NEOADJUVANT CHEMOTHERAPY WITH VINCRISTINE AND CISPLATIN FOLLOWED BY RADICAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY FOR FIGO STAGE IB BULKYCERVICAL-CANCER - A GYNECOLOGIC-ONCOLOGY-GROUP PILOT-STUDY

Thirty-five patients with bulky (designated as greater than or equal t o 4 cm size) International Federation of Gynaecology and Obstetrics (F IGO) Stage IB cervical cancer were treated with cisplatin, 50 mg/m(2), and vincristine, 1 mg/m(2), administered intravenously at 10-day inte rvals for a total of three courses before planned radical hysterectomy , One patient died of unrelated cause following one course of chemothe rapy and was not evaluated for response. Of the 34 evaluable patients who completed chemotherapy, a complete clinical response was noted in two patients (6%) and a partial response in 26 patients (76%). Five pa tients (15%) had stable disease and one patient (3%) had disease progr ession, All chemotherapy was completed within 4 weeks (range 17-28 day s). There was no grade 4 toxicity noted, Only one case each of reversi ble grade 3 granulocytopenia and stomatitis and two cases of reversibl e grade 3 peripheral neuropathy were noted, Of the 34 patients who rec eived chemotherapy, the only patient with disease progression received standard pelvic radiation therapy in lieu of radical surgery. A secon d patient with stable disease had unresectable pelvic lymph node metas tases and underwent confirmatory lymph node biopsy only and received s tandard radiation therapy postoperatively, The remaining 32 patients u nderwent radical hysterectomy and pelvic lymphadenectomy from 12 to 49 days following chemotherapy. Surgery was performed without significan t difficulty. Eight of these patients (25%) had pelvic node metastases and received postoperative pelvic radiation therapy, Twenty-four mont hs following initiation of treatment, 25 (74%) were alive and presumed free of disease, 4 had died of cancer (12%), 1 was alive with recurre nce (3%), and 4 patients (12%) were lost to follow-up, A prospective r andomized study is needed to assess the value of this approach compare d with standard management. (C) 1995 Academic Press, Inc