Objective: To evaluate the complications and results of neoadjuvant treatment before surgery and radiotherapy in locally advanced cervical carcinoma.
Methods: Between March 1988 and June 1989, 24 consecutive patients with locally advanced cervical carcinoma received chemotherapy consisting of six weekly courses of cisplatin (50 mg/m2), vincristine (1 mg/m2), and bleomycin (30 mg), followed by radical hysterectomy and radiotherapy. Lymph node metastases were detected by means of lymphangiography and confirmed by fine-needle aspiration in 21 patients.
Results: Twenty-one women (87.5%) completed the planned sequence of treatment and 16 (66.7%) achieved objective responses. Three patients did not complete chemotherapy (one refusal, one myocardial infarction, one severe allergic reaction) and were treated further by radiotherapy. Nineteen subjects (79%) underwent subsequent radical surgery and radiotherapy without serious complications. After a minimal follow-up of 3 years, 16 patients had died of disease. Distant recurrences developed in only three of eight women in whom the nodes were negative originally, possibly reflecting systemic effectiveness of the chemotherapy.
Conclusion: This sequence of treatment, although feasible, does not seem to improve long-term survival compared to standard treatment.