Pilot study on induction chemotherapy with cisplatin, epirubicin, etoposide and bleomycin in cervical cancer stage Ib, IIa and IIb.

METHODS

Induction chemotherapy, consisting of 3 courses of cisplatin (30 mg/m2/i.v. 1st and 2nd day), epirubicin (30 mg/m2/i.v. 1st and 2nd day), etoposide (75 mg/m2/i.v. 1st and 2nd day) and bleomycin (15 mg/i.v. 1st and 2nd day), prior to radical hysterectomy and lymph nodes resection, was used in the primary treatment of 34 consecutive patients (pts) with cervical carcinoma: 8 stage Ib < 4 cm, 11 stage Ib > 4 cm, 13 stage IIa, 2 stage IIb. Median age was 55 years (range 32-75) and median Karnofsky performance status was 90% (range 70-100%).

RESULTS

Among the 34 evaluable patients (pts), the overall clinical response rate was 53%, which included a complete response in 9 pts (26.5%) and a partial response in 9 subjects (26.5%). Fifteen stable diseases and one progression were also observed. All the pts were operated on and no invasive residual tumor was found in the surgical specimens obtained from 6/9 clinical complete responders. Lymph-node metastases were found after chemotherapy in 16% (5/32) of the pts with stable disease. Eight pts presented disease recurrence, four had isolated pelvic recurrences, two had pelvic and distant failure, and two had isolated distant metastases. Until now, 9 pts have died. The most frequent toxic effects were: alopecia 100%, nausea-vomiting 73% (25/34), leukopenia 65% (22/34).

CONCLUSION

The results suggest that the administration of induction chemotherapy prior to surgery is effective in reducing the tumor volume and results in tolerable toxicity. However, the impact on survival is questionable and randomized trials for conventional treatment are needed.