title: A preoperative single course of high-dose cisplatin and bleomycin with glutathione protection in bulky stage IB/II carcinoma of the cervix.
abstract: One course of preoperative chemotherapy including high-dose cisplatin (40 mg/m2 daily for 5 consecutive days) with glutathione protection and bleomycin (15 mg on days 2, 8 and 9) was administered to 27 patients with bulky operable cervical carcinoma (stage IB/II) in a pilot study. In all patients the tumor diameter was greater than 4 cm. Surgery (radical hysterectomy with pelvic and para-aortic lymphadenectomy) was planned within one month of chemotherapy. In 27 evaluable patients, nausea/vomiting was the most pronounced side effect. Significant (but transient) increases in serum transaminases were detected in 19 patients. Electrolyte imbalance (hypokalemia) was detected in 6 patients (one with hypocalcemia). These reversible effects were not associated with other signs of renal toxicity. Objective clinical responses were observed in 21 patients, 18 of them partial and 3 complete responders (pathologically confirmed in 2). Radical hysterectomy with pelvic and para-aortic lymphadenectomy was performed with no particular complications. The shrinking of bulky tumor made the operation easier, especially in parametrial resections. High-dose cisplatin chemotherapy prior to surgery is feasible with acceptable toxicity. The encouraging results of this study warrant further investigations to define the role of neoadjuvant therapy.
authors.affiliation: Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fontanelli
authors.forename: G
authors.initials: G
authors.lastname: Spatti
authors.forename: F
authors.initials: F
authors.lastname: Raspagliesi
authors.forename: F
authors.initials: F
authors.lastname: Zunino
authors.forename: F
authors.initials: F
authors.lastname: Di Re
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005978:Glutathione / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011300:Preoperative Care; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D001761:Bleomycin; D005978:Glutathione; D002945:Cisplatin