RESPONSE EVALUATION OF NEO ADJUVANT CHEMOTHERAPY WITH CISPLATIN AND 5-FLUROURACIL IN LOCALLY ADVANCED SQUAMOUS CELL CARCINOMA OF CERVIX

Abstract

Objective: To assess the frequency of different responses of neoadjuvant therapy with cisplatin and 5-flourouracil in patients presenting with locally advanced squamous cell carcinoma of cervix. Patients and Methods: This was a descriptive case series study conducted at Department of Oncology, Jinnah Hospital, Lahore from 10-07-2015 and completed on 9-01-2016. One hundred and fifty patients were included. Selected patients received chemotherapy with Cisplatin 75mg/m2 on day 1 and 5-flurouracil 750 mg/m2/day continuous infusion from day1 to day5, 3 weekly for a total of 2 cycles. Response assessment was done after completion of 2 cycles of chemotherapy and it was documented as either complete response (CR) or Partial response (PR) or Stable Disease (SD) or Progressive Disease (PD) according to Standard Method of “Response Evaluation Criteria in Solid Tumors(RECIST 1.1)” with CT scan.

Results: Mean age of study population was 48.19±6.23 year. Majority (49 patient or 32.7%) had stage IIIb disease, 21(14 %) patients had stage IIB disease, 33 (22%) had stage IIIa and 47 (31.3%) had stage IVA disease at baseline. Fifty patients (33.3%) had lymph node involvement and100 patients (66.7%) had no lymph nodal involvement. 116 (77.3%) patients had ECOG performance status of 1 and remaining had performance status of 2.Partial response was seen in 15 (12.7%) with stage IIb patients, 24(20.3%) with stage IIIa, 39 (33.1%) with stage IIIb patients and 40 (33.9%) with stage IVa patients. Stable disease was seen in 4(16.7%) with IIb, 6(25%) with IIIa, 8(33.3%) with IIIb and 6(25%) with IVa patients. Complete response was seen in 2(28.6%) with IIb,3(42.9%) with IIIa, and 1(14.3%) with IIIb and IVa patients each. Progressive disease was seen in only one patient with stage IIIb. Response rates in stage IIIB and IVa patients were better than the stage IIb and IIIa patients but it was not statistically significant.

Conclusion: Neo-adjuvant chemotherapy has fair response rates in locally advanced squamous cell carcinoma of cervix. In resource constraint countries like Pakistan where due to lack of treatment facilities like radiotherapy and skilled oncological surgeons many patients miss the chance of cure due to long waiting times, Neo-adjuvant chemotherapy can be used as a bridge therapy in patients who are waiting for definitive treatment options.