Neoadjuvant Intra-Arterial Chemotherapy for Locally Advanced Uterine Cervical Cancer: Clinical Efficacy and Factors Influencing Response

摘要

Purpose: To evaluate the effects of neoadjuvant intra-arterial chemotherapy (NAIC) for locally advanced uterine cervical cancer, and to analyze factors influencing the response to the chemotherapy. Methods: Thirty-four patients with invasive cervical cancer more than 4 cm in diameter were enrolled in this study. NAIC was performed using cisplatin-based regimens. The response was assessed by magnetic resonance imaging (MRI) and examination of surgical specimens. Pretreatment factors involved in the response to NAIC were evaluated and the relationship between the factors and the prognosis was assessed. Results: Clinical response was achieved in 28 (82%) patients. Thirty-one of 49 invasions in the parametrial halves disappeared. Seventeen of 28 lymph node swellings responded to NAIC. Six of the 14 stage III patients became operable. In the 19 surgical cases, pathologically complete responses were found in four. Twenty-eight of the 38 parametrial halves were free from cancer. No lymph node metastases were found in eight patients. Initial tumor volume was found to be an independent, significant determining factor of the response to NAIC. Patients with initial tumor volumes less than 80 cm3 had a significantly better estimated 5-year disease-free survival rate compared with those with larger tumors. Conclusion: NAIC for locally advanced cervical cancer is useful for preoperative tumor reduction. Tumor volume is a significant determining factor for the response to NAIC.