Neoadjuvant chemotherapy with mitomycin-C, vincristine and cisplatin (MVC) for patients with loco-regionally advanced cervical carcinoma

Choi, Chel Hun; Kim, Tae Joong; Lee, Jeong Won; Kim, Byoung Gie; Lee, Je Ho; Bae, Duk Soo

Abstract

OBJECTIVE
The efficacy and toxicity of neoadjuvant chemotherapy (NAC) with mitomycin-C, vincristine and cisplatin (MVC) were assessed in bulky cervical carcinoma patients.
METHODS
Forty-six patients with stage Ib2 to IIb bulky cervical cancer were treated with intravenous combination of mitomycin-C 10 mg/m2, vincristine 1 mg/m2 and cisplatin 75 mg/m2 every three weeks. After three cycles of NAC, the patients either underwent surgery or radiation therapy, depending on their suitability for radical hysterectomy.
RESULTS
All 46 patients enrolled in this study underwent surgery after NAC. Toxic nonhematologic reactions consisted primarily of grade 1-2 nausea and vomiting (86.8%) and the most common hematologic toxicity was anemia (59.6%). Clinical responses occurred in 82.6% (38/46) of patients, including 23.9% (11/46) with a complete response (CR) and 13.0% (6/46) with a pathologically determined complete response. For a median follow up period of 28 months, the 3-year disease-free and overall survival rates were 74.0% and 80.0%, respectively. Pathologically confirmed lymph node metastasis or parametrial involvement or an initial tumor size > or = 16 cm2 were associated with shorter disease-free survival (p=0.040, p=0.000, p=0.001, respectively). Adjuvant postoperative RT did not show a survival benefit in patients who had no indications for adjuvant therapy after surgery (p=0.970). Therefore, 26 patients (56.5%) could have been managed without RT; these patients traditionally require RT without the NAC protocol.
CONCLUSION
Intravenous administration of MVC as a NAC seems to be well tolerated and beneficial in patients with loco-regionally advanced cervical cancer.