title: Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: randomized study.
abstract: OBJECTIVE
  The use of preoperative neoadjuvant chemotherapy (NAC) in locally advanced cervical cancer (LACC) was hindered by the disadvantages of a delay of curative treatment for nonresponders and the development of radioresistant cells. However, these disadvantages may be overcome by a 'quick' high-dose scheme administered in a short period before surgery. Our purpose is to assess the efficacy of NAC with short cycle-length, high-dose agents for LACC.
  
  
  METHODS
  From 1999 to 2004, 142 of patients with LACC (stage IB2IIB, tumor diameter >or=4 cm) were assigned to randomly receive either NAC followed by surgery or primary surgery directly. A modified NAC scheme with short cycle-length, high-dose agents was used.
  
  
  RESULTS
  The overall clinical response rate was 69.4%. The chemotherapeutic response was more favorable in the squamous carcinoma and the tumors smaller than 8 cmP=0.005, P=0.029). Pathologic findings showed that the pelvic metastasis and parametrial infiltration rates were significantly lower in NAC group than in the primary surgery group (P=0.025; P=0.038). Among patients who received NAC, the lymph node metastasis rate was still as high as 45.5% in non-NAC responders, and it decreased to 16.0% in NAC responders (P=0.008). The same thing also occurred with parametrial infiltration: 45.5% in non-NAC responders compared with 16.0% in NAC responders (P=0.008). Survival analysis revealed that although test showed a longer survival in NAC group than in the primary surgery group (P=0.041), Cox hazard analysis did not indicate the therapy modality as a prognostic predictor (P=0.074). However, after further subdivision, we found that NAC responders had longer survival and lower recurrence rate than non-NAC responders (P=0.000; P=0.013). NAC response was also an independent prognostic predictor (P=0.005).
  
  
  CONCLUSIONS
  The modified preoperative NAC is well tolerated and beneficial in reducing tumor size, eliminating pathological risk factors, and improving prognosis for responders. It also avoids the delay of effective treatment for non-NAC responders.
authors.affiliation: Department of Gynecologic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China. huijunchen1981@sina.com
authors.forename: Huijun
authors.initials: H
authors.lastname: Chen
authors.forename: Chuan
authors.initials: C
authors.lastname: Liang
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Shuang
authors.initials: S
authors.lastname: Huang
authors.forename: Xufeng
authors.initials: X
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil