Phase II trial of neoadjuvant chemotherapy in early-stage small cell cervical cancer

Clinical complete response (CR) to chemotherapy is not uncommon in small ce ll carcinoma. To understand its pathologic response, we conducted a phase I I trial with neoadjuvant chemotherapy followed by hysterectomy in patients with small cell cervical cancer and reviewed all reported cases receiving n eoadjuvant chemotherapy followed by hysterectomy through a MEDLINE search, From December 1993 to December 1997, the enrolled patients were treated wit h two to three courses of vincristine, adriamycin and cyclophosphamide alte rnating with cisplatin and etoposide (VAC/PE) before hysterectomy. Another three courses of chemotherapy were added after surgery. A total of seven pa tients was enrolled, clinical CR was observed in six patients, but microsco pic residual tumor was present in all. Lymphatic permeation, scattered resi dual tumor clusters and residual superficial invasive adenocarcinoma over t he cervix presented in five cases, and another had a metastatic pelvic node with no residual cervical tumor, Three of these seven patients have been a live with no evidence of disease for 16.2, 45.2 and 56.6 months, respective ly, The other four died from disease 10.3-23.6 months after diagnosis. Thes e findings indicate the discrepancy between clinical and pathologic respons es in small cell cervical cancer after chemotherapy and emphasize the neces sity of local treatment. [(C) 1999 Lippincott WiIliams & Wilkins.].