Monday, April 25, 2011

Neoadjuvant chemotherapy followed by surgery

(Sorry if this is getting boring, but I'm kind of obsessed right now.

Those in the class who have not opted for the elective Orwell's Picnic short course in gynecological oncology may spend the period in the library.)

But, seriously, doesn't this look like great numbers? Check it out.

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer. Prognostic factors for response and survival

Between January 1986 and September 1988, 75 patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stages IB–III) received three courses of neoadjuvant chemotherapy (NAC), [That's what they're thinking of giving me. It means a short course of chemo before surgery to reduce the size of the tumour.] including cisplatin, bleomycin, and methotrexate (PBM). Fifteen percent of patients achieved a complete response (CR) [Holy crap!] and 68% a partial response (PR). [That means that the treatment worked at least to some degree in 83% of cases.]

Pretreatment characteristics were analyzed for response to NAC. Significantly lower response rates were found in patients with tumor size more than 5 cm in diameter and bilateral parametrial involvement to the pelvic side wall. [Well, that sort of stands to reason, one would think. That's some pretty seriously advanced cancer.]

None of the biological parameters studied was related to chemoresponsiveness. Patients achieving CR or PR had a significantly improved 3-year survival rate compared with those who did not respond. [Again, one would think...]

After NAC, radical surgery was possible in all responding patients. The median number of lymph nodes removed was 60. A lower than expected incidence of lymph node metastases was detected. None of the clinical and pathologic features considered was significantly correlated with the lymph node status.

Twelve of the 62 operated patients had disease recurrence. [Don't forget, we're talking about a total of 75 patients with stages 1B through 3, so that doesn't seem too bad.] Pathologic parametrial involvement and cervical infiltration equal to or deeper than 5 mm were found to be significant prognostic factors for recurrence. [That means 'late stage' in layman's terms.]

A 3-year, disease-free survival of 89%, 73%, and 43% for Stage IB –IIA, IIB, and III, respectively, was found. Among the operated patients these rates increased to 100%, 81%, and 66% for Stage IB –IIA, IIB, and III, respectively.


Every article I've read on this treatment has the same kind of numbers.

So, OK, I now have a specific thing for y'all, in your charity, to pray for.

Please pray that Professore Scambia, (the head of the department) and the hospital ethics committee decide to allow this treatment.



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