title: Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: single institution experience.
abstract: OBJECTIVE
  The aim of the study is to evaluate the response to neoadjuvant chemotherapy (NACHT) of patients with recurrent cervical cancer who were poor candidates for pelvic exenteration (PE), and the impact on DFS and OS.
  
  
  METHODS
  A retrospective data collection extracted from medical records of 61 patients submitted to pelvic exenteration was performed: 30 underwent up-front exenterative procedure whereas 31 received NACHT.
  
  
  RESULTS
  The median tumor size was significantly (P=0.0006) larger in the NACHT group compared to the up-front PE one (43.9 mm vs 28 mm), and a significant (P=0.04) higher percentage of patients (45 vs 20%) had lateral pelvic wall invasion in the NACHT group. No statistically significant difference in early and late complications was observed in the two groups. Median overall survival in study population was 42.9 months (95% CI: 22.2, 180.8). Median overall survival times as well as recurrence free survival times were not significantly different between NACHT (42.9 months and 36.1 months for OS and DFS respectively) vs. No NACHT (111.9 months and 48.1 months for OS and DFS respectively). There was an overall significant difference in DFS between negative and positive margins but the curves were similar for NACHT and up-front PE groups stratified by resection margin status.
  
  
  CONCLUSIONS
  In our series, though small and retrospective, NACHT prior to PE represents a feasible therapeutic option without intra-operative and early post-operative mortality or worsening of early and late complication rate and with acceptable long-term survival and DFS for recurrent cervical cancer patients who are poor candidates for up-front pelvic exenteration.
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Landoni
authors.forename: V
authors.initials: V
authors.lastname: Zanagnolo
authors.forename: P G
authors.initials: PG
authors.lastname: Rosenberg
authors.forename: A
authors.initials: A
authors.lastname: Lopes
authors.forename: D
authors.initials: D
authors.lastname: Radice
authors.forename: L
authors.initials: L
authors.lastname: Bocciolone
authors.forename: G
authors.initials: G
authors.lastname: Aletti
authors.forename: G
authors.initials: G
authors.lastname: Parma
authors.forename: N
authors.initials: N
authors.lastname: Colombo
authors.forename: A
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery*; D010385:Pelvic Exenteration; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*