Diagnosis
Cervical tumor with signs of metastatic involvement of the lymph nodes. Squamous Cell Carcinoma, PD-L1: CPS <1. Left-sided nephrostomy.
Patient:
Female, 54 years old, Russia
Physician:
Dr. Jörg Falbrede, Chief Physician, Department of Gynecology and Gynecologic Oncology, Agaplesion Bethesda Klinik
Patient Questions
A diagnosis of cervical cancer has been established at my place of residence. Enlarged lymph nodes up to 16×17 mm are observed on both sides at the bifurcation of the iliac vessels. No signs of metastatic lesions in the thoracic or abdominal organs have been identified. Left-sided ureterectasia is present.
According to the histological report, I have squamous cell carcinoma of the cervix, and the programmed death-ligand receptor PD-L1 corresponds to CPS <1. Given the extent of the tumor, 6 courses of chemotherapy are planned as the first phase of treatment.
What treatment would you recommend in this case?
Response from Dr. Jörg Falbrede
Surgical treatment is not possible in this case.
Immunochemotherapy with Pembrolizumab (Keytruda), an antibody against the PD-1 receptor, is ineffective when CPS and TPS are below 1.
- Chemotherapy serves only a supportive role. The main treatment method is radiation therapy.
- The primary treatment consists of radiation therapy in combination with cisplatin. Additional medications administered during or after radiation therapy cause only side effects.
Initially, external beam radiation is performed together with cisplatin, up to a dose of 54 Gy ventro-dorsally from the abdominal region, including the pelvic and para-aortic lymph nodes.
This is followed by vaginal irradiation in the form of brachytherapy, until the total radiation dose reaches approximately 90 Gy.
As an alternative, the San Marino protocol can be used, which I have successfully applied on several occasions. Currently, the radiation dose in brachytherapy is increased to 90 Gy.
Model A: Cisplatin only, once per week at 40 mg/m², for at least 5 cycles every 7 days. Monday – cisplatin administration, Monday to Friday – radiation therapy, Saturday and Sunday – rest.
This schedule continues for 5 weeks, followed by brachytherapy, preferably again with cisplatin as before.
Model B: See schedule according to the San Marino protocol.
In any case, radiation therapy should be started as soon as possible!!!, which requires treatment planning using CT, or preferably MRI.
Current scientific data support primary combined radiation therapy (abdominal and vaginal) in combination with cisplatin, without subsequent treatment with additional chemotherapeutic agents.
The examples of treatment presented on our website are for informational purposes only and must not be used as medical recommendations. Medications should be administered only under the supervision of a qualified physician.