OBJECTIVE

To increase the efficiency of treatment for locally advanced cervical cancer, by using neoadjuvant intra-arterial chemotherapy, followed by chemoradiotherapy.

Subjects and methods. The investigation enrolled 25 patients diagnosed with cervical cancer (IIB-IIIB (T2b-T3bN0(1)M0)), including 15 patients with Stages IIIB and IIB10. The combination treatment program provided regional chemotherapy at the first stage according to the following scheme: intra-arterial cisplatin 75 mg/m² and intravenous paclitaxel 175 mg/m²; two cycles at an interval of 21 days. At the second stage of treatment, after the two cycles of regional combination chemotherapy, there was combined chemoradiotherapy involving external intensity-modulated radiation therapy (IMRT) of the pelvis and regional metastatic areas; a cumulative focal dose (CFD) of 48—50 Gy; a fractionated daily 2 Gy dose 5 times a week. During teleradiotherapy, cisplatin at a dose of 40 mg/m² was used as a radiomodifying agent. Brachytherapy was performed at 4—5 weeks of irradiation on teleradiotherapy-free days. The fractionation mode included 4 fractions of 7 Gy each up to a CFD of 28 Gy (equivalent to 40 Gy). At the same time, the total doses of a combination radiotherapy cycle were 80—90 Gy at point A and 60 Gy at point B.

RESULTS

Complete tumor resorption was observed in 21 (84%) patients, partial resorption was in 4 (16%) patients. During subsequent observations, none of the 25 cases showed a locoregional recurrence. At 5 months after treatment, patients with incomplete regression exhibited metastases in the bones in 2 cases and those in the supraclavicular lymph node in one case. At the moment, all the patients are 3-to-24-month survivors.

CONCLUSION

Neoadjuvant regional chemotherapy for patients with Stage IIB-IIIB locally advanced cervical cancer makes it possible to achieve an objective tumor response to treatment (RECIST 1.1) and subsequently to implement the chemoradiation stage of treatment up to radical doses.