Comparative Study of Bulky Stage IB and IIA Cervical Cancer Patients Treated by Radical Hysterectomy with and without Neoadjuvant Chemotherapy : Long-Term Follow-up
SUMONMAL MANUSIRIVITHAYA, M.D.*, VIRUCH CHAREONIAM, M.D.**, AREE PANTUSART, B.Sc.*** PA WARES ISARIYODOM, M.D.**, JATUPOL SRISOMBOON, M.D.***,
Affiliation : * Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok 10300, ** Kasernradht Hospital, Chiang Mai, *** Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
One hundred and ninety patients with bulky (> 3 em) stage IB and IIA cervical cancer who underwent radical hysterectomy between 1991 and 1994 at Maharaj Nakorn Chiang Mai Hos- pital were reviewed to determine whether neoadjuvant chemotherapy (NAC) with MY AC (Metho- trexate, Vinblastine, Adriamycin, Cisplatin) improved survival. There were 42 patients treated with pre-operataive NAC (MVAC 1-3 courses) and 148 patients treated by primary surgery (PS). In the NAC group, the overall response rate from MVAC was 88.1 per cent with 31.0 per cent having complete clinical response and 7.1 per cent with complete pathological response. Pelvic lymph node metastasis was not significantly different between the NAC group (16.7%) and the PS group (18.2%). At a median follow-up of 64.5 months, 19.0 per cent in the NAC group and 18.2 per cent in the PS group had tumor recurrence. The 5-year progression free and overall sur- vival was 80.8 per cent and 92.0 per cent respectively for the NAC group which was not signifi- cantly different from 80.2 per cent and 92.9 per cent respectively in the PS group. In conclusion, although NAC can decrease the tumor size and produce a high response rate, it does not improve survival in bulky stage IB and IIA cervical cancer patients.
Keywords : Chemotherapy, Cervical Cancer, Survival
