NEOADJUVANT CHEMOTHERAPY IN STAGE IB2 SQUAMOUS-CELL CARCINOMA OF THE CERVIX

To determine the effects of neoadjuvant chemotherapy (NAG) in the mana gement of cervical carcinoma Stage IB2 (tumor diameter >4 cm), we revi ewed 52 surgically treated patients diagnosed between January 1987 and December 1993. There were 20 patients treated with preoperative neoad juvant chemotherapy and 32 treated by primary radical hysterectomy. Me an tumor diameter was significantly larger in the neoadjuvant, compare d with the primary surgery group (6.5+/-1.8 vs 5.4+/-0.7, P=0.003). In the NAC group, 5 of 20 patients were treated with three courses of ci splatin, methotrexate, and bleomycin every 21 days, whereas 15 of 20 p atients received three courses of cisplatin, vincristine, and bleomyci n every 10 days. Postoperative adjuvant therapy consisting of either r adiation or chemotherapy was employed in 13/ 20 patients (65%) in the NAC group and 20/32 patients (63%) in the primary surgical group. At a median follow-up of 52.5 months, 4/20 patients (20%) in the NAC group recurred vs 11/32 (34%) in the primary surgery group. The overall res ponse rate to NAC was 90%, with 2/20 complete clinical responders and 16/20 partial responders. High-risk pathologic factors were less commo nly observed in the NAC group when compared with the primary surgical group with the incidence of nodal metastases, positive vascular space involvement, undiagnosed parametrial disease, and greater than or equa l to 75% depth of invasion observed in 10.0% vs 37.5%, 20.0% vs 46.9%, 0.0% vs 15.6%, and 30.0% vs 68.8%, respectively. No differences were noted in operative time or blood loss. Cox proportional-hazards analys is indicated that the most significant prognostic factor was depth of invasion. Although the patients who received neoadjuvant chemotherapy had significantly larger tumors at baseline, their 5-year survival rat e was slightly higher than that of the primary surgery group (80.0% vs 68.7%, P=0.162). Patients receiving neoadjuvant chemotherapy, despite having significantly larger pretreatment tumors, had fewer high-risk pathologic factors, postoperatively. Although this was a small, nonran domized study, the relative improvement in pathologic response and lon gterm outcome associated with neoadjuvant chemotherapy was encouraging . This highlights the need for a prospective randomized clinical trial to establish whether neoadjuvant chemotherapy can significantly impro ve the long-term outcome of women with Stage IB2 squamous cell carcino ma of the cervix. (C) 1997 Academic Press.