Neoadjuvant chemotherapy followed by radical surgery and radiotherapy vs. pelvic irradiation in patients with cervical cancer FIGO stage IIB - IVA.
OBJECTIVE
To compare the 2-year recurrence-free survival, recurrence rates and their localization after treatment with definitive radiation therapy (RT) vs. neoadjuvant chemotherapy (NCT) followed by radical surgery and post-operative RT in cervical cancer patients with FIGO stages IIB through IVA.


METHODS
43 patients were included in the study, 25 of whom (group 1) were treated with pelvic RT(50-52 Gy external beam RT) and 18 (group 2) with NCT followed by surgery and postoperative RT(50-52 Gy). The operations performed were class III-V radical hysterectomy with total pelvic and paraaortic lymph node dissection. NCT included 3 courses of cisplatin, ifosfamide and bleomycin delivered every 3 weeks. In group 1, 17 (68%) patients were staged IIB and 8 (32%) IIIB; 23 (92%) patients had squamous cell carcinoma and 2 (8%) adenocarcinoma. In group 2, 13 (72.2%) patients were staged IIB, 4 (22.2%) IIIB and 1 (5.6%) IVA. All 18 patients had squamous cell carcinoma. The median age of group 1 and 2 patients was 54.6 years (range 35-71) and 46.3 years (range 32-64), respectively.


RESULTS
The 2-year recurrence-free survival for group 1 was 47.3% and 76.7% for group 2 (p=nonsignificant). Pelvic recurrences were seen in 28% in group 1 and 11.1% in groups 1 and 2 were 8% and 16.7%, respectively (p=nonsignificant).


CONCLUSIONS
In FIGO stages IIB-IVA cervical cancer patients cisplatin-based NCT followed by surgery and postoperative external beam RT lead to a better 2-year recurrence-free survival compared to pelvic RT alone. The latter is connected with higher, but not statistically significant local recurrence rates in comparison with the NCT/surgery/ postoperative RT group.
Kornovski
Y
Y
Clinic of Gynecology, St.Anna Hospital, Medical University, Varna, Bulgaria. ykornovska@abv.bg
Gorchev
G
G
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010388:Pelvis / Q000528:radiation effects; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*