Long-term follow-up of neoadjuvant cisplatin and 5-fluorouracil chemotherapy in bulky squamous cell carcinoma of the cervix

Abstract

Fifteen patients with bulky (designated as > 3 cm largest diameter) FIGO stage Ib or IIa squamous cervical cancer were treated with cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2 continuously on days 1-5) administered intravenously at 21-day intervals for a total of two or three courses before planned radical hysterectomy. A complete clinical response was noted in four patients and a partial response in ten patients, which represents a 93% overall response rate. One patient had stable disease (two courses of chemotherapy), and none had progressive disease. Median tumor volume was 78.5 cm3 and 2.5 cm3 at diagnosis and after neoadjuvant chemotherapy, respectively (p < 0.001). This indicates that chemotherapy resulted in a 97% median reduction of tumor volume. Median overall and disease-free survival was not reached, and the actuarial five-year survival rate was 73% and 67%, respectively. There was no grade 4 toxicity. Myelosuppression was acceptable; however, two patients experienced significant ototoxicity, and in two patients serum creatinine increased. All patients with major toxicity received two cycles of chemotherapy only. The improved local control and survival in our series are in accordance with other results reported, but need to be confirmed in a randomized prospective trial.