Abstract
Background: We conducted a phase II trial of radical surgery following neoadjuvant chemotherapy in patients with stage IIIB cervical cancer.
Methods: A total of 26 patients with stage IIIB cervical cancer were entered in this study. Patients were treated with a chemotherapeutic regimen consisting of intraarterial infusion of cisplatin and intravenous infusion of other anticancer agents, to a maximum of 3 courses. If the results of the evaluation indicated that surgery was feasible, radical surgery, including complete removal of pelvic vessels, partial resection of adjacent organs, and pelvic and paraaortic lymphadenectomy, was performed. Patients whose tumors showed no response received radiotherapy. We evaluated operability, survival rate, toxicities, and complications. Additionally, we examined prognostic variables by multivariate analysis in the patients treated by radical surgery.
Results: Eighteen patients (69.2%) underwent radical surgery. The remaining eight patients received radiation therapy. The 3-year disease-free survival rate was 72.2% in patients who received surgery and 25.0% in those who received radiotherapy. Multivariate analysis did not show any independent prognostic factors in the patients who underwent surgery.
Conclusion: Radical surgery following neoadjuvant chemotherapy may be feasible in two thirds of patients with stage IIIB cervical cancer; therefore, phase III trials can be recommended.
Similar content being viewed by others
References
Mendenhall WM, Thar TL, Bova FJ, Marcus RB Jr, Morgan LS, Million RR. Prognostic and treatment factors affecting pelvic control of stage IB and IIA-B carcinoma of the intact uterine cervix treated with radiation therapy alone.Cancer 1984;53:2649–54.
FIGO. Annual report on the results of treatment in gynecological cancer.Int J Gynecol Obstet 1991;36(suppl):38–9.
Lara PC, Garcia-Puche JL, Pedraza V. Cisplatin-ifosfamide as neoadjuvant chemotherapy in stage IIIB cervical uterine squamous-cell carcinoma.Cancer Chemother Pharmacol 1990;26(suppl):36–8.
Sardi J, Sananes C, Giaroli A, Maya G, di Paola G. Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri.Gynecol Oncol 1990;38:486–93.
Benedetti-Panici P, Scambia G, Baiocchi G, et al. Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer. Prognostic factors for response and survival.Cancer 1991;67:372–9.
Rabinovich MG, Focaccia G, Ferreyra R, Elem Y, Leone BA, Vallejo CT. Neoadjuvant chemotherapy for cervical carcinoma.Obstet Gynecol 1991;78:685–8.
Souhami L, Gil RA, Allan SE, Canary PC, Araujo CM, Pinto LH, Silveira TR. A randomized trial of chemotherapy followed by pelvic radiation therapy in stage IIIb carcinoma of the cervix.J Clin Oncol 1991;9:970–7.
Potish RA, Twiggs LB. On the lack of demonstrated clinical benefit of neoadjuvant cisplatinum therapy for cervical cancer.Int J Radiat Oncol Bio Phys 1993;27:975–9.
Eddy GL Sr. Neoadjuvant chemotherapy before surgery in cervical cancer.J Natl Cancer Inst Monogr 1996;21:93–9.
Benedetti-Panici P, Maneschi F, Cutillo G, et al. Modified type IV-V radical hysterectomy with systemic pelvic and aortic lymph-adenectomy in the treatment of patients with stage III cervical carcinoma.Cancer 1996; 78:2359–65.
Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer.Obstet Gynecol 1974;44:265–72.
World Health Organization.WHO Handbook for Reporting Results of Cancer Treatment. Geneva: WHO, 1979:16–21. Offset Publication No. 48.
Kigawa J, Minagawa Y, Itamochi H, Kanamori Y, Ishihara H, Terakawa N. Platinum concentrations in uterus and serum after internal iliac arterial infusion of platinum compounds in rabbits.Obstet Gynecol 1995;86:265–8.
Itamochi H, Kigawa J, Minagawa Y, Cheng X, Okada M, Terakawa N. Antitumor effects of internal iliac arterial infusion of platinum compounds in a rabbit cervical cancer model.Obstet Gynecol 1997;89:286–90.
Collins JM. Pharmacologic rationale for regional drug delivery.J Clin Oncol 1984;2:498–504.
Schwartz JL, Rotmensch J, Beckett MA, et al. X-ray and cis-diamminedichloroplatinum (II) cross-resistance in human tumor cell lines.Cancer Res 1988;48:5133–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Minagawa, Y., Kigawa, J., Irie, T. et al. Radical surgery following neoadjuvant chemotherapy for patients with stage IIIB cervical cancer. Annals of Surgical Oncology 5, 539–543 (1998). https://doi.org/10.1007/BF02303647
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303647