Neoadjuvant chemotherapy and radical surgery in locally advanced cervical carcinoma: a pilot study

Neoadjuvant chemotherapy with cisplatin, bleomycin, and methotrexate was used in the primary treatment of 33 consecutive patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stages IB-III; tumor volume greater than 4 cm). This therapy induced responses in 25 of the 33 patients (four complete, 21 partial; overall 75.7%), thus permitting radical surgery in all these cases despite initial bulky tumor. Surgery consisted of type III-IV radical hysterectomy plus systematic para-aortic and pelvic lymphadenectomy. The average number of lymph nodes removed was 63 (range 37-117). At histologic examination, complete responses were found in four cases (12.1%) and partial responses in 14 cases (42.4%). The highest response rates were found for vaginal disease (80%), followed by cervical disease (72%) and parametrial disease (63.1%). A lower than expected incidence of lymph node metastases was detected (16%, four of 25). Chemotherapy did not seem to complicate surgery in these circumstances. The combination of cisplatin, bleomycin, and methotrexate chemotherapy and surgery did not produce severe morbidity. However, chemotherapy-induced nausea and vomiting and moderate postoperative complications did occur. These encouraging preliminary results need a longer follow-up to evaluate the influence of treatment on disease-free survival.