title: Explanation for the failure of neoadjuvant chemotherapy to improve outcomes after radiotherapy for locally advanced uterine cervical cancer from the standpoint of the tumor regression rate.
abstract: OBJECTIVE
  Treatment outcomes for patients with locally advanced cervical cancer are no better with neoadjuvant chemotherapy (NAC) combined with radiotherapy (RT) than with RT alone. We investigated the reason for this failure from the standpoint of the tumor regression rate (RR).
  
  
  METHODS
  A total of 48 patients with clinical stage IIB-IVA cervical squamous cell carcinoma were treated clinically with cisplatin-based NAC plus RT (n = 15) or RT alone (n = 33). The RR was defined as the slope of a tumor shrinkage curve derived with magnetic resonance images. The local control rate (LCR) and disease-free rate (DFR) were estimated by clinical stage (IIB vs. III-IVA), pretreatment volume (< or = median vs. > median), lymph node status (negative vs. positive), treatment type, overall treatment time (< or =8 weeks vs. >8 weeks), and RR (< or = median vs. > median) using univariate and multivariate analyses.
  
  
  RESULTS
  RR during NAC or during NAC and RT (n = 15) was not significantly higher than RR by RT alone (n = 33). Low RR and positive nodal status were significantly powerful prognostic factors for both the LCR and DFR, whereas the others were not.
  
  
  CONCLUSIONS
  Although effective in reducing tumor volume prior to RT, NAC showed no overall effect in increasing the RR, which was shown to be the most powerful prognostic factor.
authors.affiliation: Department of Radiation Oncology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan. ki-ohara@md.tsukuba.ac.jp
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Hajime
authors.initials: H
authors.lastname: Tsunoda
authors.forename: Yumiko Oishi
authors.initials: YO
authors.lastname: Tanaka
authors.forename: Kayoko
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Keiko
authors.initials: K
authors.lastname: Nemoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Fukumitsu
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hata
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Akine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*