LONG-TERM RESULTS OF SEQUENTIAL POSTOPERATIVE TREATMENT WITH VINCRISTINE, BLEOMYCIN, MITOMYCIN-C, CISPLATIN AND RADIOTHERAPY AFTER SURGERY FOR HIGH-RISK PATIENTS WITH CERVICAL-CARCINOMA STAGE IB-IIA

Adjuvant treatment of patients with risk factors after surgery for cer vical carcinoma remains unsatisfactory. A combination of radiotherapy and chemotherapy might improve the control of microscopic metastases. In this prospective study, 28 patients with risk factors after surgery for cervical carcinoma underwent a sequential treatment consisting of two courses of chemotherapy with vincristine, bleomycin, mitomycin c and cis-platin (VBMP), followed by radiotherapy with 54 Gy to the pelv is and the aortic nodes. Risk factors mainly consisted of nodes metast ases (25 patients), but patients with parametrial invasion or histolog ic evidence of neoplastic vascular permeation outside the tumor were a lso included in the study. The treatment was well tolerated and all pa tients received the planned dose of chemotherapy and radiotherapy; in the follow-up one patient died of ileal necrosis and one died of pulmo nary embolism after being medically treated for subocclusion. With a m inimal follow-up of 70 months, 15 patients are alive and free of disea se, two have died of complications (one with local recurrence), one ha s died of intercurrent disease and 10 have died of disease (six distan t, four local). The site of recurrence was outside the field of irradi ation in six eases (lungs in two cases, liver and para-aortic nodes in one and distant nodes in three). This treatment is feasible but contr ol of distant metastases in high-risk patients after surgical treatmen t remains unsatisfactory.