MULTIMODAL TREATMENT WITH NEOADJUVANT INTRAARTERIAL CHEMOTHERAPY AND RADICAL SURGERY IN PATIENTS WITH STAGE IIIB-IVA CERVICAL-CANCER - A PRELIMINARY-STUDY

Background, The purpose of this study was to determine the role of neo adjuvant intraarterial chemotherapy (NIC) in patients with advanced ce rvical cancer. Methods. From June 1989 to December 1993, 36 consecutiv e patients with International Federation of Gynecology and Obstetrics Stage IIIB-IVA cervical cancer were admitted to the study, Treatment c onsisted of a bilateral infusion in the internal iliac artery of bleom ycin (2.5 mg), doxorubicin (10 mg), and cisplatin (20 mg) for five cou rses after a 4-day rest period. Results. Twenty-nine (80.5%) patients received 100% df the programmed chemotherapeutic dose. The major toxic effects, according to World Health Organization criteria, were hemato logic (19.4%, Grade 3 or 4), renal (2.8%, Grade 2), and gastrointestin al (61.1%, Grade 1 or 2), Only four patients (11.1%) had scanty bleedi ng around the site of catheter insertion, Neoadjuvant intraarterial ch emotherapy induced responses in 33 of the 36 patients (5 complete, 28 partial; overall response rate, 91.7%), thus permitting radical surger y in all of these cases, Pretreatment characteristics were analyzed fo r response to NIC, None of the clinical parameters studied were relate d to chemoresponsiveness. A lower than expected incidence of lymph nod e metastases was detected (33.3%). Ten (30.3%) of the 33 patients who underwent surgery had disease recurrence. Lymph node status and pathol ogic parametrial involvement were significant prognostic factors for r ecurrence, The 5-year estimated survival for patients with a complete response, partial response, and stable disease was 100%, 36.2%, and 0% , respectively (P < 0.001). Clinical stage (P = 0.003) and response to NIC (P < 0.001) were significant prognostic factors in the overall es timated survival. The 5-year actuarial survival for patients with Stag e IIIB and IVA disease was 66.7% and 0%, respectively. Conclusion. The se results suggest that NIC should be considered as a means of achievi ng prompt local control before surgery and/or radiotherapy.