Locally advanced cervical carcinoma. The ''UCSC'' experience on pre-operative chemotherapy combined with radical surgery.

A group of 44 consecutive patients with locally advanced primary cervical carcinoma have been preoperatorily treated with three courses of cisplatinum 100 mg/mq i.v. on day 1, bleomycin 15 mg i.v. on days 1 and 8, methotrexate 300 mg/mq i.v. on day 8. Patients with tumor volume reduced to less than 4 cm. underwent Piver's type III-IV radical hysterectomy with para-aortic and pelvic lymphadenectomy. Of the 44 total cases, 42 could be evaluated for clinical response to chemotherapy. Of these, 37 had received the 100% of the programmed chemotherapeutical dose, and 32 underwent radical surgery. Postoperative complications were lymphocysts in 10, pulmonary microembolisms in 3, deep venous thromboses in 2 and temporary ureteral ectasias in 2 cases. Considering the histologic examination of surgical specimens, cancer response to preoperative chemotherapy was clinically overestimated in 9 (28%) of the 32 patients. Apparently, vaginal lesions showed the highest number of complete response, followed by parametria and cervical tissue. Surgical resection margins were tumor-free in 31 (97%) of the 32 patients. Lymph nodes were positive in 6 of the 32 cases (18.7%), with an incidence much lower than the 60-80% reported in the literature. Mean follow-up was 24 months after diagnosis: two central recurrences, 5 and 7 months after surgery, were oberved.