Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri

One hundred fifty-one patients (107 stage IIB and 44 stage IIIB) who had completed 2 years of follow-up after treatment with neoadjuvant chemotherapy ("Quick" VBP scheme), prior to standard therapy, are presented. Four groups of patients with different prognosis and operability status, according to tumor response, were identified. In the first group (excellent responders) 96% of the patients had no evidence of disease (NED), whereas in the fourth group (no response), only 33% had NED after 2 years of follow-up. In the first group, no pelvic failure was observed. On the other hand, of 21 patients in group 4, 11 (52%) had pelvic recurrences. The response to neoadjuvant therapy is strongly associated with the initial tumor volume ecographically evaluated. The critical pretreatment volume for response was 84 cm3 (4.85 cm in diameter). Surgery and radiotherapy were equally effective in those patients with initial tumor volume of 84 cm3 or less. But surgery appears to have a better outcome in those patients with tumors larger than the critical pretreatment tumor volume. Radiotherapy in this controversial group was ineffective in avoiding pelvic recurrences, especially when the tumor volume was not sufficiently reduced. The advantage of neoadjuvant chemotherapy is evident in stage IIB, with 79% (85/107) of patients showing no evidence of disease as compared with 47% (24/51) in a nonrandomized control group (P less than 0.01). Statistically significant differences were also obtained in stage IIIB (50% vs 26% in the control group).