Factors predicting response to chemotherapy and survival in patients with metastatic or recurrent squamous cell...

Different regimens of chemotherapy have been proposed with contradictory results in patients with metastatic and recurrent cervical carcinoma: this seems mainly due to the lack of information about prognostic factors. This study was aimed at identifying significant factors predicting response to treatment and survival in 140 patients treated with chemotherapy for advanced, recurrent, or persistent squamous cell cervical carcinoma. Age, performance status, histologic type and grade, previous irradiation, interval from start of primary treatment and from irradiation, site of tumor, and therapeutic regimen were considered as possible predictors of response and survival in multivariate analysis. By multivariate analysis, only performance status and interval from irradiation (> 1 year) were significant in predicting response to treatment, whereas interval from first diagnosis, site of tumor, and response to treatment were significant in predicting survival. None of the polychemotherapy regimens significantly improved survival, despite a fourfold increase in the costs when compared to the least expensive monochemotherapy regimen. Ethical and economical concerns should be considered when proposing aggressive regimens to the patients. Factors such as site of tumor, performance status, and interval from first treatment should be considered as minimal requirements for correct evaluation of newly proposed regimens.