Intense Neoadjuvant Chemotherapy with Cisplatin and Epirubicin for Advanced or Bulky Cervical and Vaginal Adenocarcinoma

• Published in: Gynecologic oncology Vol. 64; no. 3; pp. 431 - 435
• Main Authors: Zanetta, Gerardo, Lissoni, Andrea, Gabriele, Antonio, Landoni, Fabio, Colombo, Alessandro, Perego, Patrizia, Mangioni, Costantino
• Format: Journal Article
• Language: English
• Published: San Diego, CA Elsevier Inc 01.03.1997; Elsevier
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Epirubicin - administration & dosage; Female; Follow-Up Studies; Humans; Hysterectomy; Medical sciences; Neoplasm Staging; Pharmacology. Drug treatments; Survival Rate; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Vaginal Neoplasms - drug therapy; Vaginal Neoplasms - mortality; Vaginal Neoplasms - pathology; Vaginal Neoplasms - surgery; Adenocarcinoma; Antineoplastic agent; Human; Treatment efficiency; Vagina; Vaginal diseases; Malignant tumor; Uterine cervix; Cisplatin; Neoadjuvant treatment; Female genital diseases; Chemotherapy; Treatment; Advanced stage; Anthracyclins; Epirubicin; Preoperative; Uterine cervix diseases; Platinum II Complexes
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.1996.4561

Twenty-two consecutive patients with bulky or locally advanced cervical or vaginal adenocarcinoma were treated with a neoadjuvant chemotherapy regimen consisting of nine weekly courses of cisplatin (50 mg/m2) and three courses of epirubicin (70 mg/m2) at Weeks 1, 4, and 7, followed by radical hysterectomy. Salvage radiotherapy was administered to inoperable patients, whereas postoperative treatment with irradiation or further chemotherapy was given to those with detection of risk factors at surgery. Three patients (14%) did not complete the planned courses of chemotherapy (one refused after the first administration, one had severe myelotoxicity, and one had severe nephrotoxicity). Twenty-one subjects received at least four courses of treatment and were therefore evaluable for response. We observed 4 clinically complete and 10 partial responses, accounting for an objective response rate of 67%. Eighteen subjects (82%) underwent surgery without serious complications. No histopathologic complete response was observed. The response rate is in the lower range observed with other regimens for squamous cell carcinoma. Although feasible, this regimen implies a significant risk of myelotoxicity. This enhanced toxicity may be justified only if balanced by long-term survival.