Prospective comparative study of dose dense neo-adjuvant chemotherapy followed by chemo-radiation and definitive chemo-radiation alone in stage IB2-IVA cervical cancer

Abstract

INTRODUCTIONCervical cancer is the fourth most common cancer among women worldwide. 1 It is the second most common diagnosed cancer and third most leading cause of death in less developed countries. India accounts for 25% of cervical cancer deaths in less developed countries. Concurrent chemo radiotherapy (CRT) has become the standard of care for cervical cancer patients from stages 1B2 to IVA. 2 There is 6% improvement in the survival rates with the addition of chemotherapy to radiation as per the meta-analysis of 13 trials comparing chemoradiation and radiation alone. 3 There were no major advances in the treatment of cancer cervix after definitive chemo-radiation became the standard of care. There are still potential therapeutic advantages of giving chemotherapy before radiotherapy to reduce tumour size and control micro metastatic disease. A number of randomised trials have explored the use of neo-adjuvant chemotherapy (NACT) because of impressive response rates. As per the meta-analysis of neo-adjuvant chemotherapy for locally advanced cervical cancer 2003, there was no benefit for neo-adjuvant chemotherapy but the trials which used shorter cycle lengths showed 7% Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background:The standard of care for locally advanced cervical cancer is chemo-radiation. Role of neo-adjuvant chemotherapy not clear yet. Dose dense, short-term neo-adjuvant chemotherapy with early initiation of radiotherapy has shown survival benefit but randomised trials not available yet. Hence this study was done for feasibility of neoadjuvant chemotherapy and for its comparison with the standard chemo-radiation. Methods: Cervical cancer patients not randomly assigned into two arms. Arm A received 3 cycles NACT of paclitaxel and carboplatin weekly. All patients of arm A after NACT and arm B received EBRT on linear accelerator for a dose of 4500-5000cGy in 23-25 fractions with concurrent cisplatin 40mg/m2 followed by 3 applications of HDR intracavitary brachytherapy of 700 or 800cGy respectively. All patients were assessed clinically and radiologically with MRI after completion of CTRT and at follow up of 6 weeks. Results: A total of 15 patients treated in each arm. Stage IIB and IIIB constituted 93% of the patients, well matched in both the arms. The CR rate at follow up of 6 weeks after NACT was 73% compared to only 46.7% in arm B. Neutropenia of grade 3 were seen equally in both the arms and grade 2 neutropenia was seen in about 60% patients in arm A compared to only 20% patients in arm B which was manageable without growth factors. Conclusions: Dose dense neo-adjuvant chemotherapy is a feasible and effective option in treating cancer cervix.