Neoadjuvant chemotherapy with cisplatin, ifosfamide and 5-fluorouracil in the treatment of locally advanced cervical cancer

The objective of this study was to evaluate clinical and histological respo nse, resectability, and survival in patients with cervical epidermoid carci noma stage IB2 to IIIB with the use of neoadjuvant chemotherapy followed by radical surgery and/or radiation therapy. Between September 1989 and Febru ary 1996, 53 patients were admitted to this study. They were given three cy cles of cisplatin 30 mg/m(2)/day, 5-fluorouracil 500 mg/m(2)/day, ifosfamid e 2000 mg/m(2)/day i.v., and mesna 400 mg/m(2)/day i.v. at hour 0 and 400 m g/m(2) at hours 4 and 8 during three days every 21-28 days. We evaluated 47 patients. Global clinical response obtained was 85% {95% (CI), 75-97%, CR in 14 patients (30%) and PR in 26 patients (55%)}. Twenty-three patients un derwent surgery. Six patients (13%) had a complete histological response. M edian follow-up was 42 months (5-96). In resected patients, with a median f ollow-up of 57 months (5-96), the estimated five-year disease-free survival was 78%. Global survival estimated to 60 months was 83% for stage IB2, 70% for IIB, and 20% for IIIB. This mode of therapy offers a new option to imp rove survival in locally advanced cervical cancer. Randomized trials are re quired in order to establish a definitive role for this therapeutic strateg y.