LONG-TERM SURVIVAL FOLLOWING NEOADJUVANT CHEMOTHERAPY AND RADICAL SURGERY IN LOCALLY ADVANCED CERVICAL-CANCER

The aim of this study was to analyse the long-term survival and the re lationships between prognostic factors at presentation, chemoresponsiv eness and disease outcome in patients with locally advanced cervical c ancer treated by neoadjuvant chemotherapy and radical surgery (RS). Tw o consecutive studies of neoadjuvant chemotherapy containing cisplatin , bleomycin plus/minus methotrexate followed by radical hysterectomy a nd systematic aortic and pelvic lymphadenectomy were carried out betwe en January 1986 and September 1990 on 130 patients with greater than o r equal to 4 cm stage IB2-III cervical cancer. Survival analysis was p erformed using the Kaplan and Meier test and Cox's multivariate regres sion analysis. 128 (98%) of the patients enrolled were evaluable for c linical response and survival. 83% (106) of the patients responded to chemotherapy, with a 15% complete response rate. Logistic regression a nalysis demonstrated that International Federation of Gynecology and O bstetrics (FIGO) stage, cervical tumour size, parametrial involvement and histotype are highly predictive of response. Responding patients u nderwent laparotomy, but 8% were not amenable for radical surgery. The 10-year survival estimates were 91%, 80% and 34.5% for stage IB2-IIA bulky, IIB and III, respectively (P < 0.001). After Cox's regression a nalysis, the parameters significantly associated with survival were th e same factors predicting response to neoadjuvant chemotherapy. No sta ge IB2-IIA bulky patient has so far relapsed, while 12% stage IIB and 56% stage III patients recurred. The 10-year disease-free survival est imates are 91% and 44% for stage IB2-IIB and III, respectively (P < 0. 001). Metastatic nodes and persistent tumour in the parametria were th e only two independent factors for disease-free survival after multipl e regression analysis. After a long-term follow-up (median follow-up 9 8 months (20-129+)), our results give new evidence of the prognostic v alue of response to neoadjuvant chemotherapy and of a possible therape utic benefit of the sequential treatment adopted which, however, must be verified in a randomised setting. (C) 1998 Elsevier Science Ltd. Al l rights reserved.