IMR Press / EJGO / Volume 19 / Issue 4 / pii/1998180

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Original Research

Neoadjuvant chemotherapy followed by radical hysterectomy and postoperative adjuvant chemotherapy in the treatment of carcinoma of the cervix uteri: long-term follow-up of a pilot study

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1 Gynecologic Oncologic Unit, 1st Clinic of Gynecology, Buenos Aires University Hospital, Argentina
Eur. J. Gynaecol. Oncol. 1998, 19(4), 368–373;
Published: 10 August 1998

Objective: The aim of the study was to determine if ACH given after NCH followed by RH could decrease the incidence of distant metastases in patients with locally advanced carcinoma of cervix uteri. Material: 56 pts (34 Ib. 18 IIb, 4 IIIb) with confirmed diagnosis of squamous cervical cancer were enrolled in this phase II trial. The methodology used was: 1) Figo clinical staging; 2) Ultrasonographic determination of tumor volume in < or > 4 cms; 3) V.B.P. scheme: cis-platinum 50 mg/m2/day 1; vincristine 1 mg/m2/day 1; bleomycin 25 mg/m2/days 1-2-3 (3 courses with 10 days interval); 4) Clinical and sonographic tumor response evaluation following U.I.C.C. response criteria; 5) Radical hysterectomy; 6) Patho­logical risk factor evaluation; 7) ACH with P.M.C. (cis-platinum 50 mg/m2. methotrexate 30 mg/m2, ciclophosfamide 500 mg/m2) 3 courses every 21 days; 8) Comparison and location of recurrences with a neoadjuvant group (NCH + RH + RT to whole pelvis), and with a control group treated with conventional radiotherapy were done. For statistical analysis the Chi-Square was used and D.F.S. and overall survival (O.S.) were calculated according to the Kaplan Meier and Log Rank Test. Results: After a median follow-up of 75 months (range 42-108), O. S. for stage Ib was 88%, Stage IIb 78%, and 50% for IIIb. The recurrences were 12% (4/34) for Stage Ib (3 local and 1 distant); 28% for IIb (5/18) (4 pelvic and 1 distant); 50% (2/4) for IIIb (2 pelvic recurrences). When residual tumor volume was < 2 cm in the surgical specimen (n = 39) there were 4 recurrences (3 pelvic and 1 distant), and 7 (6 pelvic and l distant) for tumors > 2 cm. (p < 0.01 for pelvic recurrences). For the stage Ib with residual tumor < 2 cm (n = l4) there were no pelvic recurrences and only 1 distant. Comparing for Stage Ib with previous tumor volume >4 cm of the ACH Group (n = 17) with a classical NCH (n = 5l) and control (n = 5l) groups, there were observed 2 (11.7%) pelvic and I (5,8%) distant relapses for the lst. Group, 3 (5.9%) pelvic and 3 (5.9%) distant relapses for the 2nd, and 11 (21.6%) pelvic and 5 (9.8%) distant relapses for the 3rd. Group. From the comparison of locally advanced tumors (Stages IIb + IIIb) of ACH group (n = 22), with a Stage IIIb surgically removed of classical NCH group (n = 38) and with a control group of conventional RT (n = 5l). there were observed 6 (27%) pelvic and 1 (4.5%) distant relapses for the 1st Group, 4 (11%) pelvic and 7 (18.4%) distant relapses for the 2nd, and 31 (60.7%) pelvic and 5 (9.8%) distant for the 3rd one. Conclusion: ACH after NCH + RH could be used for stage Ib with tumor volume > 4 cm, with complete clinical response or resi­dual tumor < 2 cm. The results of this group of tumors suggest the importance of going on phase III trials comparing NCH+RH alone vs. NCH+RH+ACH. ACH could also be used to try to obtain better control of distant metastases in Stages IIb and IIIb. In these cases radiotherapy to the whole pelvis must not be excluded.

Neoadjuvant chemotherapy
Radical hysterectomy
Postoperative adjuvant chemotherapy
Sandwich scheme
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