Pathologic response after neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the cervix

A. Maneo, G. Brancatelli, P. Donesana, A. Buda, M. Zoccatelli, F. Landoni, C. Mangioni

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the impact on survival of the pathologic response of locally advanced squamous cervical cancer after chemotherapy with cisplatin 50 mg/m2, vincristine 1 mg/m2 and bleomycin 30 mg (POB) administered before radical surgery. Methods: From May 1988 to June 1996 the 124 patients with newly diagnosed squamous cervical carcinoma stage IB2-IVA received weekly neoadjuvant chemotherapy (6 courses scheduled). Seven patients with cervical adenocarcinoma revealed by examination of the final surgical specimen were not analyzed. Class III radical hysterectomy with pelvic lymphadenectomy and aortic node sampling was scheduled within 3 weeks after the completion of chemotherapy Adjuvant radiotherapy was administered to 32 cases for lymphnode metastasis or neoplastic involvement of the surgical margins, and to 16 patients for parametrial involvement or uninvolved cervical stroma <3 mm. The extent of the pathologic residual tumour in the cervix was classified as follows: complete response, minimal residue tin situ or microinvasive <3 mm) and necrotic or massive residual tumour. Complete response and minimal residue are grouped as ″optimal response″, while the term ″suboptimal response″ indicates cases with necrotic or massive neoplastic persistence. Results: One hundred and eleven patients out of 117 (95) received the planned six courses of chemotherapy. Clinical response was complete in 16 (14), partial in 82 (74), no change in 11 (10) and progression in two (2). Seventeen (15) were deemed unsuitable for radical surgery because of partial response or progressive disease (12), or complications which occurred during chemotherapy (5). In all, 94 patients who received 6 courses and one who received 5 courses underwent surgery (95 cases, 81). In six cases (6) no evidence of residual disease was found in the uterine surgical specimen; carcinoma in situ was observed in 5 patients (5), microinvasive residue in 6 (6), necrotic residual disease in 10 (11) and massive neoplastic persistence in 68 (72). Five-year survival for the operated patients is 61. Patients with optimal pathologic response obtained a 100 survival rate, compared to 58 in the group with suboptimal response (p = 0.0009). Conclusions: The cisplatin-vincristine-bleomycin scheme prior to surgery is effective in locally advanced squamous cervical carcinoma. Pathologic response should be regarded as a major prognostic factor. Any innovative chemotherapeutic scheme capable of increasing the rate of pathologic optimal response could be effective also in improving survival with less morbidity than conventional radiotherapy or radiosurgical combination.

Original languageEnglish
Pages (from-to)139-144
Number of pages6
JournalItalian Journal of Gynaecology and Obstetrics
Volume11
Issue number4
Publication statusPublished - 1999

Keywords

  • Cervical cancer
  • Neoadjuvant chemotherapy
  • Pathologic response
  • POB

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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