A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer A Prospective Randomized Controlled Study on Multiple Neoadjuvant Treatments for Patients With Stage IB2 to IIA Cervical Cancer Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Randomized trial of neoadjuvant chemotherapy comparing paclitaxel, ifosfamide, and cisplatin with ifosfamide and cisplatin followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the SNAP01 (Studio Neo-Adjuvante Portio) Italian Collaborative Study. Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri. Follow-up in a long-term randomized trial with neoadjuvant chemotherapy for squamous cell cervical carcinoma. 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. A phase II, randomized trial of neo-adjuvant chemotherapy comparing a three-drug combination of paclitaxel, ifosfamide, and cisplatin (TIP) versus paclitaxel and cisplatin (TP) followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the Snap-02 Italian Collabo Phase III randomized trial of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) versus RH for bulky stage I/II cervical cancer (JCOG 0102). Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: randomized study. The role of neoadjuvant chemotherapy for squamous cell cervical cancer (Ib-IIIb): a long-term randomized trial. Randomized study of preoperative chemotherapy versus primary surgery for stage IB cervical cancer.
Background : We investigated the feasibility of dose-dense neoadjuvant chemotherapy ( NACT ) with paclitaxel and carboplatin before radical chemoradiation ( CRT ) and assessed the response rate to such a regimen . Methods : CxII is a single-arm phase II trial of 46 patients , with locally advanced cervical cancer ( stage Ib2-IVa ) . Patients received dose-dense carboplatin ( AUC2 ) and paclitaxel ( 80 mg m−2 ) weekly for six cycles followed by CRT ( 40 mg m−2 of weekly cisplatin , 50.4 Gy , 28 fractions plus brachytherapy ) . The primary end point was response rate 12 weeks post-CRT . Results : Baseline characteristics were : median age at diagnosis 43 years ; 72 % squamous , 22 % adenocarcinoma and 7 % adenosquamous histologies ; FIGO stage IB2 ( 11 % ) , II ( 50 % ) , III ( 33 % ) , IV ( 7 % ) . Complete or partial response rate was 70 % ( 95 % CI : 54–82 ) post-NACT and 85 % ( 95 % CI : 71–94 ) post-CRT . The median follow-up was 39.1 months . Overall and progression-free survivals at 3 years were 67 % ( 95 % CI : 51–79 ) and 68 % ( 95 % CI : 51–79 ) , respectively . Grade 3/4 toxicities were 20 % during NACT ( 11 % haematological , 9 % non-haematological ) and 52 % during CRT ( haematological : 41 % , non-haematological : 22 % ) . Conclusion : A good response rate is achieved by dose-dense weekly NACT with carboplatin and paclitaxel followed by radical CRT . This treatment regimen is feasible as evidence d by the acceptable toxicity of NACT and by the high compliance to radiotherapy ( 98 % ) Objective Patients with stage IB2 to IIA cervical cancer have a poor survival regardless of what primary treatment is performed . We conducted a study to demonstrate whether neoadjuvant treatment could offer survival benefits to those patients . Methods Between January 2006 and December 2009 , 123 patients with stage IB2 to IIA cervical cancer were enrolled and r and omly assigned to receive 1 of the following 4 treatments : radical surgery alone ( arm RS ) , brachytherapy with a total dose of 15Gy to point A followed by radical surgery ( arm BT ) , intravenous chemotherapy with cisplatin 50 mg/m2 plus 5-fluorouracil 750 mg/m2 at a 2-week interval for 2 courses followed by radical surgery ( arm IVCT ) , or intra-arterial chemotherapy with the same regimen as the IVCT arm followed by radical surgery ( arm IACT ) . Two weeks after neoadjuvant treatment , all patients underwent evaluation for response and operability . Those who were not amenable to surgery received concurrent chemoradiotherapy . Results With a mean follow-up of 34.8 months , 120 patients were evaluable . Baseline characteristics were similarly distributed in the 4 arms . Clinical overall response rates were 61.3 % , 42.9 % , and 79.3 % in the BT , IVCT , and IACT groups , respectively . Two patients achieved pathological complete response . Three-year progression-free survival rates were 70.7 % , 66.3 % , 81.5 % , and 79.7 % in the RS , BT , IVCT , and IACT arms , respectively ( P = 0.354 ) . Three-year overall survival was 73.3 % , 68.3 % , 82.9 % and 80.4 % , respectively ( P = 0.431 ) . Multivariate analysis showed that only lymph node status correlated with progression-free survival . Conclusions Neoadjuvant treatment had no significant impact on the outcomes of patients with stage IB2 to IIA cervical cancer BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications OBJECTIVE To determine if three courses consisting of 50 mg/m2 cis-platinum , 1 mg/m2 vincristine , and 25 mg/m2 bleomycin ( day 1 - 3 ) at 10-day intervals can improve survival before Wertheim-Meigs + radiotherapy . MATERIAL Two hundred five unselected stage Ib patients ( having tumors > 2 cm in diameter ) were divided into two groups at r and om : ( 1 ) The group control consisted of 103 patients ( 56 bulky , > 4 cm diameter ) treated with Wertheim-Meigs ( if the tumor was resectable with free surgical margins ) + adjuvant radiotherapy to whole pelvis ( extended field radiation was used only in patients with paraaortic lymph node metastases ) . When the tumor was unresectable , a surgical staging was performed and radiotherapy was the chosen treatment . ( 2 ) Neoadjuvant ( 102 patients , 61 bulky ) had neoadjuvant chemotherapy and then the same treatment as the control patients . RESULTS After 67 ( 31 - 102 ) months of follow-up , no difference was seen in tumors > 2 and < 4 cm in both groups ( C = 77 % vs N = 82 % ) , but statistically significant differences were seen in survival and disease-free survival , in bulky tumors , and between patients with neoadjuvant chemotherapy + Wertheim-Meigs + radiotherapy ( 80 % ) and the control ( 61 % ) . This was due to an increased operability that was substantially improved in bulky tumors in the neoadjuvant chemotherapy group ( 61/61 , 100 % ) vs control ( 48/56 , 85 % ; P < 0.01 ) . After 7 years of follow-up , the outcome of the unresectable bulky control group of patients is significantly worse ( 14 % ) than that of the resectable group ( 69 % ; P < 0.001 ) . With regard to recurrences , a significant decrease in pelvic failures in the neoadjuvant chemotherapy group was observed ( P < 0.001 ) . Survival was improved in bulky resectable cases ( N = 81 % vs C = 69 % , P < 0.05 ) . Pathological findings for the surgical specimens revealed differences between both groups because all the risk factors such as parametrial and lymph node metastases , tumor bulk , and vascular embolism had been decreased ( P < 0.001 ) . CONCLUSION Neoadjuvant chemotherapy can improve survival because of increased operability with free survival margins and a decrease in pathologic risk factors in unselected , bulky ( > 4 cm diameter ) stage Ib patients PURPOSE Neoadjuvant chemotherapy may represent an alternative to irradiation in locally advanced squamous cell cervical cancer . Aims of this study were to compare a three-drug ( paclitaxel , ifosfamide , and cisplatin [ TIP ] ) with a two-drug ( ifosfamide and cisplatin [ IP ] ) regimen and to assess the prognostic value of pathologic response on survival . PATIENTS AND METHODS Patients ( n = 219 ) were r and omly assigned to ifosfamide 5 g/m(2 ) during 24 hours plus cisplatin 75 mg/m(2 ) , or paclitaxel 175 mg/m(2 ) plus ifosfamide 5 g/m(2 ) during 24 hours and cisplatin 75 mg/m(2 ) every 3 weeks for three courses . RESULTS Grade s 3 to 4 neutropenia , anemia , and thrombocytopenia were more frequent with TIP . We recorded four deaths related to toxicity . The optimal pathologic response ( OPT ) rate ( residual disease < 3 mm stromal invasion ) was higher with TIP than with IP ( 48 % v 23 % ; odds ratio , 3.22 ; 95 % CI , 1.69 to 5.88 ; P = .0003 ) . At a median follow-up of 43.4 months , 79 women experienced disease progression or died ( 46 in the IP arm , 33 in the TIP arm ) . Patients receiving TIP experienced a treatment failure rate 25 % less than those receiving IP , but this difference was not statistically significant ( hazard ratio [ HR ] , 0.75 ; 95 % CI , 0.48 to 1.17 ; P = .20 ) . Sixty-one patients died ( 37 in the IP arm , 24 in the TIP arm ) , and the HR of death was in favor of TIP , although not significantly ( HR , 0.66 ; 95 % CI , 0.39 to 1.10 ; P = .11 ) . In patients assessable for response ( n = 189 ) , the average death rates were higher in the group that did not achieve OPT ( HR , 5.88 ; 95 % CI , 2.50 to 13.84 ; P < .0001 ) . CONCLUSION The TIP regimen is associated with a higher response rate than the IP regimen , without a statistically significant effect on overall survival . OPT was a prognostic factor