A Randomized Trial of Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Radiotherapy Alone in Stage IIIb Carcinoma of the Uterine Cervix

Abstract

Abstract

Objective: Adding chemotherapy to standard treatments for locally advanced cervical carcinoma has been reported to improve prognosis. We compared the survival rates of neoadjuvant chemotherapy followed by radical hysterectomy (NAC+RH) versus radiotherapy alone (Rad) for stage IIIb squamous carcinoma of the cervix. Design: The study design was a simple two-arm randomized controlled trial between NAC+RH and Rad. Methods: We enrolled 42 consecutive women with stage IIIb cervical carcinoma to perform a randomized trial between NAC+RH (n = 22) and Rad (n = 20) in one university hospital. The NAC+RH group received intraarterial chemotherapy with cisplatin, bleomycin, and mitomycin. If the tumor became operable within three courses, radical hysterectomy was performed. The Rad group received radiotherapy to the whole pelvis of 40 Gy, midline shield coverage of 20 Gy, and intracavitary of 24–30 Gy. The main outcome measure was overall survival rates. Results: The median duration of follow-up was 60 months. Disease-free and overall survival rates between the groups did not differ significantly. The 5-year survival rate was 47% for the NAC+RH group and 48% for the Rad group. Keratinizing type of carcinoma responded poorly to radiotherapy compared to nonkeratinizing type. However, both keratinizing and nonkeratinizing types responded similarly to NAC+RH. Conclusions: Neoadjuvant chemotherapy is as effective as radiotherapy in treating stage IIIb squamous carcinoma of the cervix. Women with keratinizing type may benefit from neoadjuvant chemotherapy rather than radiation therapy. (J GYNECOL SURG 26:105)