LOCALLY ADVANCED CERVICAL ADENOCARCINOMA - IS THERE A PLACE FOR CHEMO-SURGICAL TREATMENT

The increased frequency and poor prognosis of cervical adenocarcinoma call for new therapeutic strategies, especially in locally advanced di sease. Combined neoadjuvant chemotherapy (NACT)-radical surgery (RS) h as been investigated to assess its feasibility and the possible impact on disease outcome. Data were pooled from three consecutive trials on a total of 42 patients with FIGO Stage IB-IIA >4 cm (9), IIB (19), an d IIIB (14) cervical adenocarcinomas. NACT regimens consisted of cispl atin (P), bleomycin (B) and methotrexate, high-dose PB, and P and doxo rubicin combinations, for one to three cycles. Responding patients und erwent RS while those still ineligible for RS underwent radiotherapy. Fisher and chi(2) tests were used to defect significant factors affect ing response to NACT. Cox multivariate regression analysis was used to evaluate parameters affecting response and survival. Medians and life tables were computed by the method of Kaplan and Meier. Median follow -up times were 56 (17-95) and 54 months (15-92) from enrollment and RS , respectively. NACT-induced toxicity was generally mild and did not c ompromise RS when indicated. The 33 (79%) responders underwent laparot omy, while the 9 nonresponders received radiotherapy. RS was feasible in 29 (69%) patients. Macroscopic intraperitoneal tumor (IPT) excluded abandoning RS in 4 cases. Mild to moderate RS-related complications w ere seen in 41% of cases with the same pattern as in the absence of an y prior treatment. In patients undergoing RS, node metastasis and micr oscopic IPT were detected in 2 (7%) and 3 (10%) patients, respectively . The 5-year overall and disease-free survivals were 71% (100% IB-IIA and 84% IIB vs 36% IIIB; P = 0.001) and 88%, respectively. None of the nonresponders survived (median 10 months, 6-25), compared with an 84% 5-year survival of responders (P < 0.001). FIGO stage and parametrial involvement significantly predicted response to NACT which was the on ly independent variable affecting survival (P = 0.006). This retrospec tive study provided evidence of the chemosensitivity of locally advanc ed cervical adenocarcinoma and that chemoresponsiveness is the most po tent predictor of cure, as demonstrated in squamous cell cervical canc er. Combined NACT and RS is a feasible treatment which seems to he abl e to improve the outcome of Stage IB-IIB cervical adenocarcinoma. Rand omized trials comparing this new strategy with conventional treatments seem to be warranted. (C) 1996 Academic Press, Inc.