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Abstract
BackgroundCisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; however, neoadjuvant modalities are currently being tested. Neoadjuvant studies in several tumor types have underscored the prognostic significance of pathological response for survival; however there is a paucity of studies in cervical cancer investigating this issue.MethodsFour cohorts of patients with locally advanced cervical carcinoma (stages IB2-IIIB); included prospectively in phase II protocols of either neoadjuvant chemotherapy with 1) cisplatin-gemcitabine, 2) oxaliplatin-gemcitabine, 3) carboplatin-paclitaxel or 4) chemoradiation with cisplatin or cisplatin-gemcitabine followed by radical hysterectomy were analyzed for pathological response and survival.ResultsOne-hundred and fifty three (86%) of the 178 patients treated within these trials, underwent radical hysterectomy and were analyzed. Overall, the mean age was 44.7 and almost two-thirds were FIGO stage IIB. Pathological response rates were as follows: Complete (pCR) in 60 cases (39.2%), Near-complete (p-Near-CR) in 24 (15.6 %) and partial (pPR) in 69 cases (45.1%). A higher proportion rate of pCR was observed in patients treated with chemoradiotherapy (with cisplatin [19/40, 47.5%]; or with cisplatin-gemcitabine [24/41, 58.5%] compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5%) for cisplatin-gemcitabine, oxaliplatin-gemcitabine and carboplatin-paclitaxel respectively [p = 0.0001]). A total of 29 relapses (18.9%) were documented. The pathological response was the only factor influencing on relapse, since only 4/60 (6.6%) patients with pCR relapsed, compared with 25/93 (26.8%) patients with viable tumor, either pNear-CR or pPR (p = 0.001). Overall survival was 98.3% in patients with pCR versus 83% for patients with either pNear-CR or pPR (p = 0.009).ConclusionComplete pathological response but no Near-complete and partial responses is associated with longer survival in cervical cancer patients treated with neoadjuvant chemotherapy or chemoradiotherapy.
Highlights
Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; neoadjuvant modalities are currently being tested
We have reviewed the outcome of the patients that underwent surgery in our series of phase II studies of neoadjuvant chemotherapy or chemoradiation followed by radical hysterectomy
A higher proportion rate of pathological complete response (pCR) was observed in patients treated with chemoradiotherapy compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5 %) for cisplatin-gemcitabine, oxaliplatingemcitabine and carboplatin-paclitaxel respectively (p = 0.0001), table 2
Summary
Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; neoadjuvant modalities are currently being tested. The epidemiology of cervical cancer is strongly related to the standard of living of populations, underdeveloped countries present the higher mortality rates which can be as high as >70 per 100 000 inhabitants and most cases are diagnosed in locally advanced disease -stages IB2-IVA- according to the FIGO classification [1]. Cisplatinbased chemoradiation was largely accepted as the standard of care for cervical cancer patients whose treatment requires radiation. Concomitant chemoradiotherapy has shown benefit in locally advanced cervical cancer; a meta-analysis of neoadjuvant chemotherapy followed by radical hysterectomy has shown an absolute benefit of 15% at 5-year survival [8]; currently, the EORTC is conducting a randomized phase III trial comparing these two treatment modalities. Multimodal treatments incorporating radiation, chemotherapy and surgery must be investigated in the aim to further improve the prognosis [9]
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