Neoadjuvant chemotherapy followed by radical surgery and radiotherapy vs. pelvic irradiation in patients with cervical cancer FIGO stage IIB - IVA

Abstract

Purpose: To compare the 2-year recurrence-free survival, recurrence rates and their localization after treatment with definitive radiation therapy (RT) vs. neoadjuvant chemotherapy (NCT) followed by radical surgery and post-operative RT in cervical cancer patients with FIGO stages IIB through IVA.

Patients and methods: 43 patients were included in the study, 25 of whom (group 1) were treated with pelvic RT(50-52 Gy external beam RT) and 18 (group 2) with NCT followed by surgery and postoperative RT(50-52 Gy). The operations performed were class III-V radical hysterectomy with total pelvic and paraaortic lymph node dissection. NCT included 3 courses of cisplatin, ifosfamide and bleomycin delivered every 3 weeks. In group 1, 17 (68%) patients were staged IIB and 8 (32%) IIIB; 23 (92%) patients had squamous cell carcinoma and 2 (8%) adenocarcinoma. In group 2, 13 (72.2%) patients were staged IIB, 4 (22.2%) IIIB and 1 (5.6%) IVA. All 18 patients had squamous cell carcinoma. The median age of group 1 and 2 patients was 54.6 years (range 35-71) and 46.3 years (range 32-64), respectively.

Results: The 2-year recurrence-free survival for group 1 was 47.3% and 76.7% for group 2 (p=nonsignificant). Pelvic recurrences were seen in 28% in group 1 and 11.1% in groups 1 and 2 were 8% and 16.7%, respectively (p=nonsignificant).

Conclusion: In FIGO stages IIB-IVA cervical cancer patients cisplatin-based NCT followed by surgery and postoperative external beam RT lead to a better 2-year recurrence-free survival compared to pelvic RT alone. The latter is connected with higher, but not statistically significant local recurrence rates in comparison with the NCT/surgery/ postoperative RT group.