Update on chemotherapy in gynaecological cancers

Abstract

Key content Ovarian cancer requires multidisciplinary management, usually with postoperative adjuvant chemotherapy. In some cases, however, neo-adjuvant chemotherapy and delayed surgery may be offered. Recurrent ovarian cancer management is usually treated with chemotherapy, with drug choice often influenced by the platinum-free interval. The role of adjuvant chemotherapy for endometrial cancer remains open to debate. Adjuvant chemotherapy is increasingly offered for high-risk cases with lymphovascular space invasion. Carboplatin and paclitaxel are the most effective drugs in adjuvant and recurrent settings. Concomitant cisplatin with radiation therapy is the standard of care for locally advanced cervical cancer; recent studies have shown that the addition of bevacizumab to carboplatin and paclitaxel leads to improved response rates in the recurrent, metastatic setting. There are many rare gynaecological cancers that require multidisciplinary management, and entry into clinical trials should be strongly supported. Learning objectives To understand the role and scheduling of chemotherapy in both newly diagnosed and recurrent epithelial ovarian cancer. To understand when chemotherapy should be offered in cervical and endometrial cancers. To be able to seek information sources for the management of rare and uncommon gynaecological cancers. Ethical issues The question of systemic lymphadenectomy remains controversial and should be carefully discussed with the patient. Women should be encouraged to participate in clinical trials to help address some of the controversies in endometrial cancer management. Keywords: carcinoma of the cervix / carcinoma of the endometrium / carcinoma of the ovary / carcinoma of the vulva / chemotherapy Linked resource: Single best answer questions are available for this article at https