J Formos Med Assoc 2002 • Vol 101 • No 3 195 Neoadjuvant Chemotherapy and Cervical Cancer (J Formos M ed Assoc 2002;101:195–202) Key words: cervical carcinoma neoadjuvant chemotherapy survival Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei. Received: 6 August 2001. Revised: 29 August 2001. Accepted: 6 November 2001. Reprint requests and correspondence to: Dr. Chang-Yao Hsieh, 7 Chung-Shan South Road, Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan. RADICAL HYSTERECTOMY ALONE OR COMBINED WITH NEOADJUVANT CHEMOTHERAPY IN THE TREATMENT OF EARLY STAGE BULKY CERVICAL CARCINOMA Chi-An Chen, Wen-Fang Cheng, Lin-Hung Wei, Yi-Ning Su, and Chang-Yao Hsieh Cervical cancer is the most common gynecologic malignancy worldwide. Despite remarkable improve- ments in clinical management, the survival of cervical cancer patients has shown only minor progress. In the early stage of this disease, survival is influenced by multiple factors including lymph node metastasis, parametrial invasion, tumor size, lymphovascular Background and Purpose: Early-stage bulky cervical carcinoma treated with conven- tional surgery or radiotherapy has a higher rate of recurrence compared to smaller tumors at the same stage. Whether neoadjuvant chemotherapy prior to radical hysterectomy can improve survival in early-stage bulky cervical carcinoma remains unclear. This study was designed to answer this question. Methods: Fifty-eight women with early-stage bulky cervical cancer were included in this retrospective study. Thirty-one had received neoadjuvant chemotherapy before radical hysterectomy, and the other 27 patients underwent surgery alone. The chemotherapeutic regimen was a combination of cisplatin, vincristine, and bleomycin with a 10-day interval for two to three courses. Results: The age, parity, and tumor diameter before treatment in the two groups were similar. The mean tumor diameter was significantly decreased after neoadjuvant chemotherapy (4.6 ± 0.8 vs 3.4 ± 1.5 cm, P = 0.003). Patients without neoadjuvant chemotherapy had a significantly higher incidence of parametrial invasion (14/ 27 vs 7/ 31, P = 0.022). More involved lymph nodes were found during surgery in patients without neoadjuvant chemotherapy (23.1 ± 10.5 vs 17.4 ± 7.1, P = 0.024), but the incidence of lymph node metastasis was not different between the two groups (18/ 31 vs 17/ 27, P = 0.71). The response rate of primary tumor to chemotherapy was 48.4% (15/ 31). No significant differences in clinical and pathologic parameters were found between responders and non-responders. Deep stromal invasion ( ≥ 3/ 4 thickness of cervical stroma) was the only independent prognostic factor for disease- free survival (DFS) and overall survival (OS) in the 58 patients and in the 31 patients who received neoadjuvant chemotherapy. Neither neoadjuvant chemotherapy nor the response to it was an independent prognostic factor for DFS or OS. Conclusions: Neoadjuvant chemotherapy could reduce the incidence of local invasion for bulky early-stage cervical carcinoma but did not improve the DFS or OS in our patients. Without further randomized study of the effects of neoadjuvant chemotherapy, this treatment should be chosen carefully. involvement, and histologic grade [1–3]. Most investi- gators agree that the tumor size is a significant negative prognostic factor for cervical cancer that is inversely correlated with both survival and time to recurrence [2, 3]. Bulky primary tumors (diameter ≥ 4 cm) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or IIA cervical carci-