Neoadjuvant chemotherapy for locally advanced stage (IB2-IIA2-IIB) cervical carcinoma: Experience of tertiary center and comprehensive review of the literature

Etlik Zubeyde Hanim Women’s Health Training And Research Hospital, Faculty Of Medicine, University Of Health Sciences

Aim: In this study the effectiveness of NACT is evaluated.
Introduction: Neoadjuvant chemotherapy (NACT) is one of the methods for the initial therapy in locally advanced cervical carcinoma.
Materials and Methods: The data of 43 patients with locally advanced cervical carcinoma who had NACT are reviewed. NACT protocols were cisplatin/5-fluorauracil, cisplatin/UFT and carboplatin/paclitaxel. After NACT, the patients were re-examined and the patients who had a tumor size equally and less than 40mm were operated (Piver-Rutledge type III radical hysterectomy) and radiotherapy was given to the others. Following the NACT clinical response were assessed according to the WHO criteria.
Results: The mean age of patients was 49.4 years, and the median follow up was 48 (range, 5-228) months. The median tumor size was 50 mm before NACT and 30 mm after NACT. Response rates were as follows; complete clinical response in four patients (9.3%), partial clinical response in eight (18.6%) and pathologic complete response in three (6.9%). Stable disease was in 30 patients (69.9%) and progression was seen in one patient (2.3%). After NACT 31 patients have had radical surgical procedure. 5-year disease-free survival was 72%, 5-year disease-specific survival was 91%. Age, FIGO 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT and lymph node metastasis were not associated with disease-free survival.
Conclusions: After NACT there was a significant reduce in tumor dimension and the probability of radical surgery is increased. But clinical response did not predicted survival.

Keywords:

Lokal olarak ileri evre (IB2-IIA2-IIB) servikal karsinom için neoadjuvan kemoterapi: tersiyer merkez deneyimi ve literatürün kapsamlı incelemesi

Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim Ve Araştırma Hastanesi

Amaç: Bu çalışmada NACT'ın etkinliği değerlendirilmiştir.
Giriş: Neoadjuvan kemoterapi (NACT), lokal olarak ilerlemiş servikal karsinomda başlangıç tedavisi için yöntemlerden biridir.
Gereç ve Yöntemler: Lokal olarak ilerlemiş servikal karsinomlu, NACT olan 43 hastanın verileri gözden geçirildi. NACT protokolleri cisplatin / 5-fluorauracil, sisplatin / UFT ve carboplatin / paclitaxel idi. NACT sonrası hastalar tekrar muayene edildi ve tümör boyutu 40 mm ve altı olan hastalar ameliyat edildi (Piver-Rutledge tip III radikal histerektomi) ve diğer hastalara radyoterapi verildi. NACT klinik yanıtı, WHO kriterlerine göre değerlendirildi.
Bulgular: Hastaların ortalama yaşı 49.4 yıl ve ortanca takip süresi 48 (aralık, 5-228) aydı. Ortalama tümör boyutu NACT'tan önce 50 mm ve NACT'tan sonra 30 mm idi. Yanıt oranları aşağıdaki gibidir; dört hastada (% 9,3) tam klinik yanıt, sekiz hastada (% 18,6) kısmi klinik yanıt ve üç hastada (% 6,9) patolojik tam yanıt. 30 hastada (% 69.9) stabil hastalık ve bir hastada (% 2.3) progresyon görüldü. NACT'tan sonra 31 hasta radikal cerrahi prosedür geçirdi. 5 yıllık hastalıksız sağkalım% 72, 5 yıllık hastalığa özgü sağkalım% 91 idi. Yaş, FIGO 2009 evresi, histopatolojik tip, NACT protokolü, NACT sonrası tümör boyutundaki azalma oranı, klinik yanıt, kurs sayısı, NACT öncesi tümör boyutu, NACT sonrası tümör boyutu ve lenf nodu metastazı hastalıksız sağkalım ile ilişkili değildi.
Sonuçlar: NACT sonrası tümör boyutunda önemli bir azalma oldu ve radikal cerrahi olasılığı arttı. Ancak klinik yanıt, sağkalımı tahmin etmedi.

Anahtar Kelimeler:

Caner Cakir, Fatih Kilic, RIZA DUR, Dilek Yuksel, Mehmet Unsal, Vakkas Korkmaz, Cigdem Kilic, Gunsu Kimyon Comert, Nurettin Boran, osman turkmen, Sevgi Koc, Taner Turan. Neoadjuvant chemotherapy for locally advanced stage (IB2-IIA2-IIB) cervical carcinoma: Experience of tertiary center and comprehensive review of the literature. . 2021; 18(3): 0-0

Corresponding Author: Caner Cakir, Türkiye