Neoadjuvant Chemotherapy Reduces Adjuvant Radiation Therapy in Patients with Locally Advanced Cervical Cancer

Abstract Background: To investigated whether carboplatin-paclitaxel neoadjuvant chemotherapy (NACT) benefits patients with locally advanced cervical cancer (LACC) through avoiding or delaying postoperative radiation.Methods: Patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB2-IIA2 who received carboplatin-paclitaxel chemotherapy followed by radical surgery (NACT group) or received primary radical surgery (PRS group) between 2007 and 2017 at our hospital were included. Their clinicopathological characteristics, treatments and follow-up data were retrospectively collected and analyzed. The clinical outcomes, including adjuvant radiation, progression-free survival (PFS), and overall survival (OS), were compared between the groups.Results: There were 197 and 217 patients included in the NACT group and PRS group, respectively. The baseline characteristics were significantly different between the groups, with more patients with more advanced tumor stages and larger tumor sizes in the NACT group. Postoperative pathology examination revealed lower incidences of deep stromal invasion in the NACT group than in the PRS group. More importantly, the cumulative postoperative radiation rate was significantly lower in the NACT group (P = 0.041), while the differences in 5-year OS and PFS were not statistically significant between the groups.Conclusions: NACT reduces the pathological risk factors and adjuvant radiation without compromising survival in patients with LACC, which may protect younger patients from radiation-related side effects and subsequently improve the quality of life.

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Neoadjuvant Chemotherapy With Cisplatin and Gemcitabine Followed by Chemoradiation Versus Chemoradiation for Locally Advanced Cervical Cancer: A Randomized Phase II Trial

Journal of Clinical Oncology ◽

10.1200/jco.19.00674 ◽

2019 ◽

Vol 37 (33) ◽

pp. 3124-3131 ◽

Cited By ~ 13

Author(s):

Samantha Cabral S. da Costa ◽

Renata Colombo Bonadio ◽

Flavia Carolina G. Gabrielli ◽

Andrea S. Aranha ◽

Maria Luiza N. Dias Genta ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Phase Ii ◽

Phase Ii Trial ◽

Locally Advanced ◽

Additional Treatment ◽

Hazard Ratio ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Gynecology And Obstetrics

PURPOSE Although chemoradiation therapy (CRT) with cisplatin remains the standard treatment of patients with locally advanced cervical cancer (LACC), 40% of patients present with disease recurrence. Additional treatment strategies are required to improve outcomes. We conducted a trial to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with cisplatin and gemcitabine followed by CRT. METHODS In this phase II trial, patients with LACC (International Federation of Gynecology and Obstetrics stage IIB to IVA or with positive lymph nodes) were randomly assigned to three cycles of NAC with cisplatin and gemcitabine followed by standard CRT with weekly cisplatin plus pelvic radiotherapy or to standard CRT alone. The primary end point was 3-year progression-free survival (PFS). Secondary end points were response rate, 3-year locoregional control, 3-year overall survival (OS), safety, and quality of life. RESULTS From 107 patients enrolled in the trial, 55 were randomly assigned to the NAC arm and 52 to the CRT-alone arm. The majority of patients had squamous cell carcinoma (87.8%). After a median follow-up of 31.7 months, NAC was associated with an inferior PFS, with 3-year PFS rates of 40.9% v 60.4% in the CRT arm (hazard ratio, 1.84; 95% CI, 1.04 to 3.26; P = .033). NAC also was associated with a lower OS (3-year OS rate, 60.7% v 86.8%; hazard ratio, 2.79; 95% CI, 1.29 to 6.01; P = .006). After treatment completion, complete response rates were 56.3% in the NAC arm and 80.3% in the CRT arm ( P = .008). Toxicities were similar in both arms, with the exception of hypomagnesemia and neuropathy being more common with NAC. CONCLUSION This study shows that the addition of NAC consisting of cisplatin and gemcitabine to standard CRT is not superior and is possibly inferior to CRT alone for the treatment of LACC.

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Neoadjuvant Chemotherapy Followed by Radical Surgery versus Concurrent Chemo-Radiotherapy in the Treatment of Locally Advanced Cervical Cancer: A Multicenter Retrospective Analysis

Journal of Investigative Surgery ◽

10.1080/08941939.2020.1856239 ◽

2020 ◽

pp. 1-7

Author(s):

Paolo Sala ◽

Stefano Bogliolo ◽

Fabio Barra ◽

Alessandra Fazio ◽

Mattia Maramai ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Retrospective Analysis ◽

Radical Surgery ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer

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Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer during pregnancy: a case report

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2007.07.034 ◽

2007 ◽

Vol 197 (4) ◽

pp. e5-e6 ◽

Cited By ~ 48

Author(s):

Innocenza Palaia ◽

Milena Pernice ◽

Marialida Graziano ◽

Filippo Bellati ◽

Pierluigi Benedetti Panici

Keyword(s):

Cervical Cancer ◽

Case Report ◽

Neoadjuvant Chemotherapy ◽

Radical Surgery ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer

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Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5093 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5093-5093

Author(s):

Roberto Angioli ◽

Francesco Plotti ◽

Corrado Terranova ◽

Michela Angelucci ◽

Irma Oronzi ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Radical Surgery ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Platinum Based Chemotherapy ◽

Node Metastases

5093 Background: The aim of this study is to evaluate the efficacy, in terms of overall survival and progression free survival, and safety of adjuvant chemotherapy after neoadjuvant chemotherapy followed by radical surgery both in patients with and without node metastases. Methods: Between June 2000 to May 2007, all patients with diagnosis of locally advanced cervical cancer referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were elegible for this protocol.All enrolled patients received 3 cycles of platinum-based chemotherapy every 3 weeks according to the scheme cisplatin 100 mg/mq and paclitaxel 175 mg/mq. After neoadjuvant chemotherapy all patients with stable or progression to treatment were excluded from the protocol, all other were submitted classical radical hysterectomy and bilateral systematic pelvic lymph node dissection, and after to adjuvant treatment with 6 cycles of platinum based chemotherapy with cisplatin 100 mg/mq and paclitaxel 175 mg/mq. Results: 110 patients with local advanced cervical cancer received the treatment with neoadjuvant chemotherapy followed by radical surgery and adjuvant chemotherapy.Our study focused on clinical and operative data , in terms of overall survival and disease free survival at 5 and 3 years. 5-year OS of our series was 78% at five years and 86% at 3-years, with encouraging results also in subgroup with and without node mestastases. Conclusions: The adjuvant chemotherapy regimen after neoadjuvant chemotherapy and radical surgery rappresents a valid treatment option for patients with locally advanced cervical cancer without lymph node involvement, both in terms of overall survival than in terms of disease-free interval, the results have also confirmed the validity of this approach in lymph node metastases, with a complication rate lower than the standard radio-chemotherapy regime.

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