Long-term results of sequential postoperative treatment with vincristine, bleomycin, mitomycin c, cis-platin and radiotherapy after surgery for high-risk patients with cervical carcinoma stage IB-IIA.

Adjuvant treatment of patients with risk factors after surgery for cervical carcinoma remains unsatisfactory. A combination of radiotherapy and chemotherapy might improve the control of microscopic metastases. In this prospective study, 28 patients with risk factors after surgery for cervical carcinoma underwent a sequential treatment consisting of two courses of chemotherapy with vincristine, bleomycin, mitomycin c and cis-platin (VBMP), followed by radiotherapy with 54 Gy to the pelvis and the aortic nodes. Risk factors mainly consisted of nodes metastases (25 patients), but patients with parametrial invasion or histologic evidence of neoplastic vascular permeation outside the tumor were also included in the study. The treatment was well tolerated and all patients received the planned dose of chemotherapy and radiotherapy; in the follow-up one patient died of ileal necrosis and one died of pulmonary embolism after being medically treated for subocclusion. With a minimal follow-up of 70 months, 15 patients are alive and free of disease, two have died of complications (one with local recurrence), one has died of intercurrent disease and 10 have died of disease (six distant, four local). The site of recurrence was outside the field of irradiation in six cases (lungs in two cases, liver and para-aortic nodes in one and distant nodes in three). This treatment is feasible but control of distant metastases in high-risk patients after surgical treatment remains unsatisfactory.