title: Multimodal therapy including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for stage IIB to IV cervical cancer.
abstract: OBJECTIVE
  The purpose of this study was to determine the survival rates and toxicity levels that are associated with multimodal therapy (including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin [MVAC]) in patients with stage IIB to IVB cervical cancer.
  
  
  METHODS
  We retrospectively reviewed the cases of 49 patients who were treated between 1989 and 1997 with neoadjuvant MVAC for advanced cervical cancer.
  
  
  RESULTS
  The clinical response rate was 90% (27 partial responders, 17 complete responders). Grade 3 or greater toxicity was mostly limited to neutropenia; no deaths were attributed to MVAC. Combined therapy after MVAC included operation in 34 patients (69%) and radiation in 41 patients (84%). Twenty-one patients (43%) had <2 cm residual tumor at histologic evaluation. Pelvic control was achieved in 86% of patients. Five-year disease-specific survival for patients with stage III disease was 60%.
  
  
  CONCLUSIONS
  For patients with advanced cervical cancer, neoadjuvant MVAC had a high response rate (90%) and an acceptable toxicity level. Compared with historic control subjects, multimodal treatment may be associated with improved rates of pelvic control.
authors.affiliation: Section of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Cecelia H
authors.initials: CH
authors.lastname: Boardman
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Wilson
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Hartmann
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Long
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D009503:Neutropenia / Q000139:chemically induced; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate