A Retrospective Study of Patients With Locally Advanced Cancer of the Cervix Treated With Neoadjuvant Chemotherapy Followed by Radical Surgery

Abstract

New concept of downstaging locally advanced cancer of the cervix (LACC) with neoadjuvant chemotherapy (NACT), to make it resectable, is of great interest and needs to be explored. This is a retrospective study of 56 LACC patients. Efficacy of NACT was measured in terms of optimal pathological response (OR). Percentage of patients who needed adjuvant radiotherapy and disease-free interval at 2 years was evaluated. Clinically, 49 patients (87.5%) responded well to NACT with TIP regimen (paclitaxel, ifosfamide, and cisplatin) and underwent radical surgery. Adjuvant radiation was given for adverse factors in histopathology. Recurrences were noted; 46.4% of patients were in stage 2b, followed by 25% in stage IIIb; 92.8% of patients had squamous cell carcinoma. Optimal pathological response was seen in 15 patients (30.6%) with complete response in 8 patients (16.3%). Four patients (8.2%) had deposits in the parametrium, and 11 (22.4%) had positive nodes. On gross examination, 48.9% of patients had complete disappearance of cervical growth, and there was no microscopic evidence of cervical malignancy in 16.3%. In 20.4% of patients, cervical cancer was reduced to cervical intraepithelial neoplasia or microinvasion. Thirty-four patients (69.4%) needed full adjuvant radiotherapy. Overall, 14 patients (25.92%) had recurrence, with 11 (22.44%) being in NACT and radical surgery group. At 2 years, disease-free interval for 49 patients who underwent radical surgery was 69%. This study suggests that LACC patients who respond to NACT are surgically resectable with pathological cure in some cases, who are then spared from adjuvant radiation, which is given when recurrence occurs. However, with advancing stage, the percentage of OR decreases, and the need of adjuvant radiation increases.

High-dose density neoadjuvant chemotherapy in bulky IB cervical cancer

“…Cisplatin and ifosfamide are the most effective drugs in monotherapy in cervical cancer patients. The three-drug combination of paclitaxel, ifosfamide and cisplatin (TIP) is currently most often used in cervical cancer patients [25][26][27][28]. There are more complete responses in early stage cervical cancers, but the interval between cycles is from 21 to 28 days.…”

Fertility-Sparing Management for Bulky Cervical Cancer Using Neoadjuvant Transuterine Arterial Chemotherapy Followed by Vaginal Trachelectomy

“…16 A retrospective study of NAC for patients with cervical cancer also revealed no recurrence among patients with the optimal pathological response. 17 From 1997 through 2006, TUAC with cisplatin was administered at our institution in combination with paclitaxel or etoposide for patients with cervical cancer consisting of adenocarcinoma or small cell carcinoma, respectively. A total of 20 patients (14 patients with squamous cell carcinoma, 5 patients with adenocarcinoma, and 1 patient with small cell carcinoma) who achieved pCR were alive for more than 7 years after treatment, without recurrence.…”

A Comparative Evaluation of Radiotherapy With Concurrent Weekly Cisplatin Versus Concurrent Weekly Paclitaxel in Patients With Locally Advanced Carcinoma Cervix

“…[6] In 1999, five large prospective randomized trials performed by the Gynaecologic Oncology Group (GOG), Radiation Therapy Oncology Group (RTOG) and the SouthWest Oncology Group (SWOG) demonstrated significant survival advantage and superiority in reducing risk of death by 30-50% in cisplatin-based therapy given concurrently with pelvic radiotherapy when compared to either radiotherapy alone or radiotherapy in concurrent with nonplatinum containing chemotherapy. [7][8][9][10][11] It was stated that cisplatin-based chemoradiotherapy also decreased the relative risk of recurrence and the mortality. Based on the results of these five randomized clinical trials, which consistently showed improved survival in patients treated with cisplatin-based concurrent chemoradiotherapy the National Cancer Institute (NCI) of the United States announced that "Strong consideration should be given to the incorporation of concurrent cisplatin-based chemotherapy with RT in women who require radiation therapy for treatment of carcinoma cervix" in 1999.…”