aims? Clin Oncol (R Coll Radiol) 2016; 28(3): 171-7.
[] [PMID: 26547694]
Muckaden MA, Budrukkar AN, Tongaonkar HB, Dinshaw KA. Hypofractionated radiotherapy in carcinoma cervix IIIB: Tata Memorial Hospital experience. Indian J Cancer 2002; 39(4): 127-34.
[PMID: 12928570]
Gill BS, Lin JF, Krivak TC, Sukumvanich P, Laskey RA, Ross MS. National cancer data base analysis of radiation therapy consolidation modality for cervical cancer: The impact of new technological advancements. Int J Radiat Oncol Biol Phys 2014; 90(5): 1083-90.
Moore KN, Java JJ, Slaughter KN, et al. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol 2016; 143(2): 294-301.
[] [PMID: 27542967]
Mazeron R, Castelnau-Marchand P, Dumas I, et al. Impact of treatment time and dose escalation on local control in locally advanced cer-vical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy. Radiother Oncol 2015; 114(2): 257-63.
[] [PMID: 25497872]
Serban M, Kirisits C, Pötter R, et al. Isodose surface volumes in cervix cancer brachytherapy: Change of practice from standard (Point A) to individualized image guided adaptive (EMBRACE I) brachytherapy. Radiother Oncol 2018; 129(3): 567-74.
[] [PMID: 30243671]
Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group☆ (I): con-cepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005; 74(3): 235-45.
[] [PMID: 15763303]
Pötter R, Haie-Meder C, Limbergen EV, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy—3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78(1): 67-77.
[] [PMID: 16403584]
Sturdza A, Pötter R, Fokdal LU, et al. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol 2016; 120(3): 428-33.
[] [PMID: 27134181]
Charra-Brunaud C, Harter V, Delannes M, et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study. Radiother Oncol 2012; 103(3): 305-13.
[] [PMID: 22633469]
Fokdal L, Sturdza A, Mazeron R, et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique im-proves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol 2016; 120(3): 434-40.
[] [PMID: 27113795]
Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ. Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 1998; 71(2): 291-8.
[] [PMID: 9826474]
Yalman D, Aras AB, Ozkök S, et al. Prognostic factors in definitive radiotherapy of uterine cervical cancer. Eur J Gynaecol Oncol 2003; 24(3-4): 309-14.
[PMID: 12807246]
Yanazume Y, Yanazume S, Iio K, et al. Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer. J Obstet Gynaecol Res 2014; 40(6): 1725-32.
[] [PMID: 24888940]
Granai CO, Allee P, Doherty F, Ball HG, Madoc-Jones H, Curry SL. Intraoperative real-time ultrasonography during intrauterine tandem placement. Obstet Gynecol 1986; 67(1): 112-4.
[PMID: 3510011]
Sharma DN, Chaudhari P, Sharma S, et al. Comparison of high‐dose‐rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma. J Appl Clin Med Phys 2014; 15(2): 60-6.
[] [PMID: 24710456]
Magné N, Mancy NC, Chajon E, et al. Patterns of care and outcome in elderly cervical cancer patients: A special focus on brachytherapy. Radiother Oncol 2009; 91(2): 197-201.
[] [PMID: 18954913]
Cisplatin and Radiation Therapy With or Without Carboplatin and Paclitaxel in Patients With Locally Advanced Cervical Cancer. NCT01414608, Available from:
Guler OC, Sari SY, Birgi SD, Gultekin M, Yildiz F, Onal C. Definitive chemoradiotherapy in elderly cervical cancer patients: A multiinstitutional analysis. Int J Gynecol Cancer 2017; 27(7): 1446-54.
[] [PMID: 28604459]
Mazzola R, Ricchetti F, Fiorentino A, et al. Weekly cisplatin and volumetric-modulated arc therapy with simultaneous integrated boost for radical treatment of advanced cervical cancer in elderly patients: Feasibility and clinical preliminary results. Technol Cancer Res Treat 2017; 16(3): 310-5.
[] [PMID: 27402633]
Shimamoto K, Saito T, Kitade S, et al. A study of treatments and outcomes in elderly women with cervical cancer. Eur J Obstet Gynecol Reprod Biol 2018; 228: 174-9.
[] [PMID: 29960201]
Fujimoto J, Toyoki H, Sato E, Sakaguchi H, Tamaya T. Clinical implication of expression of vascular endothelial growth factor-C in meta-static lymph nodes of uterine cervical cancers. Br J Cancer 2004; 91(3): 466-9.
[] [PMID: 15226772]
Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 2009; 27(7): 1069-74.
[] [PMID: 19139430]
Jain RK. Normalization of tumor vasculature: An emerging concept in antiangiogenic therapy. Science 2005; 307(5706): 58-62.
[] [PMID: 15637262]
Le M, Bai J, Monk BJ, et al. A Markov model to evaluate cost-effectiveness of antiangiogenesis therapy using bevacizumab in advanced cervical cancer. Gynecol Oncol 2015; 33: 966.
Mackay HJ, Tinker A, Winquist E, et al. A phase II study of sunitinib in patients with locally advanced or metastatic cervical carcinoma: NCIC CTG Trial IND.184. Gynecol Oncol 2010; 116(2): 163-7.
