Prognostic Significance of Pathological Response After Neoadjuvant Chemotherapy or Chemoradiation for Locally Advanced Cervical Carcinoma

Overview

Journal Int Semin Surg Oncol

Publisher Biomed Central

Specialty Oncology

Date 2006 Feb 7

PMID 16457727

Citations 12

Authors

Myrna Candelaria

Jose Chanona-Vilchis

Lucely Cetina

Diana Flores-Estrada

Carlos Lopez-Graniel

Aaron Gonzalez-Enciso

David Cantu

Adela Poitevin

Lesbia Rivera

Jose Hinojosa

Jaime de la Garza

Alfonso Duenas-Gonzalez

Affiliations

Soon will be listed here.

Abstract

Background: Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; however, neoadjuvant modalities are currently being tested. Neoadjuvant studies in several tumor types have underscored the prognostic significance of pathological response for survival; however there is a paucity of studies in cervical cancer investigating this issue.

Methods: Four cohorts of patients with locally advanced cervical carcinoma (stages IB2-IIIB); included prospectively in phase II protocols of either neoadjuvant chemotherapy with 1) cisplatin-gemcitabine, 2) oxaliplatin-gemcitabine, 3) carboplatin-paclitaxel or 4) chemoradiation with cisplatin or cisplatin-gemcitabine followed by radical hysterectomy were analyzed for pathological response and survival.

Results: One-hundred and fifty three (86%) of the 178 patients treated within these trials, underwent radical hysterectomy and were analyzed. Overall, the mean age was 44.7 and almost two-thirds were FIGO stage IIB. Pathological response rates were as follows: Complete (pCR) in 60 cases (39.2%), Near-complete (p-Near-CR) in 24 (15.6 %) and partial (pPR) in 69 cases (45.1%). A higher proportion rate of pCR was observed in patients treated with chemoradiotherapy (with cisplatin [19/40, 47.5%]; or with cisplatin-gemcitabine [24/41, 58.5%] compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5%) for cisplatin-gemcitabine, oxaliplatin-gemcitabine and carboplatin-paclitaxel respectively [p = 0.0001]). A total of 29 relapses (18.9%) were documented. The pathological response was the only factor influencing on relapse, since only 4/60 (6.6%) patients with pCR relapsed, compared with 25/93 (26.8%) patients with viable tumor, either pNear-CR or pPR (p = 0.001). Overall survival was 98.3% in patients with pCR versus 83% for patients with either pNear-CR or pPR (p = 0.009).

Conclusion: Complete pathological response but no Near-complete and partial responses is associated with longer survival in cervical cancer patients treated with neoadjuvant chemotherapy or chemoradiotherapy.

Citing Articles

Combining Cisplatin with Different Radiation Qualities-Interpretation of Cytotoxic Effects In Vitro by Isobolographic Analysis.

Runge R, Reissig F, Herzog N, Oehme L, Brogsitter C, Kotzerke J Pharmaceuticals (Basel). 2023; 16(12).

PMID: 38139846 PMC: 10746989. DOI: 10.3390/ph16121720.

Prognostic Value of Mandard's Tumor Regression Grade (TRG) in Post Chemo-Radiotherapy Cervical Cancer.

Scaglione G, Arciuolo D, Travaglino A, Santoro A, Angelico G, Spadola S Diagnostics (Basel). 2023; 13(20).

PMID: 37892049 PMC: 10605878. DOI: 10.3390/diagnostics13203228.

Depth of Stromal Invasion as the Most Prognostically Relevant Regression System in Locally Advanced Cervical Cancer after Neoadjuvant Treatment: A Systematic Review and Meta-Analysis Grading.

Zannoni G, Travaglino A, Raffone A, Arciuolo D, DAlessandris N, Scaglione G Diagnostics (Basel). 2021; 11(10).

PMID: 34679470 PMC: 8534824. DOI: 10.3390/diagnostics11101772.

Adjuvant hysterectomy after radiochemotherapy for locally advanced cervical cancer.

Hass P, Eggemann H, Costa S, Ignatov A Strahlenther Onkol. 2017; 193(12):1048-1055.

PMID: 28660291 DOI: 10.1007/s00066-017-1174-1.

Neoadjuvant chemotherapy followed by radical surgery as an alternative treatment to concurrent chemoradiotherapy for young premenopausal patients with FIGO stage IIB squamous cervical carcinoma.

Yang S, Gao Y, Sun J, Xia B, Liu T, Zhang H Tumour Biol. 2015; 36(6):4349-56.

PMID: 25874487 DOI: 10.1007/s13277-015-3074-2.

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