Neoadjuvant Chemotherapy for Cervical Cancer: Rationale and Evolving Data

Cervical cancer is still the second most common female malignancy and the second most common cause of cancer-related mortality in women worldwide. [1] In 1999, the National Cancer Institute showed that in addition to radiotherapy, cisplatin chemotherapy produced a therapeutic effect in women with locally advanced cervical cancer (LACC) in 5 randomized trials. [2-7] However, the standard treatments for early cervical cancer have traditionally comprised radical hysterectomy with lymph node dissection or cisplatin-based chemoradia‐ tion. [8] Unfortunately, poor prognosis was observed in patients with tumors more than 4 cm in diameter and a poor survival rate of 50–60% was noted in patients with large tumors. To improve the therapeutic results, a new approach with neoadjuvant chemotherapy (NACT) followed by radical surgery or chemoradiation has been introduced. The definition of NACT in cervical cancer is the administration of chemotherapy for the purpose of reducing the cancer volume before the main treatment. In the late 1980s, a pilot study of NACT with cisplatin, bleomycin, and methotrexate performed for 33 patients with a tumor larger than 4 cm showed a response rate of 75.7% (complete response 12.1%, partial response 63.6%) on histologic examination. The sites showing a sensitive response to NACT were the vagina, cervix, and parametrium, in that order. [9] In 1989, Kim et al. performed NACT with vinblastine, bleo‐ mycin, and cisplatin (VBP) in 54 patients and reported a high response rate (81.0%), a low incidence of lymph node metastasis (20%), and an improvement in the 2-year tumor free survival rate (94%). [10]