Neoadjuvant combination chemotherapy and radiation therapy in the treatment of stage 111B carcinoma of the cerzix

ABSTRACT

Between 1982 and 1991, forty patients with high risk stage IIIB carcinoma of the cervix with bilateral parametrial involvement received a combination chemotherapy consisting of intravenous vincristine, methotrexate, bleomycin and cisplatin, followed by intracavitary brachytherapy of 30 Gy to point A and whole pelvis external irradiation of 50 Gy. The mean age of the patients was 55 with a range of 30-70 years. The mean follow-up was 57 with a range of 12-120 months. Five patients were lost to follow-up after the first year. The 5-year disease-free survival of 42.8% and pelvic failure rate of 17.1% compare favorably with the literature, perhaps indicating some improvement over radiotherapy alone and potentiating effect of neoadjuvant chemotherapy. High extra-pelvic failure rates of 14.1% in the para-aortic nodes and 25.7% as distant metastases were noted. Relevant factors and literature are discussed. Prophylactic para-aortic node irradiation is recommended in these patients, and it is suggested that neoadjuvant chemotherapy may be of value in improving survival and disease control, particularly in the developing countries, where sophisticated radiotherapy sources and techniques may not be available. The use of tumor markers in monitoring tumor response to chemotherapy is also suggested