The Effect of Neoadjuvant Chemotherapy in Uterine Cervical Cancer

Lee, Hyo Pyo; Park, Noh Hyun; Kim, Jae Weon; Koh, Chang Won; Song, Yong Sang; Kang, Soon Beom

Abstract

Neoadjuvant chemotherapy is used as a new therapeutic modality in the treatment of locally advanced cervical cancer, but limited information is available regarding the effectiveness and survival. The aim of this study is to identify the factors concerning chemoresponsiveness and survival, and to evaluate the efficacy of neoadjuvant combination chemotherapy(NAC) for the patients with locally advanced cervical cancer in terms of 2-year disease-free survival (DFS). Between June 1987 and May 1992, 77 patients with bulky or locally advanced cervical cancer(FIGO Stage IB-III) received two or three courses of NAC. Sixty patients were treated with FP chemotherapy regimen consisting of 5-FU 1000mg/m2(day 1~day 5), CDDP 60mg/m2(day 1) and remaining 17 patients received EP chemotherapy consisting of Epirubicin 110mg/m2(day 1), CDDP 60mg/m2(day 1). After chemotherapy, patients were treated with surgery or radiotherapy according to feasibility. The effectiveness of NAC was evaluated for response by using World Health Organization criteria. Factors related to chemores ponse and survival were analyzed. The overall clinical response rate was 61%, which included a complete response(CR) in 16 patients(20.8%) and a partial response(PR) in 27 patients (40.2%). Mass size but none of the other parameters studied(age, stage, histologic type, chemotherapy regimen) was related to chemoresponsiveness. This therapy rendered radical surgery feasible in 58 evaluable cases(75.3%). Pretereatment characteristics were analyzed for response to NAC. Significantly lower response rates(38.2%) and lower 2-year DFS rates(48.7%) were found in stage II or III patients with tumor size more than 4 cm in diameter. Patients achieving CR or PR had a significantly improved 2-year DFS rate compared with those who did not respond. Lymph-node metastases were found after chemotherapy in 34.5%(20/58) of the surgically treated patients and less than 3 lymph node were involved in 10 patients. Pathologic parametrial involvement was found to be the most significant prognostic factor for recurrence. A 2-year DFS of 72% and 48.7% for stage IB-IIA, I IB-III, respectively, was found. According to chemoresponsiveness, these rate was 78% for responders and 31.6% for nonresponders, respectively. Poor chemoresponsiveness and uncertain survival benifits in stage II, III with bulky mass necessitate more effective therapeutic modalities in this group of patients.