Neoadjuvant chemotherapy followed by radical surgery in patients affected by FIGO stage IVA cervical cancer.
BACKGROUND
Concomitant chemoradiotherapy represents the standard treatment for patients affected by locally advanced cervical cancer. Survival rates in patients affected by FIGO stage IVA disease remain poor. Some authors have suggested that neoadjuvant chemotherapy followed by radical surgery might be a valid alternative to standard treatment. The objective of this study was to analyze the feasibility and results obtained by neoadjuvant chemotherapy in patients affected by stage IVA disease.


METHODS
Eighteen patients affected by FIGO stage IVA cervical cancer were treated with 175 mg/m(2) paclitaxel and 75 mg/m(2) cisplatin every 21 days for three courses followed by radical surgery when feasible.


RESULTS
All patients were subjected to the three planned chemotherapy courses. Two patients achieved a complete clinical response, and 10 patients achieved a partial clinical response. Ten patients were subjected to anterior pelvic exenteration, whereas the remaining eight patients were treated with chemotherapy, radiotherapy, and concomitant chemoradiotherapy. The estimated 3-year and 5-year overall survival rates were 47.4% and 31.6%, respectively. Patients eligible for surgery benefited from significantly longer survival rates.


CONCLUSIONS
Neoadjuvant chemotherapy followed by radical surgery is feasible in approximately half of patients affected by FIGO stage IVA cervical cancer. Overall survival rates appear similar to those reported with concomitant chemoradiotherapy. Patients who are amenable to radical surgery after chemotherapy may benefit from long-term survival rates.
Benedetti Panici
Pierluigi
P
Department of Obstetrics and Gynecology, University of Rome La Sapienza, Viale del Policlinico, 155, Rome, Italy. pierluigi.benedettipanici@uniroma1.it
Bellati
Filippo
F
Manci
Natalina
N
Pernice
Milena
M
Plotti
Francesco
F
Di Donato
Violante
V
Calcagno
Marco
M
Zullo
Marzio Angelo
MA
Muzii
Ludovico
L
Angioli
Roberto
R
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
D017239:Paclitaxel; D002945:Cisplatin