Neoadjuvant chemotherapy followed by radical surgery and radiotherapy vs. pelvic irradiation in patients with cervical cancer FIGO stage IIB - IVA.

PURPOSE

To compare the 2-year recurrence-free survival, recurrence rates and their localization after treatment with definitive radiation therapy (RT) vs. neoadjuvant chemotherapy (NCT) followed by radical surgery and post-operative RT in cervical cancer patients with FIGO stages IIB through IVA.

PATIENTS AND METHODS

43 patients were included in the study, 25 of whom (group 1) were treated with pelvic RT(50-52 Gy external beam RT) and 18 (group 2) with NCT followed by surgery and postoperative RT(50-52 Gy). The operations performed were class III-V radical hysterectomy with total pelvic and paraaortic lymph node dissection. NCT included 3 courses of cisplatin, ifosfamide and bleomycin delivered every 3 weeks. In group 1, 17 (68%) patients were staged IIB and 8 (32%) IIIB; 23 (92%) patients had squamous cell carcinoma and 2 (8%) adenocarcinoma. In group 2, 13 (72.2%) patients were staged IIB, 4 (22.2%) IIIB and 1 (5.6%) IVA. All 18 patients had squamous cell carcinoma. The median age of group 1 and 2 patients was 54.6 years (range 35-71) and 46.3 years (range 32-64), respectively.

RESULTS

The 2-year recurrence-free survival for group 1 was 47.3% and 76.7% for group 2 (p=nonsignificant). Pelvic recurrences were seen in 28% in group 1 and 11.1% in groups 1 and 2 were 8% and 16.7%, respectively (p=nonsignificant).

CONCLUSION

In FIGO stages IIB-IVA cervical cancer patients cisplatin-based NCT followed by surgery and postoperative external beam RT lead to a better 2-year recurrence-free survival compared to pelvic RT alone. The latter is connected with higher, but not statistically significant local recurrence rates in comparison with the NCT/surgery/ postoperative RT group.