Neoadjuvant chemotherapy followed by surgery in cervical cancer: past, present and future

Abstract

BackgroundCisplatin-based concurrent chemoradiation is the standard treatment for locally advanced cervical cancer. In view of the difficulties associated with implementation of standard radiation protocols in low- and middle-income countries and the associated toxicities of chemoradiation, neoadjuvant chemotherapy followed by surgery has been tried as an alternative treatment for locally advanced cervical cancer.MethodsA comprehensive review was undertaken of the existing literature, caveats and potential avenues of neoadjuvant chemotherapy followed by surgery compared with chemoradiation in locally advanced cervical cancer.ResultsRandomized studies conducted in the pre-chemoradiation era comparing neoadjuvant chemotherapy followed by surgery with definitive radiotherapy alone showed favorable outcomes with the chemo-surgical approach. However, contemporary studies evaluating the role of neoadjuvant chemotherapy followed by surgery have failed to establish this approach as the standard. About 25–30% of patients who undergo neoadjuvant chemotherapy remain inoperable and require definitive chemoradiation. A similar proportion of patients would require adjuvant (chemo)radiation after neoadjuvant chemotherapy followed by surgery, resulting in excessive morbidity. Evaluation of time trends across the past few decades reveals that the advancements in delivery of radiation (external beam and brachytherapy) have translated into improvement in outcomes for locally advanced cervical cancer, while a similar trend was not observed for surgery or chemotherapy.ConclusionNeoadjuvant chemotherapy followed by surgery cannot be considered a standard of care in patients with locally advanced cervical cancer. This approach needs further clinical research to generate robust high-quality evidence especially for the sub-sets that might potentially benefit in terms of survival, toxicity and quality of life, against the gold standard treatment of concomitant chemoradiation.

Circ_0001589/miR‐1248/HMGB1 axis enhances EMT‐mediated metastasis and cisplatin resistance in cervical cancer

“…19 In recent years, the neoadjuvant chemotherapy followed by surgery shows improved treatment effects for patients with advanced cervical cancer. 5 The existence of drug resistance, either intrinsic or acquired resistance, in cervical cancer cell severely interferes the efficacy of chemotherapy. The current study provided evidence that circ_0001589/miR-1248/HMGB1 axis could be a promising target for clinic therapy, which not only sensitized cervical cancer cells to DDP treatment, but also inhibit the local invasion and distant metastasis.…”

“…Due to most cervical cancer are at advanced stage or with distance metastasis when initially diagnosed, which deteriorates the 5‐year relative survival rate to only 17.1%, 3 the explorations of therapeutic target against local invasion and metastasis is still urgent. Currently, besides the surgery excision, concurrent cisplatin (DDP)‐based chemotherapy and radiotherapy has meet the satisfactory treatment effects for patients with locally advanced cervical cancer, 4 which is considered as the standard treatment in clinic 5 . However, the resistance to DDP, either intrinsic or acquired resistance, is a serious problem that compromises the efficacy of DDP 6 .…”

“…concurrent cisplatin (DDP)-based chemotherapy and radiotherapy has meet the satisfactory treatment effects for patients with locally advanced cervical cancer, 4 which is considered as the standard treatment in clinic. 5 However, the resistance to DDP, either intrinsic or acquired resistance, is a serious problem that compromises the efficacy of DDP. 6 Therefore, it is necessary to investigate the mechanism of carcinogenesis, metastasis, and drug resistance in cervical cancer for improving the prognosis of cervical cancer.…”

Perspectives of ERCC1 in early-stage and advanced cervical cancer: From experiments to clinical applications

“…Cisplatin-based chemotherapy and radiotherapy are the common-used combined treatments for locally advanced cancer diseases, while radiotherapy alone is considered to be applied for patients with early disease ( 44 ). Almeida et al.…”

Neoadjuvant chemotherapy and less invasive surgery for the management of early stage cervical cancer: A brief report from Botswana

“…( Luckett et al, 2018 ) Between 2017 and 2019, the lack of a specialty trained gynecologic oncologist in the country created an opportunity to evaluate other treatment modalities for early stage cervical cancer. The rationale for the use of neoadjuvant chemotherapy (NAC) in early-stage disease include reduction in tumor volume amenable to simple hysterectomy, and control of micro-metastatic disease ( Miriyala et al, 2022 , Rydzewska et al, 2012 ). While NAC followed by radical surgery has been unsuccessfully explored for patients with locally advanced cancers ( Gupta et al, 2018 ), the role for NAC and less invasive surgery hasn't been well explored for management of early-stage cervical cancer ( Kim et al, 2013 ).…”