Radiosensitizers in cervical cancer. Cisplatin and beyond

Cervical cancer remains one of the greatest killers of women worldwide. According to Globocan 2000, it is estimated that in 2000 the numbers of patients diagnosed with and those who died from this disease were 470,606 and 233,372, respectively [1]. It is remarkable that these rates occur, despite the fact that cervical cancer is a model for early detection due to its long and relatively well-known natural history that offers an excellent opportunity for its detection before lesions become invasive [2].Cervical cancer is currently staged clinically according International Federation of Gynecology and Obstetrics (FIGO) guidelines. In terms of treatment, invasive disease can be divided into three main groups: 1) early stage, which ranges from microinvasive disease IA1, IA2 to macroscopic disease confined to cervix and measuring <4 cm, IB1; 2) locally advanced FIGO stages IB2-IVA, and 3) IVB and recurrent disease [3].The recommended treatment for IA1 patients is either a local procedure such as conization or total hysterectomy, depending on the patient's desire to remain fertile, whereas for IA2 patients the recommendation is for a radical hysterectomy which removes parametrial tissue, upper vagina and pelvic lymph nodes. On average, 8% of cases show positive pelvic lymph nodes. Because many women at this disease stage wish and deserve to preserve fertility, radical trachelectomy is becoming an option for these patients as well as for IB1 patients [4]. In surgically treated early-stage cases, the presence in the surgical specimen of a combination of intermediate-risk factors (vascular and lymphatic permeation, tumor size >2 cm, and deep cervical stroma invasion) or high-risk factors (positive pelvic lymph nodes, parametrial infiltration, and positive surgical margins) dictates the use of adjuvant radiation [5] or chemoradiation, respectively [6].Treatment results for these patients are far from optimal. In this regard, treatment of locally advanced cervical cancer exper