"study of concurrent cisplatin and external radiotherapy prior to radical hysterectomy and lymphadenectomy in patients with stage ib-iib cervical cancer"

the purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program ib-iia, bulky and suspicious iib by radical surgery in patients with stage ib-iib cervical cancer. from september 1999 to april 2002, 30 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy of 45 gy in 5 weeks. patients received concurrent continuous infusion of cisplatin 50 mg/m2 for one day in week during 5 weeks of radiation. radical surgery was performed 4-6 weeks after completion of the preoperative treatment. toxicity with chemoradiation was usually mild. two patients developed vesicovaginal fistula, and four developed long-term hydronephrosis that needed ureteral stenting. clinical response was observed in 100% of the patients (23.7% complete response). the analysis of the surgical specimens revealed complete pathological response in 43.3% of the cases and partial pathological response in 56.7%. the degree of pathological response was not predictable by the degree of clinical response. thirty months disease-free survival and overall survival were 66.3% and 77.31%, respectively. patients with complete and partial pathological response were not significantly different in terms of disease-free survival (p= 0.08) and overall survival (p= 0.3). cisplatin in preoperative chemoradiation is effective and usually welltolerated in bulky cervical cancer and parametrial invasion, inducing a high rate of clinical and pathological complete responses. when this therapy is followed by radical surgery, disease-free and overall survival rates are higher. the latter may be possible only through extensive surgical resection with a parallel increase in complication rates.