Rritish zyxwvutsrqpo Journal zyxwvutsrq oJ Obstetrics zyxwvuts and Gynaecology zyxwvut June zyxwvutsrqp 1987, Vol. 94. pp. 583-588 zyxwvutsr Combination chemotherapy followed by surgery or radiotherapy in patients with locally advanced cervical cancer F. KIRSTEN, K. H. ATKINSON, J. V. M. COPPLESON, P. M. ELLIOTT, D. GREEN, R. HOUGHTON, J. C. MURRAY, P. RUSSELL, H. J. SOLOMON, M. FRIEDLANDER, C. E. SWANSON, M. H. N. TATTERSALL Summary. Forty-seven patients with locally advanced cervical cancer at high risk of relapse received three cycles of chemotherapy with PVB (cisplatin, vinblastine and bleomycin) before definitive local treatment with either radical surgery or radiotherapy. Thirty-one of the 47 patients (66%) responded to initial chemotherapy, and 11 of them have relapsed compared with 13 of the 16 non-responders. Median time to recurrence was 31 weeks for PVB non-responders but has not yet been reached for PVB responders. After a median follow-up of 128 weeks, 14 of the 31 responders (45%) are alive and disease free compared with 3 of the 16 non- responders (19%). There was a positive correlation between response to chemotherapy and subsequent response to radiotherapy. PVB was in general well tolerated although one death is probably attributable to chemotherapy. A randomized study comparing radiotherapy alone with initial PVB chemotherapy followed by radiotherapy is in progress. Ludwig Institute for Cancer Research (Sydney Branch), Blackburn Building, University of Sydney, Sydney, NSW 2006, Australia F. KIRSTEN M. FRIEDLANDER C. E. SWANSON zyxwvuts M. H. N. TATTERSALL King George V Hospital, Campertown, NSW 2050, Australia Department of Gynaecological Oncology K H. ATKINSON J V. M. COPPLESON P. M ELLIOTT R. HOUGHTON J. C. MURRAY H. J. SOLOMON Department of Anatomical Pathology P. RUSSELL Department of Radiotherapy, Royal Prince Alfred Hospital, Campertown, NSW 2050, Australia D. GREEN Correspondence: M. H. N. Tattersall Early stage cervical cancer is curable by surgery or radiotherapy, but cure rates fall sharply with more advanced stage disease (Hanks el al. 1983; Perez et al. 1983; Jampous et zy af. 1975). Radio- therapy is the mainstay of treatment of locally advanced cervical cancer with the clinical stage and tumour bulk being the major predictors of pelvic recurrence after radiotherapy (Piver &L Chung 1975; Mendenhall eraf. 1984). Both also correlate with frequency of lymph node meta- stases (Piver & Chung 1975). The incidence of distant failure after radiotherapy is predicted by the initial clinical stage (Perez et al. 1983; Jam- pous el al. 1975). Strategies to improve the results of primary treatment in patients with locally advanced cervical cancer are directed toward improved local control as well as effec- tive management of lymph node and presumed microscopic distant metastases. Several approaches including the use of 583