NEOADJUVANT CHEMOTHERAPY AND BRACHYTHERAPY - A NEW PERSPECTIVE IN THETHERAPY OF ADVANCED CERVICAL-CARCINOMA

A prospective study with a neoadjuvant radiochemotherapy (NRCHT) regim e was designed in order to achieve operability or to increase efficacy of subsequent external irradiation in locally advanced cervical carci noma. The therapy consisted of 3 courses carboplatin 300 mg/m(2) on da y 1 plus ifosfamide 2 g/m(2) on days 1-3 repeated every 4 weeks in com bination with 5 intracavitary brachytherapy courses with altogether 40 Gy/A. In case of operability patients underwent radical hysterectomy with lymphadenectomy. In all other cases followed a full course of ext ernal-beam irradiation consisting of 50.5 Gy in the ICRU50 reference p oint. 44 patients (x=53.6 years) with stage IIB (3) and IIIB (41) canc ers were enrolled. After NRCHT clinical CR and PR were achieved in 7 ( 15.9%) and 31 (70.4%) patients, respectively (total 86.3%). Surgery wa s possible in 15 (34.1%) patients. Histological CR was observed in 10 (66.7%) of them. Two (4.6%) patients experienced a NC and 3 (6.8%) a P D. One (2.3%) woman with PD died due to myelosuppression. All patients with CR and PR received 3 further chemotherapy courses after surgery or irradiation. The 5-year overall survival according to Kaplan and Me ier was 63% in all patients but 80% and 54% in the operated and in the irradiated group, respectively. The preliminary data indicate that th erapeutic results of advanced cervical cancer may be improved by NRCHT .