Three-year results after neoadjuvant chemotherapy, radical surgery, and radiotherapy in locally advanced cervical carcinoma.

Abstract

To evaluate the complications and results of neoadjuvant treatment before surgery and radiotherapy in locally advanced cervical carcinoma. Between March 1988 and June 1989, 24 consecutive patients with locally advanced cervical carcinoma received chemotherapy consisting of six weekly courses of cisplatin (50 mg/m2), vincristine (1 mg/m2), and bleomycin (30 mg), followed by radical hysterectomy and radiotherapy. Lymph node metastases were detected by means of lymphangiography and confirmed by fine-needle aspiration in 21 patients. Twenty-one women (87.5%) completed the planned sequence of treatment and 16 (66.7%) achieved objective responses. Three patients did not complete chemotherapy (one refusal, one myocardial infarction, one severe allergic reaction) and were treated further by radiotherapy. Nineteen subjects (79%) underwent subsequent radical surgery and radiotherapy without serious complications. After a minimal follow-up of 3 years, 16 patients had died of disease. Distant recurrences developed in only three of eight women in whom the nodes were negative originally, possibly reflecting systemic effectiveness of the chemotherapy. This sequence of treatment, although feasible, does not seem to improve long-term survival compared to standard treatment.