Lymph node metastases in carcinoma of the cervix uteri: Response to neoadjuvant chemotherapy and its impact on survival

Giaroli, Adolfo; Sananes, Carlos; Sardi, Juan; Maya, Antonio Gustavo; Bastardas, Maria L.; Snaidas, L.; Rueda, Nidia Gomez; Vighi, Susana; Paola, Guillermo R. di

doi:10.1016/0090-8258(90)90395-2

Cited by 58 publications

(24 citation statements)

References 13 publications

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“…20,23 Neoadjuvant chemotherapy has shown a high response rate, 53-94%, with complete pathological response rates of 10-13.8%. 8,11,[24][25][26] We observed a complete response of 7.1% (3/42), along with significant reductions in tumor size and depth of invasion after NAC compared with the PS group. These results suggest that NAC improved operability in patients with bulky cervical cancer by decreasing tumor size.…”

Section: Discussionmentioning

confidence: 82%

“…5,6 Among the main advantages of neoadjuvant chemotherapy are the potential elimination of micrometastases, shrinkage of the primary tumor to achieve radical operability and the surgical down-staging of patients. 7,8 Despite its high response rates, 6,7,[9][10][11][12] neoadjuvant chemotherapy for cervical cancer still remains controversial. While an Italian trial and a meta-analysis has demonstrated that neoadjuvant cisplatin-based chemotherapy followed by radical surgery affords survival benefits in patients with stage IB2-IIB cervical cancer, 13,14 a recent phase III GOG trial failed to demonstrate any survival benefit.…”

Section: Introductionmentioning

confidence: 99%

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Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Cho

Kim

et al. 2009

J Gynecol Oncol

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Objective:To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer. Methods: From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter ＞4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone. Results: There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival. Conclusion: As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Cho

Kim

et al. 2009

J Gynecol Oncol

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“…Platinum-based NACT followed by radical hysterectomy has obtained good results in stage Ib2-IIb squamous cell carcinoma of the uterine cervix (6)(7)(8)11,(13)(14)(15), whereas few data are currently available about the efficacy of this chemosurgical treatment in cervical adenocarcinoma, with clinical overall response rates ranging from 50% to 93% (34,(36)(37)(38)(39)(40)(41)(42) (Table IV). Pooled data from three consecutive trials using different regimens showed a 5-year overall survival rate of 84% in the 33 responding patients, whereas all 9 nonresponders died after a median of 10 months (p<0.0001) (36).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Platinum-based Chemotherapy Followed by Radical Hysterectomy for Stage Ib2-IIb Adenocarcinoma of the Uterine Cervix – An Italian Multicenter Retrospective Study

et al. 2018

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Abstract. Aim: To assess the patterns of recurrence and clinical outcomes of patients with cervical adenocarcinoma who underwent neoadjuvant platinum-based chemotherapy (NACT) followed by radical hysterectomy. Patients andConcurrent cisplatin-based chemotherapy and radiotherapy (CCRT) is the standard-of-care for patients with locally advanced cervical cancer and recent meta-analyses of randomized trials have confirmed that this therapeutic approach significantly improves progression-free survival and overall survival compared to definitive radiotherapy alone (1-5). Neoadjuvant chemotherapy (NACT) followed by radical hysterectomy is an interesting alternative to CCRT for patients with locally advanced cervical cancer, especially for those with stage Ib2-IIb disease (6-16). A meta-analysis of six randomized trials, including 1078 patients with early or locally advanced disease, revealed that NACT followed by radical hysterectomy significantly reduced the risk of progression [hazard ratio (HR)=0.75, 95% confidence Interval (CI)=0. 61-0.93, p=0.008] and the risk of death (HR=0.77, 95% CI=0.62-0.96 p=0.02) compared to primary radical hysterectomy (17). Moreover, a meta-analysis of five 3627 This article is freely accessible online.

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“…This suggests that the more advanced is the stage, the more limited is the benefit achievable by neoadjuvant chemotherapy followed by surgery. This may be explained by the direct correlations between disease volume, chemoresponsiveness, radical operability and outcome in many solid tumors such as cervical cancer [27][28][29] . The greater the volume, the larger is the hypoxic and resting phases cell population with reduced or no chemosensitivity and the probability of developing resistant clones.…”

Section: Neoadjuvant Chemotherapy Followed By Surgerymentioning

confidence: 99%

“…These figures are much lower than the 40-80% reported earlier in patients with bulky stage IB2-IIA who did not receive NACT [32,33] . Results of trials utilizing neoadjuvant chemotherapy followed by surgery showed that overall response rates with cisplatinbased chemotherapy are high (80-95%) and clinical complete response rates vary considerably [25,[29][30][31] . Kim et al [30] found that the number of chemotherapy cycles correlated with the response in the primary tumor.…”

Section: Response and Toxicities Profile In Neoadjuvant Chemotherapymentioning

confidence: 99%

Neoadjuvant Chemotherapy: An Alternative Option of Treatment for Locally Advanced Cervical Cancer

Loizzi¹,

Cormio²,

Vicino³

et al. 2007

Gynecol Obstet Invest

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Although the incidence of cervical cancer has declined in both North America and Europe, it still represents the second most common cancer in women and the fifth most common malignancy worldwide. Most patients in the developed countries present with disease either confined to the cervix or with limited extension beyond it. Historically, the standard treatment was usually radiotherapy or radical hysterectomy with node dissection. In 1999, five randomized clinical trials performed by the Gynecologic Oncology Group, the Radiation Therapy Oncology Group and the Southwest Oncology Group have demonstrated a significant outcome advantage when cisplatin-based chemotherapy was administered during radiation in patients with cervical cancer. In the current review, we will analyze the role of neoadjuvant chemotherapy followed by radiotherapy and surgery as an alternative option treatment to the standard chemoradiation for locally advanced cervical cancer (stage Ib2 or larger).

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Lymph node metastases in carcinoma of the cervix uteri: Response to neoadjuvant chemotherapy and its impact on survival

Cited by 58 publications

References 13 publications

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Neoadjuvant Platinum-based Chemotherapy Followed by Radical Hysterectomy for Stage Ib2-IIb Adenocarcinoma of the Uterine Cervix – An Italian Multicenter Retrospective Study

Neoadjuvant Chemotherapy: An Alternative Option of Treatment for Locally Advanced Cervical Cancer

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