2011 Volume 63 Issue 4 Pages 493-498
Adenocarcinoma (including adenosquamous carcinoma) of the uterine cervix is resistant to radiation therapy and patients in advanced stages have a worse prognosis than those with squamous cell carcinoma. Cervical carcinoma FIGO stage IVa without lateral invasion can be completely resected with exenteration. From 1998 through 2006, a clinical trial of neoadjuvant chemotherapy (NAC) was conducted at our institution. The regimen consisted of paclitaxel (intravenous, 60 mg/m2, days 1, 8, and 15) and cisplatin (trans-uterine arterial infusion of 70 mg/m2, followed by transcatheter embolization with gelatin sponge particles on day 2) repeated every 3 weeks for 2-3 cycles. Two patients with FIGO stage IVa disease were enrolled, and achieved long-term survival after anterior or posterior exenteration following NAC. [Case 1] A 66-year-old multipara with Parkinson's disease was admitted to our hospital for vaginal bleeding. A cervical adenocarcinoma 8 cm in diameter, FIGO stage IVa, was diagnosed by cervical biopsy, MRI, and barium enema results. After 2 cycles of NAC, feces appeared through the vagina and a recto-vaginal fistula was diagnosed, while MRI showed disappearance of the tumor (complete response). A radical hysterectomy with low anterior resection and anastomosis of the rectum was performed, and the obtained specimen showed no malignant cells. She was alive 84 months after surgery without evidence of recurrence or bowel complications. [Case 2] A 59-year-old multipara consulted a urology clinic for macroscopic hematuria. Bladder invasion by a cervical adenocarcinoma was diagnosed and she was referred to our institution. After 3 cycles of NAC, cystoscopy revealed no abnormal findings and MRI showed partial response. Anterior exenteration (radical hysterectomy and cystectomy) was performed and she was alive at 72 months without evidence of recurrence. [Adv Obstet Gynecol, 63(4) : 493-498, 2011 (H23.11)]
