Neoadjuvant chemotherapy using low-dose consecutive intraarterial infusions of cisplatin combined with 5-fluorouracil for locally advanced cervical adenocarcinoma

Objective. The goal of this work was to evaluate response rate, toxicity, a nd survival in treatment with intraarterial 5-fluorouracil (5-FU) and cispl atin in a neoadjuvant setting; this combination was administered to patient s with locally advanced cervical adenocarcinoma. Methods. Eleven patients were treated with preoperative neoadjuvant chemoth erapy. Those eligible included patients with previously untreated stage IB, II, or III adenocarcinoma with good performance status. Treatment consiste d of bilateral internal iliac artery infusion of cisplatin (a total of 10 m g/day) for 30 min, followed by 5-FU (a total of 250 mg/day) given by 24-hou r continuous infusion for 10 days. Treatment was repeated every 3 weeks for a total of two or three cycles. All except one patient with progressive di sease underwent radical hysterectomy following neoadjuvant chemotherapy. Po stoperative radiotherapy was given to the whole pelvis to 6 patients; 3 of the 6 patients with involved common iliac nodes received radiotherapy to a paraaortic field in addition to the whole pelvis. Results. Among 11 eligible patients, 7 had a partial response (64%). Stable disease was observed in 3 cases (27%) and progressive disease in 1 (9%). H istopathological changes related to chemotherapy, however, revealed only mi ld effects. Of the 24 treatment cycles administered, no Grade 3 or 4 toxici ty was observed and there were no therapy-related deaths. The median follow -up period was 30 months (range, 1-65 months). The mean survival period was 34.7 months and the 5-year survival rate was 21.2%. Conclusions. Intraarterial neoadjuvant chemotherapy effectively reduced tum or size in patients with locally advanced cervical adenocarcinoma; however, a survival advantage was not clear. (C) 2001 Academic Press.