title: Prognostic significance of pathological response after neoadjuvant chemotherapy or chemoradiation for locally advanced cervical carcinoma.
abstract: BACKGROUND
  Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; however, neoadjuvant modalities are currently being tested. Neoadjuvant studies in several tumor types have underscored the prognostic significance of pathological response for survival; however there is a paucity of studies in cervical cancer investigating this issue.
  
  
  METHODS
  Four cohorts of patients with locally advanced cervical carcinoma (stages IB2-IIIB); included prospectively in phase II protocols of either neoadjuvant chemotherapy with 1) cisplatin-gemcitabine, 2) oxaliplatin-gemcitabine, 3) carboplatin-paclitaxel or 4) chemoradiation with cisplatin or cisplatin-gemcitabine followed by radical hysterectomy were analyzed for pathological response and survival.
  
  
  RESULTS
  One-hundred and fifty three (86%) of the 178 patients treated within these trials, underwent radical hysterectomy and were analyzed. Overall, the mean age was 44.7 and almost two-thirds were FIGO stage IIB. Pathological response rates were as follows: Complete (pCR) in 60 cases (39.2%), Near-complete (p-Near-CR) in 24 (15.6 %) and partial (pPR) in 69 cases (45.1%). A higher proportion rate of pCR was observed in patients treated with chemoradiotherapy (with cisplatin [19/40, 47.5%]; or with cisplatin-gemcitabine [24/41, 58.5%] compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5%) for cisplatin-gemcitabine, oxaliplatin-gemcitabine and carboplatin-paclitaxel respectively [p = 0.0001]). A total of 29 relapses (18.9%) were documented. The pathological response was the only factor influencing on relapse, since only 4/60 (6.6%) patients with pCR relapsed, compared with 25/93 (26.8%) patients with viable tumor, either pNear-CR or pPR (p = 0.001). Overall survival was 98.3% in patients with pCR versus 83% for patients with either pNear-CR or pPR (p = 0.009).
  
  
  CONCLUSIONS
  Complete pathological response but no Near-complete and partial responses is associated with longer survival in cervical cancer patients treated with neoadjuvant chemotherapy or chemoradiotherapy.
authors.affiliation: Division of Clinical Research, Instituto Nacional de Cancerología, Mexico City. myrnac@prodigy.net.mx
authors.forename: Myrna
authors.initials: M
authors.lastname: Candelaria
authors.forename: José
authors.initials: J
authors.lastname: Chanona-Vilchis
authors.forename: Lucely
authors.initials: L
authors.lastname: Cetina
authors.forename: Diana
authors.initials: D
authors.lastname: Flores-Estrada
authors.forename: Carlos
authors.initials: C
authors.lastname: López-Graniel
authors.forename: Aaron
authors.initials: A
authors.lastname: González-Enciso
authors.forename: David
authors.initials: D
authors.lastname: Cantú
authors.forename: Adela
authors.initials: A
authors.lastname: Poitevin
authors.forename: Lesbia
authors.initials: L
authors.lastname: Rivera
authors.forename: Jose
authors.initials: J
authors.lastname: Hinojosa
authors.forename: Jaime
authors.initials: J
authors.lastname: de la Garza
authors.forename: Alfonso
authors.initials: A
authors.lastname: Dueñas-Gonzalez