title: A phase II trial of neoadjuvant chemotherapy prior to radical hysterectomy and/or radiation therapy in the management of advanced carcinoma of the uterine cervix.
abstract: OBJECTIVE
  This prospective trial was designed to access the efficacy and safety of neoadjuvant chemotherapy followed by radical hysterectomy and/or radiation therapy in women with advanced carcinoma of the uterine cervix.
  
  
  METHODS
  Thirty women, clinical stages IIb-IVa, were enrolled in this clinical trial. Initial treatment consisted of three cycles of bleomycin, cisplatin, and vincristine administered every 10 days. Depending on the extent of disease after chemotherapy, patients then either underwent radical hysterectomy with bilateral pelvic and periaortic lymphadenectomy or surgical staging. Following review of the surgical findings, tailored radiotherapy was administered.
  
  
  RESULTS
  Only 10 women (34%) had tumor regression from neoadjuvant chemotherapy sufficient to allow radical hysterectomy prior to tailored adjuvant radiotherapy; the remainder received primary radiotherapy after surgical staging. Two-year disease-free survival was 68, 43, and 0% for women with clinical stages II, III, and IV, respectively. Four women experienced acute toxicity from chemotherapy requiring medical intervention and eight women suffered chronic toxicities requiring hospitalization and/or surgery.
  
  
  CONCLUSIONS
  The neoadjuvant chemotherapy utilized in this trial was generally ineffective in converting patients from inoperable to operable, had no apparent effect on survival, and was associated with significant toxicity.
authors.affiliation: Division of Gynecologic Oncology, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas 78236, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Bloss
authors.forename: J A
authors.initials: JA
authors.lastname: Lucci
authors.forename: P J
authors.initials: PJ
authors.lastname: DiSaia
authors.forename: A
authors.initials: A
authors.lastname: Manetta
authors.forename: M A
authors.initials: MA
authors.lastname: Schiano
authors.forename: N
authors.initials: N
authors.lastname: Ramsinghani
authors.forename: M L
authors.initials: ML
authors.lastname: Berman
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000737:chemistry* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D001761:Bleomycin; D014750:Vincristine; D002945:Cisplatin