MAJOR DEPARTURE IS SUGGESTED IN TREATMENT OF CERVICAL CANCER.

Byline: Denise Grady The New York Times

Cancer experts are recommending a major change in the treatment of advanced cervical cancer, urging that chemotherapy be added to the standard treatment: radiation. The recommendation is based on five new studies showing that the combination reduces death rates from the disease by 30 percent to 50 percent.

Officials at the National Cancer Institute announced the findings Monday and said they were mailing the new recommendation to 20,000 cancer specialists worldwide in a ``clinical announcement,'' only the fourth such notification in the past 10 years. Such announcements are used to alert doctors to important advances in treatment.

The five new studies will not be published in medical journals until later this year, but the journal editors agreed it was imperative to release the information early so it could be used to help patients now being treated. The New England Journal of Medicine, which will publish three of the papers in April, already has posted them on its Web site.

The new findings apply to women with cancers classified as ``locally advanced'' or ``invasive,'' meaning that the tumor on the cervix is large or has spread to nearby lymph nodes or other parts of the pelvis. About 25 percent of women with cervical cancer in the United States fall into that category. An estimated 12,800 new cases of the disease are expected in 1999.

The recommendation for combined treatment does not apply to women with earlier stages of the disease, who do not need such aggressive therapy, or to women with cancer that has spread beyond the pelvis, who are considered unlikely to benefit. They also do not apply to women who have already completed a course of radiation treatment.

``This is the first substantive change in the treatment of advanced cancer of the cervix in 40 years,'' said Dr. Mitchell Morris, who studied the combination treatment at the University of Texas M.D. Anderson Cancer Center in Houston.

Dr. Edward Trimble, head of the surgery section at the cancer therapy evaluation program at the National Cancer Institute, said: ``We think that based on these data the standard of care should change. These are modalities available in every hospital treating women with cervical cancer and should be adopted into clinical practice immediately.'' He said he expected the combination treatment to save thousands of lives a year.

Among women ages 35 to 54, cervical cancer is the fifth-leading cause of death from cancer, after tumors of the breast, lung, colon and rectum and ovary. The overall number of deaths in the United States, 4,800, though small in comparison to the 47,000 deaths from breast cancer, is excessive nonetheless, researchers say.