Type III radical hysterectomy after induction chemotherapy for patients with locally advanced cervical carcinoma

Neoadjuvant chemotherapy followed by surgery is a promising approach in loc ally advanced cervical carcinoma. The aim of this study was to evaluate the feasibility, technical aspects, and clinical results of surgery after indu ction chemotherapy in this patient population. Forty-one untreated cervical carcinoma patients staged as IB2 to IIIB received three 21-day courses of cisplatin 100mg/m(2) on day 1 and gemcitabine 1000 mg/m2 on days 1 and 8 fo llowed by surgery or concomitant chemoradiation. The response to chemothera py, operability, surgical/pathological findings, disease-free period, and s urvival of the surgically treated patients were evaluated. All 41 patients were evaluated for toxicity and 40 were evaluated for response. The overall objective response rate was 95% (95% confidence interval 88%-100%), and wa s complete in three patients (7.5%) and partial in 35 (87.5%). Granulocytop enia grades 3/4 occurred in 13.8% and 3.4% of the courses, respectively, wh ereas nonhematological toxicity was mild. Twenty-three patients underwent t ype III radical hysterectomy. Mean duration of surgery was 3.8 h (range 2:3 0-5:20), median estimated blood loss was 670 mi and median hospital stay wa s 5.2 days. Intraoperative complications occurred in one case (venous injur y). In all but one case the resection margins were negative. Four patients (17%) had positive nodes (one node each); six (26%) had complete pathologic response, three (13%) had microscopic; and 14 (60%) macroscopic residual d isease. At 24 months of maximum follow-up (median 20), the disease-free and overall survival rates were 59% and 91%, respectively. Induction chemother apy with cisplatin/gemcitabine produced a high response rate and did not in crease the difficulty of surgery. Operating time, blood loss, intraoperativ e complications, and hospital stay were all within the range observed for t ype III hysterectomy in early stage patients. We therefore conclude that ty pe III radical hysterectomy is feasible in locally advanced cervical cancer patients who respond to chemotherapy.