Journal Article

Neoadjuvant Platinum-based Chemotherapy Followed by Radical Hysterectomy for Stage Ib2-IIb Adenocarcinoma of the Uterine Cervix – An Italian Multicenter Retrospective Study

ZOLA, PAOLO, ZIZIOLI, VALENTINA, FERRERO, ANNA MARIA, GADDUCCI, ANGIOLO, LANDONI, FABIO, LAPRESA, MARIA TERESA, MAGGINO, TIZIANO, SARTORI, ENRICO, COSIO, STEFANIA

2018

Overview

To assess the patterns of recurrence and clinical outcomes of patients with cervical adenocarcinoma who underwent neoadjuvant platinum-based chemotherapy (NACT) followed by radical hysterectomy. Data were retrospectively analyzed for 82 patients with International Federation of Gynecology and Obstetrics stage Ib2-IIb cervical adenocarcinoma who underwent this chemo-surgical treatment. The median follow-up of survivors was 89 months (range=5-208 months). Pathological complete response, optimal response and suboptimal response with intra-cervical residual disease were obtained in five (6%), 10 (12%) and 36 (44%) patients, respectively. Adjuvant external-beam radiotherapy with or without concurrent chemotherapy was administered to 47 patients. Nineteen (23%) out of the 82 patients experienced recurrence after a median of 12 months (range=5.3-86.8 months). Recurrent disease was pelvic in 12 (63%) patients, extra-pelvic in five (26%), and both pelvic and extra-pelvic in two (10%). According to pathological response, tumor relapsed in 10% of optimal responders, 14% of sub-optimal responders with intra-cervical residual disease, and 36% of sub-optimal responders with extra-cervical residual disease or non-responders. Five-year recurrence-free and overall survival were 77% and 84%, respectively. Patients who achieved an optimal response or sub-optimal response with intra-cervical residual disease had better 5-year recurrence-free (87% vs. 64%, p=0.017) and overall (92% vs. 74%, p=0.012) survival than those who had sub-optimal response with extra-cervical residual disease or no response. The latter had a 1.441-fold higher risk of recurrence and a 1.652-fold higher risk of death than those who obtained an optimal response or a sub-optimal response with intra-cervical residual disease. NACT followed by radical hysterectomy may be an option for patients with stage Ib2-IIb adenocarcinoma of the uterine cervix.

• Publisher: International Institute of Anticancer Research
• Subject: Adenocarcinoma / Adenocarcinoma - pathology / Adenocarcinoma - therapy / Adult / Aged / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Cancer therapies / Cervical cancer / Cervix / Chemoradiotherapy / Chemotherapy / Chemotherapy, Adjuvant / Cisplatin - administration & dosage / Combined Modality Therapy / Disease-Free Survival / Female / Gynecology / Humans / Hysterectomy / Hysterectomy - methods / Magnetic resonance imaging / Medical prognosis / Middle Aged / Neoadjuvant Therapy / Neoplasm Recurrence, Local / Neoplasm Staging / Obstetrics / Patients / Platinum / Radiation therapy / Response rates / Retrospective Studies / Squamous cell carcinoma / Surgery / Survival / Treatment Outcome / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - therapy / Uterus / Young Adult