Panici P B, Scambia G, Baiocchi G, Greggi S, Ragusa G, Gallo A, Conte M, Battaglia F, Laurelli G, Rabitti C
Department of Gynecology and Obstetrics, Catholic University, Rome, Italy.
Cancer. 1991 Jan 15;67(2):372-9. doi: 10.1002/1097-0142(19910115)67:2<372::aid-cncr2820670210>3.0.co;2-5.
Between January 1986 and September 1988, 75 patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stages IB-III) received three courses of neoadjuvant chemotherapy (NAC), including cisplatin, bleomycin, and methotrexate (PBM). Fifteen percent of patients achieved a complete response (CR) and 68% a partial response (PR). Pretreatment characteristics were analyzed for response to NAC. Significantly lower response rates were found in patients with tumor size more than 5 cm in diameter and bilateral parametrial involvement to the pelvic side wall. None of the biological parameters studied was related to chemoresponsiveness. Patients achieving CR or PR had a significantly improved 3-year survival rate compared with those who did not respond. After NAC, radical surgery was possible in all responding patients. The median number of lymph nodes removed was 60. A lower than expected incidence of lymph node metastases was detected. None of the clinical and pathologic features considered was significantly correlated with the lymph node status. Twelve of the 62 operated patients had disease recurrence. Pathologic parametrial involvement and cervical infiltration equal to or deeper than 5 mm were found to be significant prognostic factors for recurrence. A 3-year, disease-free survival of 89%, 73%, and 43% for Stage IB-IIA, IIB, and III, respectively, was found. Among the operated patients these rates increased to 100%, 81%, and 66% for Stage IB-IIA, IIB, and III, respectively. A prospective randomized trial comparing NAC and surgery with radiotherapy alone is in progress.
1986年1月至1988年9月期间，75例局部晚期宫颈癌患者（国际妇产科联盟[FIGO]分期为IB - III期）接受了三个疗程的新辅助化疗（NAC），化疗方案包括顺铂、博来霉素和甲氨蝶呤（PBM）。15%的患者达到完全缓解（CR），68%的患者达到部分缓解（PR）。分析了预处理特征对NAC的反应。发现肿瘤直径超过5 cm且双侧宫旁组织累及至盆腔侧壁的患者反应率显著较低。所研究的生物学参数均与化疗反应性无关。与无反应的患者相比，达到CR或PR的患者3年生存率显著提高。NAC后，所有有反应的患者均可行根治性手术。切除淋巴结的中位数为60个。检测到淋巴结转移发生率低于预期。所考虑的临床和病理特征均与淋巴结状态无显著相关性。62例接受手术的患者中有12例疾病复发。发现宫旁组织病理累及以及宫颈浸润等于或深于5 mm是复发的重要预后因素。IB - IIA期、IIB期和III期患者的3年无病生存率分别为89%、73%和43%。在接受手术的患者中，IB - IIA期、IIB期和III期的这些比率分别升至100%、81%和66%。一项比较NAC和手术与单纯放疗的前瞻性随机试验正在进行中。
