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10.1245/s10434-007-9408-6
Annals of Surgical Oncology 14:2643-2648 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Neoadjuvant Chemotherapy Followed by Radical Surgery in Patients Affected by FIGO Stage IVA Cervical Cancer

Pierluigi Benedetti Panici, MD1, Filippo Bellati, MD1, Natalina Manci, MD1, Milena Pernice, MD1, Francesco Plotti, MD1, Violante Di Donato, MD1, Marco Calcagno, MD1, Marzio Angelo Zullo, MD2, Ludovico Muzii, MD2 and Roberto Angioli, MD2

1 Department of Obstetrics and Gynecology, University of Rome "La Sapienza", Viale del Policlinico, 155, Rome, Italy
2 Departments of Obstetrics and Gynecology, University Campus Bio-Medico of Rome, Rome, Italy

Correspondence: Address correspondence and reprint requests to: Pierluigi Benedetti Panici, MD; E-mail: pierluigi.benedettipanici{at}uniroma1.it

Background: Concomitant chemoradiotherapy represents the standard treatment for patients affected by locally advanced cervical cancer. Survival rates in patients affected by FIGO stage IVA disease remain poor. Some authors have suggested that neoadjuvant chemotherapy followed by radical surgery might be a valid alternative to standard treatment. The objective of this study was to analyze the feasibility and results obtained by neoadjuvant chemotherapy in patients affected by stage IVA disease.

Methods: Eighteen patients affected by FIGO stage IVA cervical cancer were treated with 175 mg/m2 paclitaxel and 75 mg/m2 cisplatin every 21 days for three courses followed by radical surgery when feasible.

Results: All patients were subjected to the three planned chemotherapy courses. Two patients achieved a complete clinical response, and 10 patients achieved a partial clinical response. Ten patients were subjected to anterior pelvic exenteration, whereas the remaining eight patients were treated with chemotherapy, radiotherapy, and concomitant chemoradiotherapy. The estimated 3-year and 5-year overall survival rates were 47.4% and 31.6%, respectively. Patients eligible for surgery benefited from significantly longer survival rates.

Conclusions: Neoadjuvant chemotherapy followed by radical surgery is feasible in approximately half of patients affected by FIGO stage IVA cervical cancer. Overall survival rates appear similar to those reported with concomitant chemoradiotherapy. Patients who are amenable to radical surgery after chemotherapy may benefit from long-term survival rates.

Key Words: Anterior pelvic exenteration • Cervical cancer • Neoadjuvant chemotherapy • Radical surgery






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