Treatment complication, pathologic response and survival rate after chemotherapy before surgery in locally advanced cervical cancer

Document Type : Original Article

Authors

1 Assistant Professor, Department of Radiotherapy and Oncology, Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Professor, Department of Gynecology Oncology, Women’s Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident, Department of Radiotherapy and Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Associate Professor, Department of Radiotherapy and Oncology, Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Assistant Professor, Department of Gynecology Oncology, Women’s Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Cervical cancer is the second most common cancer in less developed countries. Chemoradiation is the standard treatment for advanced cervical cancer, but there is a lack of radiotherapy equipment in developing country. Therefore, this study was performed with aim to evaluate the pathologic response, treatment complication and survival rate of patients with locally advanced squamous cell carcinoma (SCC) of cervix who were not candidate for chemoradiation with use of chemotherapy before surgery.
Methods: In this single group, before-after randomized clinical trial, 24 patients with FIGO stages IB2, IIA2, and IIB squamous cell carcinoma (SCC), who were not candidate for standard chemoradiation due to different causes, received 3 courses of neoadjuvant paclitaxel (135mg/m2)+ Cisplatin (75mg/m2) chemotherapy regimen. Then, surgery was performed. Clinical response to neoadjuvant chemotherapy and treatment side effects were assessed after each course. Wertheim hysterectomy was done 4 to 6 weeks later in those with favorable response. In the absence of major risk factors in the surgical pathology, patients received 3 additional cycles of adjuvant chemotherapy. In high risk patients, adjuvant chemoradiotherapy was performed. Data was analyzed by SPSS software (version 21) and Chi-square, and Kaplan Mayer tests. PResults: Among 24 patients, 13 cases (54.2%) and 17 (73.9%) had FIGO stageIIB and gradeII tumors, respectively. Parametrial involvement was presented in 13 patients (54.2%). Seven patients were excluded. 17 patients underwent surgical resection. Four high risk patients and were candidate for chemoradiation. Clinical and complete pathological response rate were 17 cases (70.8%) and 8 cases (47.1%), respectively. With a median follow up of 18.5 months, mean of overall survival and disease free survival of patients treated with the study protocol were 24.51 and 25.71 month, respectively. The mean of overall survival of whole patients (24 cases) was 30.8 month (CI: 95%, 29/38-32/26).
 Conclusion: Neoadjuvant chemotherapy in patients with locally advanced cervical cancer despite acceptable pathologic response is not associated with survival advantage.

Keywords

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136(5):E359-86.
  2. Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: emerging technologies and policy choices. World J Clin Oncol 2015; 6(6):281-90.
  3. Yang Z, Chen D, Zhang J, Yao D, Gao K, Wang H, et al. The efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer: a randomized multicenter study. Gynecol Oncol 2016; 141(2):231-9.
  4. Osman M. The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review. Oncol Rev 2014; 8(2):250.
  5. Jewell EL, Smrtka M, Broadwater G, Valea F, Davis DM, Nolte KC, et al. Utility scores and treatment preferences for clinical early-stage cervical cancer. Value Health 2011; 14(4):582-6.
  6. Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28(Suppl 4):iv72-83.
  7. Rydzewska L, Tierney J, Vale CL, Symonds PR. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev 2012; 12:Cd007406.
  8. Rydzewska L, Tierney J, Vale CL, Symonds PR. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev 2010; 1:CD007406.
  9. Sardi JE, Giaroli A, Sananes C, Ferreira M, Soderini A, Bermudez A, et al. Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol 1997; 67(1):61-9.
  10. Napolitano U, Imperato F, Mossa B, Framarino ML, Marziani R, Marzetti L. The role of neoadjuvant chemotherapy for squamous cell cervical cancer (Ib-IIIb): a long-term randomized trial. Eur J Gynaecol Oncol 2003; 24(1):51-9.
  11. Cai HB, Chen HZ, Yin HH. Randomized study of preoperative chemotherapy versus primary surgery for stage IB cervical cancer. J Obstet Gynaecol Res 2006; 32(3):315-23.
  12. Katsumata N, Yoshikawa H, Hirakawa T, Saito T, Kuzuya K, Fujii T, et al. Phase III randomized trial of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) versus RH for bulky stage I/II cervical cancer (JCOG 0102). J Clin Oncol 2006; 24(18 Suppl):5013.
  13. Eddy GL, Bundy BN, Creasman WT, Spirtos NM, Mannel RS, Hannigan E, et al. Treatment of ("bulky") stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of the gynecologic oncology group. Gynecol Oncol 2007; 106(2):362-9.
  14. Chen H, Liang C, Zhang L, Huang S, Wu X. Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: randomized study. Gynecol Oncol 2008; 110(3):308-15.
  15. Gupta S, Maheshwari A, Parab P, Mahantshetty U, Hawaldar R, Sastri S, et al. Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol 2018; 36(16):1548-55.
  16. Katsumata N, Yoshikawa H, Kobayashi H, Saito T, Kuzuya K, Nakanishi T, et al. Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102). Br J Cancer 2013; 108(10):1957-63.
  17. Park DC, Suh MJ, Yeo SG. Neoadjuvant paclitaxel and cisplatin in uterine cervical cancer: long-term results. Int J Gynecol Cancer 2009; 19(5):943-7.
  18. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer 2003; 39(17):2470-86.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 12
February 2020
Pages 1-10

Files

Share

How to cite

Statistics