Clinical efficacy and safety of paclitaxel plus carboplatin as neoadjuvant chemotherapy prior to radical hysterectomy and pelvic lymphadenectomy for Stage IB2-IIB cervical cancer

Abstract

Objective: To assess the efficacy and toxicity of the combination of paclitaxel plus carboplatin as neoadjuvant chemotherapy (NACT) for locally advanced cervical cancer (LACC) prior to radical hysterectomy and pelvic lymphadenectomy.

Methods: We reviewed patients with cervical cancer of the International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin followed by radical hysterectomy (NACT group) or only received primary radical surgery (PRS group) in our hospital between Jan 2007 and Jan 2012. Toxicity, NACT response, surgery pathological factors and survival data were collected and analyzed.

Results: In the NACT group, the overall response rate was 71.3% (82/115). Eighteen (15.7%) patients achieved complete remission. Well differentiated tumors showed a more favorable response to NACT (P=0.011). Myelosuppression was the most common adverse effect (51.7%) and serious adverse effects were rare (3.4%). The median follow-up period was 44 months (range, 6-75). The NACT responders had significantly longer OS and PFS when compared to the non-NACT responders and patients in the PRS group.

Conclusion: Patients with LACC can benefit from neoadjuvant chemotherapy with paclitaxel plus carboplatin when they have response to the chemotherapeutic agents.

Keywords: Neoadjuvant chemotherapy; efficacy; locally advanced cervical cancer; paclitaxel plus carboplatin; prognosis.

Figure 1

Kaplan-Meier curves for comparison of survival between groups. Log-Rank test was used to calculate statistical significance. There was no significant difference in OS (A) and PFS (B) between the NACT and the PFS groups (POS=0.405, PPFS=0.472). The OS (C) and PFS (D) of NACT responders was significantly longer than that of non-NACT responders (POS=0.000, PPFS=0.000) and patients in surgery group (POS=0.033, PPFS=0.023). However, there was no significant difference in OS or PFS between the non-NACT responders and the patients undergoing primary surgery (POS=0.124, PPFS=0.065).