The impact of modified neoadjuvant chemotherapy on the complex treatment results of patients with locally advanced cervical cancer
Authors:   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation, Menshenina A.P. , Moiseenko T.I. ,   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation, Frantsiyants E.M. ,   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation, Ushakova N.D. ,   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation, Verenikina E.V. ,   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation, Adamyan M.L. ,   National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation
Published: November 2021

Aim: to study the possibilities of improving the immediate and long-term treatment results of patients with locally advanced cervical cancer (LACC) via the modified neoadjuvant polychemotherapy (NAPCT). Patients and Methods: the study included data on 237 patients with T2a-3aN0-1M0 squamous cell LACC at the age of 24 to 61 years. All patients were treated with NAPCT courses, including cisplatin and bleomycetin. Patients of the control group (n=84) underwent systemic intravenous NAPCT without modification; 60 patients of the 1st main group had plasmapheresis before the NAPCT course; 93 patients of the 2nd main group had plasmapheresis before NAPCT and a course of non-specific immunotherapy with alloferon was performed in parallel with NAPCT. The number of NAPCT courses varied from 1 to 3 and depended on the treatment effect. After achieving tumor resectability, patients underwent the Piver type III surgery. Patients with insufficient response after NAPCT were prescribed chemoradiotherapy. Results: the maximum number of complete tumor regressions in NAPCT was observed in the 2nd main group — 25.8%, in the control group it was noted in 3.6% of cases. The number of operated patients significantly differed: 54.8% — in the control group, 81.6% — in the 1st main group, 93.5% — in the 2nd main group. As the number of components during NAPCT increased, the number of cytostatic therapy courses necessary for making the tumor resectable decreased. Three courses of NAPCT in the control group were conducted in 69% of cases, in the 1st main group — in 48%, in the 2nd main group — in 22.6%. Five-year relapse-free survival in the control group was 44.5±6.7%, in the 1st main group — 48.5±6.4%, in the 2nd main group — 69.3±6.4%, overall survival — 51.5±6.5, 66.7±6.4 and 83.5±4.4%. The differences in the overall and relapse-free survival rates of the main groups and the control group were statistically significant. Conclusion: plasmapheresis has an indirect immunomodulatory effect due to the unblocking of the cell receptor triggering apparatus, allowing the cytostatic therapy action and the direct immunomodulatory and antiviral action of alloferon to be realized. The proposed method of treating patients with LACC (with the inclusion of plasmapheresis and neoadjuvant non-specific immunotherapy with alloferon in combination with NAPCT) makes it possible to achieve the tumor regression in a shorter period in a larger number of patients, to increase the overall and relapse-free survival of patients, which is the main goal of antitumor treatment of any oncological disease. KEYWORDS: locally advanced cervical cancer, squamous cell carcinoma, neoadjuvant polychemotherapy, plasmapheresis, immunomodulatory peptide, alloferon, surgical treatment, overall survival, relapse-free survival. FOR CITATION: Menshenina A.P., Moiseenko T.I., Frantsiyants E.M. et al. The impact of modified neoadjuvant chemotherapy on the complex treatment results of patients with locally advanced cervical cancer. Russian Medical Inquiry. 2021;5(8):531–537 (in Russ.). DOI: 10.32364/2587-6821-2021-5-8-531-537.