for survival One hundred fifty-one patients ( 107 stage IIB and 44 stage IIIB ) who had completed 2 years of follow-up after treatment with neoadjuvant chemotherapy ( " Quick " VBP scheme ) , prior to st and ard therapy , are presented . Four groups of patients with different prognosis and operability status , according to tumor response , were identified . In the first group ( excellent responders ) 96 % of the patients had no evidence of disease ( NED ) , whereas in the fourth group ( no response ) , only 33 % had NED after 2 years of follow-up . In the first group , no pelvic failure was observed . On the other h and , of 21 patients in group 4 , 11 ( 52 % ) had pelvic recurrences . The response to neoadjuvant therapy is strongly associated with the initial tumor volume ecographically evaluated . The critical pretreatment volume for response was 84 cm3 ( 4.85 cm in diameter ) .  Surgery and radiotherapy  were equally effective in those patients with initial tumor volume of 84 cm3 or less . But surgery appears to have a better outcome in those patients with tumors larger than the critical pretreatment tumor volume . Radiotherapy in this controversial group was ineffective in avoiding pelvic recurrences , especially when the tumor volume was not sufficiently reduced . The advantage of neoadjuvant chemotherapy is evident in stage IIB , with 79 % ( 85/107 ) of patients showing no evidence of disease as compared with 47 % ( 24/51 ) in a nonr and omized control group ( P less than 0.01 ) . Statistically significant differences were also obtained in stage IIIB ( 50 % vs 26 % in the control group ) OBJECTIVE To assess the role of neoadjuvant chemotherapy to achieve radical surgery in a larger number of patients with locally advanced/or bulky Stage IB cervical carcinoma . We conducted a trial to determine whether neoadjuvant chemotherapy would improve disease-free survival and overall survival in Stage IB-III cervical cancer . DESIGN Prospect i ve r and omized clinical study with long-term follow-up . SETTING Department of Gynecology , Perinatology and Child Health , II Faculty University of Rome " La Sapienza " . METHODS 288 patients with squamous cell carcinoma of the uterine cervix , FIGO Stage IB-IIIB were r and omized to one of the following treatments : three courses of neoadjuvant chemotherapy with cisplatin , vincristine , bleomycin ( NACT arm ; n = 159 ) ; conventional surgery or exclusive radiotherapy ( CONV arm ; n = 129 ) . There was no difference in age , FIGO stage , tumor size and lymph node involvement between the two groups ( p = ns ) . Two hundred and thirty-four patients in Stage IB-IIb ( n = 129 NACT arm and n = 105 CONV arm ) and 24 patients in Stage III ( NACT arm ) who proved to be chemosensitive underwent radical hysterectomy .  Six Stage III patients , non responders to chemotherapy , and 24 patients , Stage III of the CONV arm , underwent radiotherapy . Follow-up extended for seven years . RESULTS The study was performed on disease-free survival related to several prognostic factors : age , FIGO stage , tumor size , grading , parametrial involvement , lymph node status and surgical margins . Recurrence of disease occurred in 49 ( 32.1 % ) patients of the NACT arm ( n = 153 ) and in 39 ( 37.1 % ) . patients of the CONV arm ( n = 105 ) . Statistically significant differences in the recurrence of the disease were related to FIGO stage ( p < 003 ) , grading ( p < .05 ) , parametrial involvement ( p < .002 ) lymph node status ( p < .0001 ) and tumor size ( p < .002 ) . No statistical significance was related to age and surgical margins ( p = ns ) . Disease-free and overall survival in the two groups were , respectively , 65.4 % vs 53.5 % ( p = ns ) and 70.4 % 65.9 % ( p = ns ) OBJECTIVE A r and omized phase III trial was conducted to determine if neoadjuvant chemotherapy ( NACT ) prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy ( RHPPL ) could improve progression-free survival ( PFS ) and overall survival ( OS ) , as well as operability , with acceptable levels of toxicity . Adjuvant radiation therapy was prescribed for specific surgical/pathological risk factors for both regimens . METHODS Eligible patients were required to have bulky FIGO Stage IB cervical cancer , tumor diameter > or = 4 cm , adequate bone marrow , renal and hepatic function , and performance status < or = 2 . Prospect i ve r and om allocation was to either NACT ( vincristine-cisplatin chemotherapy every 10 days