Long-term follow-up of neoadjuvant cisplatin and 5-fluorouracil chemotherapy in bulky squamous cell carcinoma of the cervix

Fifteen patients with bulky (designated as >3 cm largest diameter) FIGO sta ge Ib or IIa squamous cervical cancer were treated with cisplatin (100 mg/m (2) on day 1) and 5-fluorouracil (1000 mg/m(2) continuously on days 1-5) ad ministered intravenously at 21-day intervals for a total of two or three co urses before planned radical hysterectomy. A complete clinical response was noted in four patients and a partial response in ten patients: which repre sents a 93% overall response rate. One patient had stable disease (two cour ses of chemotherapy), and none had progressive disease. Median tumor volume was 78.5 cm(3) and 2.5 cm(3) at diagnosis and after neoadjuvant chemothera py, respectively (p < 0.001). This indicates that chemotherapy resulted in a 97% median reduction of tumor volume. Median overall and disease-free sur vival was not reached, and the actuarial five-year survival rate was 73% an d 67%, respectively. There was no grade 4 toxicity, Myelosuppression was ac ceptable; however. two patients experienced significant ototoxicity, and in two patients serum creatinine increased. All patients with major toxicity received two cycles of chemotherapy only. The improved local control and su rvival in our series are in accordance with other results reported, but nee d to be confirmed in a randomized prospective trial.