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Multimodal treatment for the locally advanced stage IB, IIA, IIB patients of cervical cancer
Author(s) -
Kim S.J.
Publication year - 1995
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/0020-7292(95)02410-e
Subject(s) - medicine , cervical cancer , radical hysterectomy , chemotherapy , bleomycin , regimen , stage (stratigraphy) , radical surgery , radiation therapy , hysterectomy , surgery , cancer , gynecology , oncology , urology , gastroenterology , paleontology , biology
By employing neoadjuvent chemotherapy (NCT) before radical hysterectomy (RS) and pelvic radiotherapy (RT) in bulky locally advanced cervical cancer (IB, IIA, IIB), the study was focused to update the results of the author's therapeutic experience with multimodal treatment by observing tumor free survivals along with related prognostic factors in different treatment modalities with NCT. The chemotherapy regimen for induction is composed of Vinblastin, Bleomycin and cis‐Platin regimen (VBP). The effect of neoadjuvent chemotherapy was evaluated by the WHO definition of clinical response (CR, PR, ST, PG). As a result of NCT study in the stage IA, IIA, and IIB cervical cancer patients recurrence occurred in 50 out of 138 patients (35.5%) treated with radical hysterectomy only (RS) compared with 17 out of 92 patients (18.5%) treated with NCT followed by radical surgery. In conjunction with the NCT study in the cervical cancer, another two groups of patients who were treated by neoadjuvent chemotherapy followed by radical hysterectomy (NCST) and adjuvent radiation (NCSRT) were evaluated in the high‐risk patients of cervical cancer with stage IB, IIA, and IIB. Primary responses in the NCST group ( n = 61) were CR (68.9%), PR (22.9%), ST (4.9%) and PG (3.3%) respectively, while the chemoresponse of the NCSRT group ( n = 101) were CR (65.3%), PR (18.9%), ST (4.9%) and PG (10.9%), respectively. The survival rates of the NCSRT group ( n = 101) were 100% in all 1–5 years in CR group, while the rate of the NCST group was 100% at 1 year and 98.5% at 5 years in the CR group of patients. In contrast to CR, the patients who showed PR patients showed 40.1% of 5‐year survival rate in NCST group, and 12.6% in NCRST group. Tumor size, lymphnode metastasis and primary chemoresponse pattern were correlated to each other, but 5‐year survival rate of the CR group was much higher in the same stages IB, IIA and IIB of cervical cancer. In the multivariate analysis of known risk factors, the response pattern to primary chemotherapy, the responsiveness revealed the highest value (R.R. = 3.26) as a survival predictor in the patient treated with a multimodal approach.