title: Is there a role for postoperative treatment in patients with stage Ib2-IIb cervical cancer treated with neo-adjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy [NACT] followed by radical hysterectomy is an alternative therapeutic option to concurrent chemotherapy-radiotherapy for locally advanced cervical cancer. However there are very few data about the effectiveness of any post-operative treatment in this clinical setting. The purpose of this study was to correlate the patterns of recurrence and the clinical outcomes of cervical cancer patients who received NACT, with postoperative adjuvant treatment.
  
  
  METHODS
  This retrospective multicenter study included 333 patients with FIGO stage Ib2-IIb cervical cancer who underwent platinum-based NACT followed by radical surgery. Pathological responses were retrospectively assessed as complete; optimal partial; and suboptimal response. Overall optimal response rate was the sum of complete and optimal partial response rates.
  
  
  RESULTS
  On the whole series, recurrence-free survival was significantly longer in patients who achieved an overall optimal response than in those who did not (p<0.0001), and in patients who received adjuvant chemotherapy compared to those who did not (p=0.0001). On multivariate analysis, consolidation therapy (p=0.0012) was the only independent prognostic variable for recurrence-free survival; whereas FIGO stage (p=0.0169) and consolidation therapy (p=0.0016) were independent prognostic variables for overall survival.
  
  
  CONCLUSIONS
  Optimal responders after chemo-surgical treatment for FIGO stage Ib2-IIb cervical cancer do not need any further treatment. Additional cycles of chemotherapy could be of benefit for patients with suboptimal response and intra-cervical residual disease. Both adjuvant chemotherapy and adjuvant radiation treatments do not seem to improve the clinical outcome of patients with extra-cervical residual disease compared to no further treatment.
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Sartori
authors.affiliation: Unit of Gynecology and Obstetrics, Umberto I Hospital, Venice-Mestre, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Maggino
authors.affiliation: Department of Surgical Science, University of Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zola
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cosio
authors.affiliation: Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Department of Surgical Science, University of Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Piovano
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy. Electronic address: a.gadducci@med.unipi.it.
authors.forename: A
authors.initials: A
authors.lastname: Gadducci
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin
keywords: Adjuvant treatment; Cervical cancer; Chemotherapy; Survival