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. 2005 Sep 19:5:118.
doi: 10.1186/1471-2407-5-118.

Pre-exenterative chemotherapy, a novel therapeutic approach for patients with persistent or recurrent cervical cancer

Carlos Lopez-Graniel  1 , Rigoberto Dolores, Lucely Cetina, Aaron Gonzalez, David Cantu, Jose Chanona, Jesus Uribe, Myrna Candelaria, Rocio Brom, Jaime de la Garza, Alfonso Duenas-Gonzalez
Affiliations

Pre-exenterative chemotherapy, a novel therapeutic approach for patients with persistent or recurrent cervical cancer

Carlos Lopez-Graniel et al. BMC Cancer. .

Abstract

Background: Most cervical cancer patients with pelvic recurrent or persistent disease are not candidates for exenteration, therefore, they only receive palliative chemotherapy. Here we report the results of a novel treatment modality for these patients pre-exenterative chemotherapy- under the rational that the shrinking of the pelvic tumor would allow its resection.

Methods: Patients with recurrent or persistent disease and no evidence of systemic disease, considered not be candidates for pelvic exenteration because of the extent of pelvic tumor, received 3-courses of platinum-based chemotherapy. Response was evaluated by CT scan and bimanual pelvic examination; however the decision to perform exenteration relied on the physical findings. Toxicity to chemotherapy was evaluated with standard criteria. Survival was analyzed with the Kaplan-Meier method.

Results: Seventeen patients were studied. The median number of chemotherapy courses was 4. There were 9 patients who responded to chemotherapy, evaluated by bimanual examination and underwent pelvic exenteration. Four of them had pathological complete response. Eight patients did not respond and were not subjected to surgery. One patient died due to exenteration complications. At a median follow-up of 11 months, the median survival for the whole group was 11 months, 3 months in the non-operated and 32 months in those subjected to exenteration.

Conclusion: Pre-exenterative chemotherapy is an alternative for cervical cancer patients that are no candidates for exenteration because of the extent of the pelvic disease. Its place in the management of recurrent disease needs to be investigated in randomized studies, however, its value for offering long-term survival in some of these patients with no other option than palliative care must be stressed.

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Figures

Figure 1
Figure 1
Patients with complete pathological response post-chemotherapy. CT scans of 3 patients showing residual pelvic mass after chemotherapy. Images a,c,e show CT scans pre-treatment, and images b,d,f are the post-treatment control studies. Notably, a patient (images e-f) shows a residual post-chemotherapy pelvic mass measuring 9 × 5 cm.
Figure 2
Figure 2
Overall survival in the intention to treat; four out of 17 are alive for a median survival of 11 months.
Figure 3
Figure 3
Survival in the operated and non-operated patients; median survival was 3 versus 32 months respectively. This difference is highly significant.
See this image and copyright information in PMC

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References

    1. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;4:153–156. doi: 10.1002/ijc.1440. - DOI - PubMed
    1. Dueñas-Gonzalez A, Cetina L, Mariscal I, de la Garza J. Modern management of locally advanced cervical carcinoma. Cancer Treat Rev. 2003;29:389–399. doi: 10.1016/S0305-7372(03)00068-9. - DOI - PubMed
    1. Lopez MJ, Spratt JS. Exenterative pelvic surgery. J Surg Oncol. 1999;72:102–114. doi: 10.1002/(SICI)1096-9098(199910)72:2<102::AID-JSO12>3.0.CO;2-1. - DOI - PubMed
    1. Hockel M, Knapstein P. The combined operative and radiotherapeutic tratment of recurrent tumors infiltrating the pelvic wall. Gynecol Oncol. 1992;46:20–28. doi: 10.1016/0090-8258(92)90189-P. - DOI - PubMed
    1. Leitao MM, Chi DS. Recurrent cervical cancer. Curr Treat Options Oncol. 2002;3:105–111. - PubMed

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