for 3 cycles ) before exploratory laparotomy and planned RHPPL ( NACT+RHPPL ) , or RHPPL only . RESULTS The study was closed prematurely , because of slow accrual , after 291 patients were enrolled , three were ineligible ; thus 288 were eligible and r and omly allocated to RHPPL ( N=143 ) or NACT+RHPPL ( N=145 ) . There were no notable differences between regimens with regard to patient age , race , performance status , or tumor size . The median follow-up time is 62 months among living patients . The NACT+RHPPL group had very similar recurrence rates ( relative risk : 0.998 ) and death rates ( relative risk : 1.008 ) when compared to the RHPPL group . There were 79 % that had surgery in the RHPPL group compared to 78 % in the NACT RHPPL group . There were 52 % who received post op RT in the RHPPL group compared to 45 % in the NACT+RHPPL group ( not statistically significant ) . CONCLUSION There is no evidence from this trial that NACT offered any additional objective benefit to patients undergoing RHPPL for suboptimal Stage IB cervical cancer BACKGROUND The efficacy and tolerability of the regimen containing paclitaxel and cisplatin ( TP ) in the neo-adjuvant treatment of locally advanced squamous cell cervical cancer are unknown . The TIP regimen ( TP plus ifosfamide ) showed high efficacy but high toxicity and it is used as an internal control . PATIENTS AND METHODS In all , 154 patients were r and omized to TP ( paclitaxel  175 mg/m(2 ) + cisplatin 75 mg/m(2 ) ; n = 80 ) or TIP ( TP + ifosfamide 5 g/m(2 ) ; n = 74 ) , three cycles , followed by radical surgery . Pathological response to chemotherapy was classified as optimal [ no residual tumor ( complete response ) or residual disease with < or = 3 mm stromal invasion ( PR1 ) ] or suboptimal response . RESULTS Patient characteristics ( TP/TIP ) : stage IB2 ( 56%/64 % ) , IIA ( 18%/14 % ) , IIB ( 20%/19 % ) , III-IVA ( 5%/4 % ) and median age ( 42 years/45 years ) . The optimal response rate in the TP group was 25 % , 95 % confidence interval ( CI ) = 16 % to 37 % and 43 % , 95 % CI = 31 % to 55 % in the TIP group . Grade s 3 - 4 leukopenia ( 6%/53 % ) and neutropenia ( 26%/76 % ) were significantly more frequent on TIP . CONCLUSION TP performance was below expectation since the lower 95 % confidence limit of the optimal response rate failed to reach the prespecified minimum requirement of efficacy , i.e. 22 % . The TIP regimen confirmed its activity but was associated with higher haematological toxicity than TP 5013 Background : NAC may represent an alternative to conventional RH for locally advanced cervical cancer . We compared NAC followed by RH with RH for bulky stage I/II cervical cancer . METHODS Patients ( pts ) with stage IB2 , IIA ( > 4 cm ) , or IIB squamous cell carcinoma of the uterine cervix were r and omly assigned to receive either BOMP ( bleomycin 7 mg day 1 - 5 , vincristine 0.7mg/m2 day 5 , mitomycin 7mg/m2 day 5 and cisplatin 14 mg/m2 day 1 - 5 , ) q21 days , 2 to 4 cycles  followed by radical hysterectomy ( NAC arm ) or undergo RH ( RH arm ) . Pts with positive surgical margins , metastatic nodes , infiltration to parametrium , and /or deep myometrial invasion received postoperative irradiation . Eligibility included preserved organ function , aged 20 - 70 , and Performance Status 0 or 1 . Primary endpoint was overall survival ( OS ) to be compared by log-rank test . Assuming 100 eligible pts in each arm , the study had 80 % power to detect a 15 % increase in 5-year survival at 0.05 one-sided alpha . RESULTS 134 pts ( 67 NAC , 67 RH ) were r and omized between 12/01 and 08/05 . The first planned interim analysis was performed in July 2005 using data from 108 pts registered as of 11/04 . Data and Safety Monitoring Committee recommended to terminate the study because overall survival in NAC arm was inferior to that in RH arm ( HR 2.11 , multiplicity adjusted 99 % CI 0.34 to 13.2 ) and the predictive probability of significant superiority using Spiegelhalter 's method of NAC arm was extremely low ( 6.4 % ) . No increase of operability and no decrease of surgery-related morbidity were observed in NAC arm . Response Rate of NAC was 61 % ( 33 of 54 ) using RECIST criteria . One-year progression-free survival and overall survival , up date d as of 05/05 , were 69.9 % and 91.8 % ( 95 % CI 84.1 - 99.6 ) in NAC arm and 78.6 % and 95.4 % ( 95 % CI 89.1 - 100 ) in RH arm respectively . CONCLUSIONS Neoadjuvant chemotherapy with BOMP regimen