Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: An 2002 Update

Abstract

Locally advanced cervical cancer, especially those with bulky primary lesion, is a challenge to both gynecologic oncologists and radiologic oncologists. The current standard treatment is concurrent chemoradiation. However, treatment results remain to be improved. A 40-year-old women was referred to Mackay Memorial Hospital for a bulky stage IIIB cervical carcinoma with massive vaginal bleeding on February 17, 1992. After emergent radiotherapy with 300cGy/day for 3 consecutive days for controlling tumor bleeding, the patient received 3 cycles of neoadjuvant chemotherapy with cisplatin, oncovin and bleomycin. After achieving optimal clinical response, the patient underwent radical hysterectomy with bilateral pelvic lymphadenectomy. Postoperative adjuvant radiotherapy was arranged despite pathology examination revealed only a 1.5×1.5×0.5cm residual cervical carcinoma without any pathologic risk factors. The patient has been doing well without major complication for 10 years. Neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiotherapy may achieve long-term survival without major complication in locally advanced cervical cancer. To improve the survival of locally advanced cervical cancer, multi-modality managements warrant further investigation.