Clinical outcome of FIGO 2018 stage IB3/IIA2 cervical cancer treated by neoadjuvant chemotherapy followed by radical surgery due to lack of radiotherapy equipment: A retrospective comparison with concurrent chemoradiotherapy

Abstract

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.

Delta Radiomics Analysis for Prediction of Intermediary- and High-Risk Factors for Patients with Locally Advanced Cervical Cancer Receiving Neoadjuvant Therapy

“…In LACC, cisplatin-based concurrent radiation has a better the disease-free survival (DFS) rate than NACT followed by radical surgery; however, no statistically signi cant differences are observed in the overall survival (OS) rates 8 . NACT followed by radical surgery has demonstrated an OS rate similar to that observed with concurrent radiation in patients with stage IB3 and IIA2 cervical cancer, with no increase in side effects 9 . In patients with comparable survival, approximately 25-30% of patients who undergo surgery after NACT still require adjuvant radiotherapy or chemoradiotherapy.…”

Prognostic Analysis of Local Advanced Cervical Cancer After Neoadjuvant Chemotherapy

“…Studies have shown that tumor diameter is associated with prognosis. For locally advanced cervical cancer with CCRT, large tumor diameter and non-HPV16/18 genotypes are independently associated with poor PFS [5,11,12], also there is a study suggest that HR-HPV infection was not a prognosticator of 5-year OS [13]. In this study, large tumor diameter and HPV infection were not found to be independent risk factors affecting PFS, which may be because the included patients in this study were cervical cancer patients receiving NACT, and tumor diameter was large, so the difference of tumor diameter and HPV infection had no significant effect on prognosis.…”

“…Many studies have concluded whether NACT improves the prognosis of patients. Zeng [5] evaluated the efficacy of NACT on patients with stage IB3 and stage IIA2 cervical cancer by comparing the two treatment methods of CCRT and Next-RS, and observed the 5-year survival rate and complication rate of patients in the two groups. The results showed that the survival period of patients treated with Next-RS was similar to that of patients receiving CCRT.…”

Meta-analysis of the efficacy and safety of Xihuang Pills/capsules in adjuvant treatment of uterine cervical neoplasms

“…[4] Radiotherapy and chemotherapy have gained clinical recognition as fundamental treatment methods, often administered in tandem. [5] Despite their relatively significant clinical effects, accumulating research suggests that these therapies are associated with numerous complications, toxicities, and side effects, [6] including myelosuppression, [7][8][9] gastrointestinal reactions, [10] radiation proctitis, and radiation cystitis. [11] However, over time, cervical neoplasms may develop resistance to traditional treatments and certain individuals may prove unresponsive to chemotherapy or radiotherapy.…”