Neoadjuvant Quick Cisplatin-VP16 in High Risk Cervical Cancer

Kim, Jae Hoon; Park, Dong Choon; Kim, Chan Ju; Kim, Jin Woo; Park, Jong Sup; Bae, Suk Nyun; Lee, Jun Mo; Kim, Seung Jo; Namkoong, Sung Eun; Park, Yong Gyu

Abstract

The potential role and determinants of response to a cisplatin-based regimen of neoadju-vant chemotherapy in women with a histologically confirmed first diagnosis of stage IB-III cervical cancer were analyzed. From 1993 to 1996, 92 patients with bulky(designated as more than 3X3 cm2 size) mass were treated with cisplatin 60 mg/m2 and etoposide 100 mg/m2, admi-nistered intravenously at 7 day intervals. Seventy cases of radical hysterectomy with pelvic lymph node dissection and 22 cases of radiation therapy were performed 2 to 3 weeks after chemotherapy. At the end of the cycles, the overall clinical response rate of portio was 83.7 %(34.8 % with a complete response and 48.9 % with a partial response). The older ages, lower stages, and squamous cell types correlated favorably with the clinical response of the portio, but neither with the parametrium nor with the vagina. After the operation, we found the diff-erences in histologic responses, with the following parameters : lymphovascular space invasion, 3 mm below stromal invasion and lymph node metastasis. Theses parameters correlated with the clinical responses, and the down-staging of cases were 70 %. In comparison with radiolog-ical findings of pretreatment and postoperative tissue pathology, we could find a decrease in pelvic LN metastasis. The tumor-free survival rate calculated by the Kaplan-Meier product limit method was 75 % but it was 86.1 % for cases without the occurrence of persistent disease after the completion of the treatments. All patients suffered from nausea and vomiting, but grade 4 toxicity was not detected after the routine use of antiemetics. There were no events that delayed the next step in the treatment or caused difficulty during the operation. The results of this study suggest that the neoadjuvant chemotherapy should be accepted as a routine tool in treating high risk cervical cancer in order to improve the likelihood of favorable outcomes.