The Scottish and Manchester randomised trial of neo-adjuvant chemotherapy for advanced cervical cancer

204 eligible patients were entered into a multicentre randomised trial of n eo-adjuvant chemotherapy prior to radical radiotherapy. The aim of this stu dy was to assess whether there was any survival advantage in patients under going chemotherapy and radiotherapy compared with those given radiotherapy alone. Patients were aged up to 70 years, performance status 0-1/2, with bu lky stage IIb, stage III or stage IVa squamous or adenosquamous carcinoma. Three cycles of methotrexate 100 mg/m(2) and cisplatin 50 mg/m(2) were give n at 2-weekly intervals before radical radiotherapy. 104 eligible patients received the combination treatment and 100 radiotherapy only. The two arms of the study were well balanced for tumour and patient characteristics. The response rate to chemotherapy was 49%. 33% of patients in the radiotherapy (XRT) alone arm and 45% of the combination arm were clinically free of tum our at the end of treatment. The median follow-up for surviving patients is 5.4 years (range: 11 months-8 years) and 84% have been followed-up for mor e than 4 years. 134 patients have died (68 XRT only, 66 combined arm). The median survival RT alone was 111 weeks (95% confidence interval (CI) 72-151 weeks), combination arm 125 weeks (95% CI 79-170 weeks). The estimated dea th ratio is 0.79 (P=0.19, 95% CI 0.56-1.12). The estimated 3-year survival is 40% (95% CI 30-50%) RT only compared with 47% (95% CI 37-57%) in the com bination arm. Acute and late toxicity of radiotherapy was not increased by the addition of chemotherapy. (C) 2000 Published by Elsevier Science Ltd. A ll rights reserved.