INTRAPERITONEAL TUMOR SPREAD IN LOCALLY ADVANCED CERVICAL-CARCINOMA UNDERGOING NEOADJUVANT CHEMOTHERAPY

The prognostic significance of peritoneal tumor involvement is still u nclear, correlations with tumor characteristics are somewhat controver sial, and little is known about the peritoneal influence of neoadjuvan t chemotherapy and tumor extension in patients undergoing laparotomy f ollowing clinical response to neoadjuvant chemotherapy. In this study, 208 patients with previously untreated locally advanced cervical carc inoma were primarily treated by neoadjuvant chemotherapy. The 183 clin ically responsive patients underwent laparotomy and, if judged to be r adically operable, they were submitted to radical surgery. At laparoto my, 158 of the 183 patients (86%) were still amenable for radical surg ery; 7 (4%) and 13 (7%) showed macroscopic and microscopic peritoneal tumor involvement, respectively. An intraperitoneal positive cytology was registered in 5 (3%) cases. Stage, histotype, and cervical tumor s ize were each independent predictors of peritoneal tumor involvement u pon logistical analysis. The 10-year survival estimate of patients wit h no peritoneal tumor involvement was longer (72%) than that of patien ts with peritoneal tumor involvement (17%) (P = 0.001). Multivariate a nalysis showed that the peritoneal tumor involvement together with sta ge, pathological parametrial involvement, and lymph node status were i ndependently associated with overall and disease-free survival. Adenoc arcinomas have a higher propensity to peritoneal tumor involvement tha n squamous cell carcinomas; the incidence of atypical peritoneal cytol ogy and, to a lesser extent, microscopic metastasis, are lower than ex pected in patients responsive to neoadjuvant chemotherapy, suggesting a possible effect on peritoneal tumor involvement by neoadjuvant chemo therapy. A positive relationship exists between tumor extent and perit oneal tumor involvement, even in a neoadjuvant chemotherapy setting. P eritoneal tumor involvement is an independent predictor of survival, b ut it is generally associated with other risk factors.