This study aimed to assess neoadjuvant chemotherapy’s clinical outcomes such as efficacy, toxicity, and survival outcomes followed by radical hysterectomy ((NACT-RS) among women with cervical cancer stage IB3 and IIA2, by comparing concurrent chemoradiotherapy (CCRT) and NACT-RS. The study retrospectively reviewed patients with (2018 FIGO) stage IB3 and IIA2 cervical cancer who received preoperative neoadjuvant chemotherapy followed by NACT-RS or concurrent chemoradiotherapy (CCRT). The outcome measures were the 5-year survival and complication rates between the two groups. The median follow-up was 75 months. In total, 218 patients had stage IIA2, 136 patients had stage IB3, 201 patients received CCRT, and 153 patients received preoperative NACT-RS. In the CCRT group, the incidence of early complications (myelosuppression, gastrointestinal and urinary) was higher compared with that in the NACT-RS group (76.1 vs. 26.1%; p < 0.001, respectively). There was no significant difference between the two study groups concerning late complications. Five-year PFS was 79.9% and 85.5% in the NACT-RS and CCRT groups, respectively (p = 0.093). Five-year OS was 86.9% and 85.5% in the NACT-RS and CCRT groups, respectively (p = 0.97). In the multivariate clinicopathologic characteristics analysis for OS, initial tumor size > 4.3 cm (HR 5.11; p < 0.001), AC/ASC (HR 1.89; p = 0.02), histologic grade 2–3 (HR 2.25; p = 0.04), and 2018 FIGO stage IIA2 (HR 8.67; p < 0.001) were independent risk factors. The survival of patients with stage IB3 and IIA2 cervical cancer treated with NACT-RS was similar to that of patients treated with CCRT without increasing side effects.

Background: In our clinical study, 11% of the patients with early-stage cervical cancers had different degrees of vaginal bleeding, which required a preoperative intervention. We set to assess the efficacy and safety of preoperative high-dose rate vaginal ovoid brachytherapy (HDR-VOBT) for the treatment of vaginal bleeding in women with early cervical cancer.Methods: We retrospectively identified and reviewed patients with vaginal bleeding and early-stage cervical carcinoma, treated between January 2011 and December 2014 (median follow-up of 69 months).Of the 116 patients, 59 received preoperative HDR-VOBT (a dose of 8 Gy at 0.5 cm from the tumor surface), and 57 received traditional vaginal packing with gauze alone, followed by radical hysterectomy and lymphadenectomy. Analysis of the clinical parameters was performed using the chi-square test. The outcome measures were the 3-and 5-year survival and the complication rate.Results: From the 116 patients, 25 had stage IB1, 49 had stage IB2, and 42 had stage IIA1 cervical cancer.No differences were observed regarding the 5-year overall survival (OS) (91.5% vs. 91.2%) and diseasefree survival (DFS) (76.3% vs. 86%) between the preoperative HDR-VOBT group and the vaginal packing with gauze group. The mean volume of blood loss due to vaginal bleeding after treatment was 83.4 (range: 30-150) mL: 56.8 (range: 30-80) mL in the preoperative HDR-VOBT group and 111.1 (range: 80-150) mL in the gauze packing group (P<0.001). The mean time to achieve hemostasis was 3.5 h in the preoperative HDR-VOBT group and 8.1 h in the vaginal packing with gauze group (P<0.001). There was no significant difference in postoperative risk factors, complications, and survival between the two groups.

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