Author(s): BenedettiPanici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, , BenedettiPanici P, Greggi S, Colombo A, Amoroso M, Smaniotto D,
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Abstract PURPOSE: Neoadjuvant chemotherapy (NACT) and radical surgery (RS) have emerged as a possible alternative to conventional radiation therapy (RT) in locally advanced cervical carcinoma. In 1990, a phase III trial was undertaken to verify such a hypothesis in terms of survival and treatment-related morbidity. PATIENTS AND METHODS: Patients with squamous cell, International Federation of Gynecology and Obstetrics stage IB2 to III cervical cancer were eligible for the study. They received cisplatin-based NACT followed by RS (type III to V radical hysterectomy plus systematic pelvic lymphadenectomy) (arm A) or external-beam RT (45 to 50 Gy) followed by brachyradiotherapy (20 to 30 Gy) (arm B). RESULTS: Of 441 patients randomly assigned to NACT+RS or RT, eligibility was confirmed in 210 and 199 patients, respectively. Treatment was administered according to protocol in 76\% of arm A patients and 72\% of arm B patients. Adjuvant treatment was delivered in 48 operated patients (29\%). There was no evidence for any significant excess of severe morbidity in one of the two arms. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 58.9\% and 55.4\% for arm A and 44.5\% and 41.3\% for arm B (P =.007 and P =.02), respectively. Subgroup survival analysis shows OS and PFS rates of 64.7\% and 59.7\% (stage IB2-IIB, NACT+RS), 46.4\% and 46.7\% (stage IB2-IIB, RT) (P =.005 andP =.02), 41.6\% and 41.9\% (stage III, NCAT+RS), 36.7\% and 36.4\% (stage III, RT) (P =.36 and P =.29), respectively. Treatment had a significant impact on OS and PFS. CONCLUSION: Although significant only for the stage IB2 to IIB group, a survival benefit seems to be associated with the NACT+RS compared with conventional RT.
This article was published in J Clin Oncol
and referenced in Journal of Cancer Science & Therapy