Benedetti Panici P, Scambia G, Greggi S, Di Roberto P, Baiocchi G, Mancuso S
Institute of Gynecology and Obstetrics, Università Cattolica del Sarco Cuore, Rome, Italy.
Obstet Gynecol. 1988 Mar;71(3 Pt 1):344-8.
Neoadjuvant chemotherapy with cisplatin, bleomycin, and methotrexate was used in the primary treatment of 33 consecutive patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stages IB-III; tumor volume greater than 4 cm). This therapy induced responses in 25 of the 33 patients (four complete, 21 partial; overall 75.7%), thus permitting radical surgery in all these cases despite initial bulky tumor. Surgery consisted of type III-IV radical hysterectomy plus systematic para-aortic and pelvic lymphadenectomy. The average number of lymph nodes removed was 63 (range 37-117). At histologic examination, complete responses were found in four cases (12.1%) and partial responses in 14 cases (42.4%). The highest response rates were found for vaginal disease (80%), followed by cervical disease (72%) and parametrial disease (63.1%). A lower than expected incidence of lymph node metastases was detected (16%, four of 25). Chemotherapy did not seem to complicate surgery in these circumstances. The combination of cisplatin, bleomycin, and methotrexate chemotherapy and surgery did not produce severe morbidity. However, chemotherapy-induced nausea and vomiting and moderate postoperative complications did occur. These encouraging preliminary results need a longer follow-up to evaluate the influence of treatment on disease-free survival.
顺铂、博来霉素和甲氨蝶呤新辅助化疗用于33例连续的局部晚期宫颈癌患者（国际妇产科联盟[FIGO]分期IB-III期；肿瘤体积大于4cm）的初始治疗。该疗法在33例患者中的25例（4例完全缓解，21例部分缓解；总体缓解率75.7%）诱导了缓解，从而使得所有这些病例尽管初始肿瘤体积较大仍可行根治性手术。手术包括III-IV型根治性子宫切除术加系统性主动脉旁和盆腔淋巴结清扫术。切除淋巴结的平均数量为63个（范围37-117个）。组织学检查发现，4例（12.1%）为完全缓解，14例（42.4%）为部分缓解。阴道疾病的缓解率最高（80%），其次是宫颈疾病（72%）和宫旁疾病（63.1%）。检测到淋巴结转移的发生率低于预期（16%，25例中的4例）。在这些情况下，化疗似乎并未使手术复杂化。顺铂、博来霉素和甲氨蝶呤化疗与手术联合并未产生严重的发病率。然而，确实发生了化疗引起的恶心和呕吐以及中度术后并发症。这些令人鼓舞的初步结果需要更长时间的随访来评估治疗对无病生存期的影响。
