NEOADJUVANT CHEMOTHERAPY FOR STAGES IIB-I II CERVICAL CANCERS - LONG-TERM FOLLOW-UP OF PLURICENTRIC RANDOMIZED STUDY OF 151 PATIENTS

Neoadjuvant chemotherapy for stages IIb-III cervical cancers. Long-ter m follow-up of pluricentric randomized study of 151 patients. Present chemotherapy, with cisplatin combinations, currently offers the possib ility of seeking adjuvant therapy in locally advanced and bulky carcin omas of the cervix, which have an unfavorable prognosis (nodal involve ment). This initial adjuvant chemotherapy may improve the results of c lassical pelvic irradiation. From 1982 to 1987, a randomized phase III trial was perfonned in order to determine the long term effect of ind uction chemotherapy before irradiation in stage Ilb-N1, III, MO squamo us cell carcinomas of the cervix. Radiotherapy (R) for all patients co nsisted in 50 Gy in the pelvis with a boost by external irradiation of the brachytherapy (cumulative dose of 68 Gy). The chemotherapy regime n (C + R group) was an association of methotrexate, chlorambucil, vinc ristine mid cisplatin, given every 3 weeks, at least two courses were to be given before assessing efficacy and two more courses were given to patients who responded. After a follow up of 5-10 years, 76 patient s were fully evaluable in the R arm and 75 in the C + R ann. The respo nse rate (> 50%) to chemotherapy was 42,5% and after completion of tre atment, remission rate was 93% in the R ann arm 96% in the C + R ann. The disease-free survival was 40% in the C + R group and 35% in the R group, and the median survival was 42 and 45 months respectively (NS). The survival of patients with a complete response at the end of radio therapy was significantly better in the C + R group when they are resp onding to chemotherapy, than in R group (P < 0,05). Radiotherapy was n ot modified whether patients had an initial chemotherapy or not; toler ance was not significantly different between the two groups. Efficacy of induction chemotherapy is an available test for long term results. This approach has the potential for improving the outlook in patients with high-risk primary cancer: earlier use and higher dose intensity o f chemotherapy may be associated with a better cytoreduction, and prob ably a better survival. Further controlled investigations are warrante d to confirm the value of adjuvant chemotherapy in cervical cancer.