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Platinum-Based Neoadjuvant Chemotherapy Followed by Radical Surgery for Cervical Carcinoma International Federation of Gynecology and Obstetrics Stage IB2-IIB

Minig, Lucas MD, PhD*†; Colombo, Nicoletta MD; Zanagnolo, Vanna MD; Landoni, Fabio MD; Bocciolone, Luca MD; Cárdenas-Rebollo, José Miguel PhD; Iodice, Simona PhD§; Maggioni, Angelo MD

International Journal of Gynecological Cancer: November 2013 - Volume 23 - Issue 9 - p 1647–1654
doi: 10.1097/IGC.0b013e3182a616d2
Cervical Cancer

Objective: The objective of this study was to determine the response rate to chemotherapy, as well as the progression-free survival (PFS), the overall survival (OS), and the main prognostic factors in patients treated at the European Institute of Oncology in Milan, Italy.

Methods: Retrospective data were collected on patients with uterine cervical carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB, who underwent platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy.

Results: A total of 121 patients were studied. The median (range) age was 45 years old (23–69 years). The distribution of patients by International Federation of Gynecology and Obstetrics stage was as follows: n = 88 (73%) with stage IB2, n = 7 (6%) with stage IIA, and n = 26 (21%) with stage IIB. The median (range) tumor size was 50 mm (20–90 mm). Neoadjuvant chemotherapy involved a combination of cisplatin, paclitaxel, and ifosfamide in 80 patients (65%). Using this treatment, 112 patients (93%) received 3 cycles of NACT, whereas 6 (5%) received 4 cycles. Complete and partial pathology response was observed in 9 patients (7%) and 79 patients (66%), respectively. Adjuvant radiotherapy was not necessary in 65% of patients. A 5-year PFS and OS of 58% and 71%, respectively, were observed. Independent prognostic factors for PFS and OS were identified, including response to NACT, persistent lymph node metastases, and parametrial involvement.

Conclusions: Neoadjuvant chemotherapy in this group of tumors is a promising treatment strategy and should be discussed with patients. Although these results are comparable to those obtained by standard chemoradiation treatment, one strategy should not be recommended over the other until the results of the ongoing phase 3 trial for NACT are released.

*Gynecology Oncology Program, Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Madrid, Spain; †Gynecology Department, European Institute of Oncology, Milan, Italy; ‡Department of Applied Mathematics and Statistics CEU San Pablo University, Madrid, Spain; and §Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.

Address correspondence and reprint requests to Lucas Minig, MD, PhD, Gynecology Oncology Program, HM Universitario Sanchinarro, Centro Integral Oncológico Clara Campal, Calle Oña 10, 28050 Madrid, Spain. E-mail: lucasminig@yahoo.com.

The authors declare no conflicts of interest.

Received March 8, 2013

Accepted July 21, 2013

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.