Response to neoadjuvant chemotherapy with paclitaxel and cisplatin in locally advanced cervical cancer

The purpose of this study was to evaluate the efficacy and toxicity of paclitaxel and cisplatin as neoadjuvant chemotherapy for patients with Stage IB2 to IIB cervical cancer and determine factors accountable for response. From November 2009 to January 2011, a total of 19 patients with Stage IB2 to IIB cervical cancer were treated with three ten-day courses of paclitaxel 60 mg/m2 and cisplatin 80 mg/m2 followed by type III radical hysterectomy and adjuvant therapy if indicated, or chemoradiation in non-resectable patients. Clinical response occurred in 79% (15/19) of patients, including 10.5% (2/19) with complete response, and 68.5% (13/19) with partial response. Four (21%) patients were nonresponders including 16% (3/19) with stable and 5.2% (1/19) with progressive disease. Resectability rate was 68.5% (13/19). Pathological optimal response rate was 46% (6/13) including, 15% (2/13) with complete and 31% (4/13) with residual disease < three mm stromal invasion response (PR1). Suboptimal response (PR2) (residual disease with > three mm stromal invasion) was 54% (7/13). It appears that both clinical and pathological response were correlated with tumor stage and size. Clinical response was seen in 87.5% of tumors sized = < eight cm vs 33.3% of tumors sized > eight cm (p = 0.166) and optimal pathological response was seen in 66.7% of tumors sized < four cm vs 28.6% of tumors sized four to eight cm, (p = 0.286), although because of small number of patients, the difference was not statistically significant. Adjuvant therapy was necessary for 38.5% (5/13) patients. Toxicities were not life-threatening and all manageable. The present results suggest that neoadjuvant chemotherapy (NAC) with paclitaxel and cispaltin is a highly active and well-tolerated regimen. Best candidates are patients with stages IB2/IIA bulky and IIB non-bulky than IIB bulky groups.