The standard of care for treatment of locally advanced cervical cancer in the non-metastatic setting is a combination of radiation and chemotherapy. Radiotherapy for non-metastatic cervical cancer currently consists of radiation in the form of external beam delivered over 5-6 weeks of daily therapy followed by or interdigitated with intracavitary brachytherapy. Chemotherapy is used as a sensitizing agent with radiation and this is associated with substantial improvement in local control and overall survival. The treatment of metastatic cervical cancers is challenging, The standard of care for patients with metastatic disease is systemic therapy alone. The treatment of metastatic cervical cancers is challenging, with many patients developing resistance to platinum based chemotherapy and progressing through multiple lines of treatment. Although early stage cervical cancer is highly treatable with an excellent prognosis, recurrent and metastatic disease poses a significant treatment challenge. Several large clinical trials have demonstrated significant improvements in progression free and overall survival rates with the treatment of the local disease in other sites, eg head and neck and prostate cancer . These outcomes have generated optimism for aggressively treating local disease in the metastatic setting. Furthermore retrospective studies have demonstrated improvement in OS with treatment of the primary with radiation in women with metastatic cervical cancer. None of the studies have standardized their methods of treatment. In addition, treating metastatic patients with conventionally fractionated radiation treatment will prolong treatment time and can interrupt with systemic therapy which is critical for distant disease. With imaged-based ultrafractionated radiation, high doses can be delivered without inordinately large expansion margins and shortens treatment time. Moreover, studies have shown that the dose of radiation matters with higher doses associated with improved outcomes. These high doses levels can only be achieved with modern image guidance that limits expansion margins of radiation planning. Further pulsar technique allows for adaptation to the patient's tumor and anatomy and this process reduces the dose to the normal structures, thus minimizing serious toxicity in a metastatic population. There are no prospective trials of radiation in this setting. Currently, the standard of care remains cisplatin-based doublet therapy +/- avastin and this combination with radiation treatment has the potential to change outcomes and the could impact the management for this patient population
To improve overall survival in patients with metastatic cervical cancer by loco-regional therapy with ultra-fractionated radiation therapy