Cisplatin-ifosfamide as neoadjuvant chemotherapy in stage IIIB cervical uterine squamous-cell carcinoma

Survival in patients with advanced cervical cancer (stage III B) treated by radical radiotherapy is low. In this study we attempted to assess the efficacy of the cis-diamminedichloroplatinum(II) (CDDP)-ifosfamide combination as neoadjuvant chemotherapy in advanced cervical cancer. The treatment schedule was: 20 mg/m2 CDDP on days 1-5; 1.5 g/m2 ifosfamide on days 1-5; and 900 mg/m2 mesna on days 1-5. Courses were given every 28 days. Radiotherapy was given 15 days after the completion of chemotherapy. A total of 26 patients were entered in this trial. Of the 24 patients evaluable for response, 15 (62.5%) achieved at least a 50% reduction in tumor volume, 6 (25%) showed stable disease, and three (12.5%) had progressive disease. At 38 months (mean follow-up) after completion of radiotherapy, 13 of the 24 (54%) evaluable patients were disease-free; 73% of the patients responding to chemotherapy vs 22% of the nonresponders remained free of disease (Fisher's exact test: P less than 0.02). Major hematologic depression occurred in 2 of the 26 patients evaluable for toxicity. No CNS toxicity was detected. These results are superior to those obtained by radical radiotherapy alone. Future treatment should be directed toward improving response rates as the best way of increasing both local and distant long-term disease control in these patients.