Prognostic factors for locally advanced cervical cancer treated with neoadjuvant intravenous and transuterine arterial chemotherapy followed by radical hysterectomy.

OBJECTIVE

The aim of this study was to identify prognostic factors associated with neoadjuvant transuterine arterial chemotherapy (TUAC) followed by type III radical hysterectomy.

METHODS

The medical histories of patients with stage IB2 to IIB cervical cancer who received neoadjuvant TUAC between 1996 and 2009 at our institution were retrospectively reviewed.

RESULTS

Seventy-three patients received TUAC using cisplatin combined with intravenous nedaplatin, irinotecan, paclitaxel, or etoposide administration. Forty-seven patients (64%) had squamous cell carcinoma. The radiological response rate was 96% (95% confidence interval, 91%-100%). Radical hysterectomy was completed for 95% of enrolled patients. Examination of the resected cervical specimens showed that tumor cells were absent in 19 cases and stromal invasion was less than 3 mm in 7 cases. Among these 26 patients, 23 (32%) had pathologically negative pelvic lymph nodes and no recurrence during the follow-up period. The 5-year relapse-free survival and overall survival rates were 69% and 74%, respectively. Among 23 patients with recurrence or progressive disease, the median survival time after recurrence or progression was 12 months. In multivariate analysis, a tumor size of more than 60 mm and pathological positive lymph nodes were negative prognostic factors for overall survival.

CONCLUSIONS

Tumor size, pathological response, and lymph node metastases were prognostic factors for cervical cancer. The high pathological response rate associated with TUAC makes it a promising treatment for bulky cervical cancer.