Preoperative chemoradiation and adjuvant surgery in locally advanced or recurrent cervical carcinoma

From February 1988 to May 1994, 31 patients (pts) with the established diagnosis of locally advanced (IB-IIA bulky,IIB,III,IVA) or recurrent cervical carcinoma were treated with simultaneous chemotherapy (CT) and external beam radiotherapy (RT) followed by radical surgery (RS) with or without intraoperative radiation therapy boost (IORT) to the high risk areas for recurrence. CT consisted of cisplatin 20 mg/m2 and 5-Flourouracil 1000 mg/m2 (maximum dose 1500 mg) in a 24-hour continuous IV infusion for 3-5 days during the first and fifth weeks of the scheduled course of RT. RT was delivered with standard fractionation up to a 40-46 Gy total dose. RS was performed 4-6 weeks later. Pathologic findings revealed complete and quasi-complete response (pCR+qpCR) in 74% of the surgical specimens and partial response (pPR) in 26%. With a median follow-up of 27+ months (3-71+), actuarial disease-free survival is 80% (91.3% for pCR+qpCR, 40% for pPR). Loco-regional control rate is 93.4%. The concurrent administration of RT and CT has moderate toxicity and can promote a high rate of pCR+qpCR as well as local control in high risk cervical carcinoma. The presence of a pCR or qpCR specimen seems to be correlated with good patient outcome.