followed by radical hysterectomy did not demonstrate clinical benefit , and conventional radical hysterectomy still remains to be a st and ard treatment option for bulky stage I/II cervical cancer . [ Table : see text ] 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 r and omly 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 OBJECTIVE to verify whether a regimen of preventive chemotherapy in the treatment of cervical carcinoma allows surgical treatment in a larger number of patients and whether cases treated with this combined neoadjuvant polychemotherapy/surgery regimen improves overall and disease-free survival rates . DESIGN prospect i ve r and omized clinical study . SETTING Department of Gynaecology and Obstetrics , University of Rome " La Sapienza " . METHODS 192 patients suffering from squamous cell carcinoma of the uterine cervix in Stages Ib-IIb were r and omized to one of the following treatments : three courses of neoadjuvant chemotherapy with cisplatin , vincristine , bleomycin ( NACT arm ; n = 106 ) ; conventional surgery or radiotherapy alone ( CO arm ; n = 86 ) . One hundred and fifty-six patients in Stage Ib-IIb ( n = 86 , NACT arm and n = 70 , CO arm ) and 16 patients in Stage III ( NACT arm ) who proved to be sensitive to the neoadjuvant chemotherapy , underwent radical hysterectomy . Four Stage III patients not sensitive to chemotherapy and 16 patients , Stage III , of the CO arm underwent radiotherapy . RESULTS the 5-year overall survival rates for the NACT and CO arm , respectively , were 78.6 % and 73.2 % in Stages Ib-IIa ( p = NS ) , 68.7 % and 64.3 % in Stage IIb ( p = NS ) . A 5-year disease-free survival rate for the NACT arm and CO arm , respectively , of 77.1 % and 64.3 % in Stages Ib-IIa ( p < .05 ) , 56.2 % and 57.1 % in Stage IIb ( p = NS ) was found . CONCLUSIONS the responsiveness of cervical cancer to neoadjuvant chemotherapy allows surgical treatment in a larger number of patients and results in longer overall and disease-free survival AIM To determine the most effective treatment and long-term outcome of patients with stage IB carcinoma of the cervix . METHODS From January 1999 to December 2001 , 106 women with cervical cancer stage IB received neoadjuvant chemotherapy ( n = 52 ) or primary surgery ( n = 54 ) . These were r and omly assigned . Clinical effects and pathological changes were simultaneously recorded . RESULTS The overall clinical response rate was 84.6 % and included a complete response ( CR ) in four patients ( 7.7 % ) , partial response ( PR ) in 40 patients ( 76.9 % ) , and stable disease ( SD ) in the remaining eight patients ( 15.4 % ) . Surgery revealed positive nodes in 9.6 % neoadjuvant chemotherapy group patients and in 29.6 % primary surgery group patients ( P = 0.014 ) . Similar results occurred with vascular space involvement : 27.8 % in the primary surgery group compared to 9.6 % in the neoadjuvant chemotherapy group ( P = 0.024 ) . However , parametrial infiltration was found in 7.4 % of the patients in the primary surgery group , while only 3.8 % showed it in the neoadjuvant chemotherapy group ( P = 0.679 ) . The overall 5-year survival rate was significantly higher for all patients who received neoadjuvant chemotherapy ( 84.6 % ) than for the control group ( 75.9 % ) ( P = 0.0112 ) . The median survival time in patients with complete response and partial response to chemotherapy ( 83.3 months ) was significantly higher than that of patients with stable disease to chemotherapy ( 55.2 months ) ( P = 0.0049 ) . 27.3 % of patients developed recurrent disease within 5 years of the primary treatment . The women with recurrence included partial response in six patients ( 60.0 % ) , and stable disease in four patients ( 40.0 % ) . For the other patients there was partial response and complete response in 38 patients ( 90.5 % ) , and stable disease in the remaining four patients ( 9.5 % ) ( P = 0.035 ) . CONCLUSION Neoadjuvant chemotherapy can effectively eliminate the pathological risk factors and improve long-term survival in patients with locally advanced cervical cancer
BACKGROUND A previous systematic review found that giving neoadjuvant chemotherapy before surgery improved survival compared with radiotherapy .
However , the role of neoadjuvant chemotherapy followed by surgery versus surgery alone is still unclear .
OBJECTIVES To assess the role of neoadjuvant chemotherapy in women with early or locally-advanced cervical cancer .