Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: randomized study

Abstract

Objectives: The use of preoperative neoadjuvant chemotherapy (NAC) in locally advanced cervical cancer (LACC) was hindered by the disadvantages of a delay of curative treatment for nonresponders and the development of radioresistant cells. However, these disadvantages may be overcome by a 'quick' high-dose scheme administered in a short period before surgery. Our purpose is to assess the efficacy of NAC with short cycle-length, high-dose agents for LACC.

Method: From 1999 to 2004, 142 of patients with LACC (stage IB2IIB, tumor diameter >or=4 cm) were assigned to randomly receive either NAC followed by surgery or primary surgery directly. A modified NAC scheme with short cycle-length, high-dose agents was used.

Results: The overall clinical response rate was 69.4%. The chemotherapeutic response was more favorable in the squamous carcinoma and the tumors smaller than 8 cmP=0.005, P=0.029). Pathologic findings showed that the pelvic metastasis and parametrial infiltration rates were significantly lower in NAC group than in the primary surgery group (P=0.025; P=0.038). Among patients who received NAC, the lymph node metastasis rate was still as high as 45.5% in non-NAC responders, and it decreased to 16.0% in NAC responders (P=0.008). The same thing also occurred with parametrial infiltration: 45.5% in non-NAC responders compared with 16.0% in NAC responders (P=0.008). Survival analysis revealed that although test showed a longer survival in NAC group than in the primary surgery group (P=0.041), Cox hazard analysis did not indicate the therapy modality as a prognostic predictor (P=0.074). However, after further subdivision, we found that NAC responders had longer survival and lower recurrence rate than non-NAC responders (P=0.000; P=0.013). NAC response was also an independent prognostic predictor (P=0.005).

Conclusion: The modified preoperative NAC is well tolerated and beneficial in reducing tumor size, eliminating pathological risk factors, and improving prognosis for responders. It also avoids the delay of effective treatment for non-NAC responders.