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Long-Term Clinical Benefits of Neoadjuvant Chemotherapy in Women With Locally Advanced Cervical Cancer: Validity of Pathological Response as Surrogate Endpoint of Survival
  1. Alessandro Buda, MD*,,
  2. Andrea Alberto Lissoni, MD*,,
  3. Irene Floriani, PhD,,
  4. Elena Biagioli, MSc,,
  5. Chiara Gerardi, MSc,,
  6. Cristina Bonazzi, MD*,,
  7. Stefania Chiari, MD*,,
  8. Luca Locatelli, MD§,
  9. Tiziana Dell’Anna, MD*,,
  10. Mauro Signorelli, MD*,,
  11. Costantino Mangioni*, and
  12. Rodolfo Milani*,
  1. *Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano–Bicocca, Monza;
  2. “Mario Negri” Gynecology Oncology (MaNGO) Group, Milan;
  3. Laboratory of Clinical Research, Department of Oncology, IRCCS–Istituto di Ricerche Farmacologiche“Mario Negri,” Milan; and
  4. §University of Milano–Bicocca, Monza, Italy.
  1. Address correspondence and reprint requests to Alessandro Buda, MD, Gynecologic Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano–Bicocca, Monza, Italy. E-mail:


Objective Neoadjuvant chemotherapy (NACT) is a valid treatment option for women with locally advanced cervical cancer (LACC). This study aims to evaluate the impact of sociodemographic factors, clinical factors, and NACT regimens on survival endpoints. The role of pathological response to NACT as a surrogate endpoint of survival was also assessed.

Materials and Methods Retrospective analysis of consecutive sample data from women with LACC (stages Ib2-IVa) who underwent NACT followed by radical surgery was performed. Response was classified as optimal response (including complete response and optimal partial response), suboptimal partial response, stable disease, and progressive disease.

Results Four hundred forty-six women who had undergone surgery from 1992 to 2011 were analyzed. The overall optimal response was 35.4%. At a median follow-up of 12.7 years, 165 women (37.0%) experienced recurrence or died. Increase in patient age at surgery, International Federation of Gynecology and Obstetrics stage III/IV versus stage Ib2, and lymph-node positivity versus negativity seemed to impact negatively on survival, whereas neoadjuvant platinum-Taxol–containing regimens (compared with platinum-based regimens) improved survival. Response to NACT could be considered a surrogate endpoint of survival.

Conclusions Age, International Federation of Gynecology and Obstetrics stage III/IV, lymph-node involvement, and type of NACT administered have a significant impact on survival. Response to NACT is a good surrogate endpoint of survival in patients with LACC.

  • Cervical cancer
  • Neoadjuvant chemotherapy
  • Radical surgery
  • Optimal response
  • Surrogate endpoint

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  • The authors declare no conflicts of interest.