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KMID : 0352119960120030319
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Journal of Kyung Hee University
1996 Volume.12 No. 3 p.319 ~ p.329
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The Efficacy of Neoadjuvant Chemotherapy with Vinblastine-Bleomycin-Cisplatin for Locally Advanced Cervical Carcinoma
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Abstract
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Between January 1992 and December 1994, 15 patients with locally advanced cervical carcinoma (FIGO Stages Ib-II with bulky tumor) received neoadjuvant chemotherapy, including vinblastine, bleomycin, and cisplatin (VBP) and radical hysterectomy at
Kyung
Hee University Hospital, Seoul, Korea.
Although invasive cancer of the cervix has not been eliminated, the incidence is decreasing, and it is being diagnosed earlier, leading to better survival rates. But the incidence of the cancer is more common in underdeveloped and developing
countries
and less frequent in Western and industrialized countries.
Although both surgery and radiotherapy have been very effective in the treatment of early-stage carcinoma of the cervix yielding 5-year survival rates of 85% or greater, the prognosis for patients with more advanced lesions treated with theses
modalities remain less optimistic.
In the last few years, neoadjuvant chemotherapy has been applied as a new therapeutic approach of locally advanced cervical cancer because of the disappointing results with conventional treatments.
To asses the effectiveness of neoadjuvant chemotherapy followed by radical hysterectomy and/or radiation therapy in women with locally advanced cancer (FIGO Stages Ib-II with bulky tumor), 15 selected patients with bulky mass (more than 4 cm) in
Stages
Ib and II cervical cancer were treated three or more courses of neoadjuvant VBP chemotherapy and analyzed.
@ES The results were obtained as follows:
@EN 1. The overall response rate to neoadjuvant chemotherapy was noted in 8 patients (53.3%), but stable disease in 7 patients (46.7%).
2. Of the 15 patients, 3 patients (20%) had a stagedown and 11 patients of the all patients (73%) had a reduction of tumor-size.
3. All of patients with reduction of tumor-size were performed without siginificant difficulty and revealed negative surgical margins.
4. Histologic examiniation of the resected primary tumor were revealed microscopic focus in 13.3% and patients in whom depth of invasion was less than half of the cervix in 46.7%.
5. Pelvic lymph node metastases after retroperitoneal lymphadenectomy were found in 33.3% and paraaortic lymph node metastases in 13.3%.
6. Two of these patients (13.3%) had recurrences and all had paraaortic lymph node metastases.
7. A 2-year disese-free survival rate of 100% and 74.3% was achieved for stages Ib and II, respectively.
The neoadjuvant chemotherapy showed the benefits on the increased operability rate, a reduction of tumor size and staging-down, and disease-free interval and survival.
To determine the efficacy of neoadjuvant chemotherapy, prospective randomized study comparing radical surgery alone with neoadjuvant chemotherapy followed by radical hysterectomy is in progress.
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