J Gynecol Oncol.  2016 Sep;27(5):e52. 10.3802/jgo.2016.27.e52.

Neoadjuvant chemotherapy followed by surgery has no therapeutic advantages over concurrent chemoradiotherapy in International Federation of Gynecology and Obstetrics stage IB-IIB cervical cancer

• Lee J
• Kim TH
• Kim GE
• Keum KC
• Kim YB

• KMID: 2374254
• DOI: http://doi.org/10.3802/jgo.2016.27.e52

Abstract

OBJECTIVE
We aimed to assess the efficacy of neoadjuvant chemotherapy followed by surgery (NACT+S), and compared the clinical outcome with that of concurrent chemoradiotherapy (CCRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) IB-IIB cervical cancer.
METHODS
We reviewed 85 patients with FIGO IB-IIB cervical cancer who received NACT+S between 1989 and 2012, and compared them to 358 control patients who received CCRT. The clinical application of NACT was classified based on the following possible therapeutic benefits: increasing resectability after NACT by reducing tumor size or negative conversion of node metastasis; downstaging adenocarcinoma regarded as relatively radioresistant; and preservation of fertility through limited surgery after NACT.
RESULTS
Of 85 patients in the NACT+S group, the pathologic downstaging and complete response rates were 68.2% and 22.6%, respectively. Only two young patients underwent limited surgery for preservation of fertility. Patients of the NACT+S group were younger, less likely to have node metastasis, and demonstrated a higher proportion of FIGO IB cases than those of the CCRT group (p≤0.001). The 5-year locoregional control, progression-free survival, and overall survival rates in the NACT+S group were 89.7%, 75.6%, and 92.1%, respectively, which were not significantly different from the rates of 92.5%, 74%, and 84.9% observed in the CCRT group, respectively (p>0.05).
CONCLUSION
NACT+S has no therapeutic advantages over CCRT, the standard treatment. Therefore, NACT+S should be considered only in selected patients through multidisciplinary discussion or clinical trial setting.

Keyword

Chemoradiotherapy; Hysterectomy; Uterine Cervical Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
*Chemoradiotherapy
Chemotherapy, Adjuvant
Female
Humans
*Hysterectomy
Middle Aged
*Neoadjuvant Therapy
Neoplasm Staging
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms/diagnosis/mortality/pathology/*therapy