Neoadjuvant chemotherapy, radical hysterectomy and chemoradiation for stage iva cervical carcinoma

Abstract

Despite the efficacy of chemotherapy and radiotherapy in the management of locally advanced cervical carcinoma, the overall survival rates are relatively inauspicious. We recount a case involving a 56-year-old stage IVA cervical cancer patient who underwent neoadjuvant chemotherapy, a type V radical hysterectomy and adjuvant chemoradiation in April 2006. The patient remained in clinical remission for five years until she developed a metastatic pulmonary nodule in her right middle lobe that originated from the primary cervical cancer. Thereafter, the patient was diagnosed with a right metastatic cardiophrenic nodule that responded favorably to chemotherapy. However, in August 2014, she presented with a metastatic posterior cranial fossa tumor from which she ultimately expired; interestingly, radiologic imaging revealed no evidence of an abdominopelvic recurrence. While a radical hysterectomy is often indicated for advanced cervical cancer patients with residual disease or those who fail chemoradiation, perhaps in select cases (e.g., stage IVA disease), initial treatment with neoadjuvant chemotherapy and surgery followed by chemoradiation may improve patient survival.