OBJECTIVE

To increase the efficiency of treatment and to improve overall survival in patients with locally advanced cervical cancer, by using neoadjuvant systemic combined chemotherapy.

SUBJECTS AND METHODS

The investigation included 30 patients diagnosed with Stage IIIB cervical cancer (T2b-T3bN1M0). This study was conducted in accordance with the clinical protocol approved by the Academic Council, P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of Russia. At the first stage of combined treatment, 2 systemic chemotherapy cycles were performed at a 21-day interval according to the regimen: cisplatin 75 mg/m² plus paclitaxel 175 mg/m². At the second stage of treatment, at 21 days after the last combined chemotherapy cycle, the investigators performed combined chemoradiotherapy: remote intensity-modulated radiotherapy (IMRT) at a total focal dose (TFD) of 48—50 Gy in 2 Gy daily fractions administered five times a week, with a subsequent or integrated boost to metastatic lymph nodes with a TFD of 60 Gy; cisplatin 40 mg/m² as a radiomodification is used intravenously once a week during teleradiotherapy. The brachytherapy fractionation regimen was 7 Gy in 4 fractions of a TFD of 28 Gy twice a week. At the same time, the total doses of a combined radiotherapy cycle amounted to 80—90 Gy at point A and 60 Gy at point B. Combined chemoradiotherapy was performed according to the radiation therapy practice standards.

RESULTS

The follow-up period for this cohort of patients was 24 months. All the patients completed the full treatment program. Hematological and neurological toxicities, as well as radiation reactions after combined treatment, were limited to grades I and II, which did not require an increase in the intervals between the treatment stages and interruptions. Complete and partial tumor resorption was seen in 27 (90%) and 3 (10%) patients, respectively.

CONCLUSION

Neoadjuvant systemic chemotherapy in patients with Stage IIIB locally advanced cervical cancer makes it possible to reduce the volume of cervical tumor and metastatic lymph nodes and subsequently to perform the chemoradiotherapy stage of treatment to radical doses.