Chemoradiation followed by surgery: its role in local control in advanced cervical cancer

The aim of this study was to improve local control and consequently survival, by using chemoradiation followed by surgery. After a median follow-up of 57+ months, 95% CI (9-111) five year overall survival (OS) was 81.8%, 90% and 85.7% in stage Ib2-IIa bulky, IIb and III-IVa, respectively (p = NS). Disease-free survival (DFS) was 81.8% 80% and 71.4% (p = NS) and disease-free survival of local failure (DFSLF) was 95.4%, 80% and 100% (p = NS) for stage Ib2-IIa, bulky, IIb and III-IVa respectively. Distant metastases were present in every group, ranging from 13.6% to 17% in the early bulky and advanced groups respectively. Pathologic findings revealed complete response (CR) (no residual disease or scattered microscopic tumoral foci) in 27/40 (67%), and partial response (PR) in 11/40 (27%). According to the pathologic response, DFS was 92.6% and 50% (p = 0.0029) and DFSLF was 100% and 77.8% (p = 0.0127) in complete and partial response respectively. This therapeutical approach promoted a high rate of pathologic complete response (PCR) PCR as well as of local control in this group at high risk for recurrence.