[] [PMID: 19740535]
Monk BJ, Mas Lopez L, Zarba JJ, et al. Phase II, open-label study of pazopanib or lapatinib monotherapy compared with pazopanib plus lapatinib combination therapy in patients with advanced and recurrent cervical cancer. J Clin Oncol 2010; 28(22): 3562-9.
[] [PMID: 20606083]
Scambia G, Ferrandina G, Distefano M, D’Agostino G, Benedetti-Panici P, Mancuso S. Epidermal growth factor receptor (EGFR) is not related to the prognosis of cervical cancer. Cancer Lett 1998; 123(2): 135-9.
[] [PMID: 9489479]
Schilder RJ, Sill MW, Lee YC, Mannel R. A phase II trial of erlotinib in recurrent squamous cell carcinoma of the cervix: A Gynecologic Oncology Group Study. Int J Gynecol Cancer 2009; 19(5): 929-33.
[] [PMID: 19574787]
Goncalves A, Fabbro M, Lhommé C, et al. A phase II trial to evaluate gefitinib as second- or third-line treatment in patients with recurring locoregionally advanced or metastatic cervical cancer. Gynecol Oncol 2008; 108(1): 42-6.
[] [PMID: 17980406]
Farley J, Sill MW, Birrer M, et al. Phase II study of cisplatin plus cetuximab in advanced, recurrent, and previously treated cancers of the cervix and evaluation of epidermal growth factor receptor immunohistochemical expression: A Gynecologic Oncology Group study. Gynecol Oncol 2011; 121(2): 303-8.
[] [PMID: 21329967]
Santin AD, Sill MW, McMeekin DS, et al. Phase II trial of cetuximab in the treatment of persistent or recurrent squamous or non-squamous cell carcinoma of the cervix: A Gynecologic Oncology Group study. Gynecol Oncol 2011; 122(3): 495-500.
[] [PMID: 21684583]
Kurtz JE, Hardy-bessard AC, Deslandres M, et al. Cetuximab, topotecan and cisplatin for the treatment of advanced cervical cancer: A phase II GINECO trial. Gynecol Oncol 2009; 113(1): 16-20.
[] [PMID: 19232434]
Oh DY, Kim S, Choi YL, et al. HER2 as a novel therapeutic target for cervical cancer. Oncotarget 2015; 6(34): 36219-30.
[] [PMID: 26435481]
Yang W, Song Y, Lu YL, Sun JZ, Wang HW. Increased expression of programmed death (PD)-1 and its ligand PD-L1 correlates with im-paired cell-mediated immunity in high-risk human papillomavirus-related cervical intraepithelial neoplasia. Immunology 2013; 139(4): 513-22.
[] [PMID: 23521696]
Karim R, Jordanova ES, Piersma SJ, et al. Tumor-expressed B7-H1 and B7-DC in relation to PD-1+ T-cell infiltration and survival of patients with cervical carcinoma. Clin Cancer Res 2009; 15(20): 6341-7.
[] [PMID: 19825956]
Lheureux S, Butler MO, Clarke B, et al. A phase I/II study of ipilimumab in women with metastatic or recurrent cervical carcinoma: A study of the Princess Margaret and Chicago N01 Consortia. J Clin Oncol 2015; 33(15) (suppl.): 3061.
Frenel JS, Le Tourneau C, O’Neil BH, et al. Pembrolizumab in patients with advanced cervical squamous cell cancer: Preliminary results from the phase Ib KEYNOTE-028 study. J Clin Oncol 2016; 34(15) (suppl.): 5515.
Chung HC, Schellens JHM, Delord JP, et al. Pembrolizumab treatment of advanced cervical cancer: Updated results from the phase 2 KEYNOTE-158 study. J Clin Oncol 2018; 36(15) (suppl.): 5522.
Su JH, Wu A, Scotney E, et al. Immunotherapy for cervical cancer: Research status and clinical potential. BioDrugs 2010; 24(2): 109-29.
[] [PMID: 20199126]
Cortes-Perez NG, Azevedo V, Alcocer-González JM, et al. Cell surface display of E7 antigen from human papillomavirus type-16 in Lactococcus lactis and in Lactobacillus plantarum using a new cell-wall anchor from lactobacilli. J Drug Target 2005; 13(2): 89-98.
[] [PMID: 15823960]
Sewell DA, Shahabi V, Gunn GR III, Pan ZK, Dominiecki ME, Paterson Y. Recombinant Listeria vaccines containing PEST sequences are potent immune adjuvants for the tumor-associated antigen human papillomavirus-16 E7. Cancer Res 2004; 64(24): 8821-5.
[] [PMID: 15604239]
Basu P, Mehta A, Jain M, et al. A randomized phase 2 study of ADXS11-001 Listeria monocytogenes–Listeriolysin O immunotherapy with or without cisplatin in treatment of advanced cervical cancer. Int J Gynecol Cancer 2018; 28(4): 764-72.
[] [PMID: 29538258]
Huh W, Brady WE, Dizon DS. A prospective phase II trial of the Listeria-based human papillomavirus immunotherapy axalimogenefilolisbac in second- and third-line metastatic cervical cancer: a NRG Oncology Group trial. 48th Annual Meeting of the Society of Gynecologic Oncology.
Mesko S, Sandler K, Cohen J, Konecny G, Steinberg M, Kamrava M. Clinical outcomes for stereotactic ablative radiotherapy in oligometastatic and oligoprogressive gynecological malignancies. Int J Gynecol Cancer 2017; 27(2): 403-8.
[] [PMID: 27870704]

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