Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in the management of stage IB2-IIB cervical cancer

Int J Gynaecol Obstet. 2012 Apr;117(1):23-6. doi: 10.1016/j.ijgo.2011.11.017. Epub 2012 Jan 21.

Abstract

Objective: To evaluate clinical efficacy, toxicity, and survival outcomes of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) among patients with cervical cancer stage IB2-IIB.

Methods: In a retrospective clinical study at West China Second Hospital, Chengdu, data were analyzed from 414 patients who underwent NACT followed by radical surgery (NACT-RS) or RS alone between January 2008 and November 2009.

Results: The clinical response for NACT was 90%. Lymph node metastasis (25% versus 48%, P<0.05) and deep cervical stromal invasion more than 0.5, (68% versus 91%, P<0.05) were significantly lower among responders than among non-responders, respectively, in the NACT-RS group. The 2-year progression-free survival and 2-year overall survival were 93.0% and 95.5% in the NACT-RS group, and 94.5% and 97.1% in the RS group (P>0.05). Parametric infiltration (hazard ratio [HR], 7.668; P<0.05) and lymph node metastasis (HR, 7.714; P<0.05) were independent risk factors for all study patients.

Conclusion: Compared with RS, NACT-RS did not show a significant advantage for patients with locally advanced cervical cancer. However, the data provide the rationale for assessing NACT-RS in a multicenter randomized clinical trial setting. NACT may be considered as an alternative treatment when radiotherapy is not available.

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / administration & dosage
  • Bleomycin / analogs & derivatives
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / therapy*
  • Chemotherapy, Adjuvant
  • Cisplatin / administration & dosage
  • Disease-Free Survival
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Hysterectomy
  • Ifosfamide / administration & dosage
  • Kaplan-Meier Estimate
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Invasiveness
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / therapy*
  • Young Adult

Substances

  • Bleomycin
  • bleomycetin
  • Cisplatin
  • Fluorouracil
  • Ifosfamide

Supplementary concepts

  • DDP-BLM protocol