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Three-year results after neoadjuvant chemotherapy, radical surgery, and radiotherapy in locally advanced cervical
G Zanetta1, F Landoni, A Colombo
1Department of Obstetrics and Gynecology, Ospedale S. Gerardo, Monza, Italy.
Objective:
To evaluate the complications and results of neoadjuvant treatment before surgery and radiotherapy in locally advanced cervical carcinoma.
Methods:
Between March 1988 and June 1989, 24 consecutive patients with locally advanced cervical carcinoma received chemotherapy consisting of six weekly courses of cisplatin (50 mg/m2), vincristine (1 mg/m2), and bleomycin (30 mg), followed by radical hysterectomy and radiotherapy. Lymph node metastases were detected by means of lymphangiography and confirmed by fine-needle aspiration in 21 patients.
Results:
Twenty-one women (87.5%) completed the planned sequence of treatment and 16 (66.7%) achieved objective responses. Three patients did not complete chemotherapy (one refusal, one myocardial infarction, one severe allergic reaction) and were treated further by radiotherapy. Nineteen subjects (79%) underwent subsequent radical surgery and radiotherapy without serious complications. After a minimal follow-up of 3 years, 16 patients had died of disease. Distant recurrences developed in only three of eight women in whom the nodes were negative originally, possibly reflecting systemic effectiveness of the chemotherapy.
Conclusion:
This sequence of treatment, although feasible, does not seem to improve long-term survival compared to standard treatment.
