In women with locally advanced cervical cancer (Stage IIB–IVA) treated with concurrent chemoradiation, which chemotherapy regimen is the current standard of care and what is its mechanism of radiosensitisation?

• A Paclitaxel + carboplatin every 3 weeks; mitotic arrest enhances radiation-induced apoptosis
• B Bevacizumab + cisplatin; VEGF-A inhibition enhances radiation penetration
• C Weekly cisplatin 40 mg/m²; inhibits DNA repair by forming intra-strand crosslinks, preventing radiation-induced DNA break repair ✓
• D 5-fluorouracil infusion; thymidylate synthase inhibition causes S-phase arrest

Explanation

Concurrent weekly cisplatin (40 mg/m² weekly × 5–6 cycles) during external beam radiotherapy followed by brachytherapy is the standard of care for locally advanced cervical carcinoma, based on five landmark GOG trials (1999) showing >50% reduction in cervical cancer mortality. Cisplatin forms platinum-DNA adducts (intra-strand crosslinks), inhibiting DNA repair mechanisms particularly in rapidly proliferating cells, thereby enhancing cell killing by ionising radiation. Paclitaxel-carboplatin is used in recurrent/metastatic disease. Bevacizumab is added in recurrent/metastatic disease (GOG-240 trial), not as primary concurrent sensitiser.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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