A Comparison of Different Schemes of Neoadjuvant Chemotherapy Followed by Concurrent Chemotherapy and Radiotherapy for Locally Advanced Cervical Cancer: A Retrospective Study

Abstract

Purpose

To examine the clinical significance of unoperated cervical cancer patients treated with different neoadjuvant chemotherapy (NACT) schemes followed by concurrent chemotherapy and radiotherapy (CCRT).

Methods

This retrospective analysis included women with locally advanced cervical cancer treated with NACT-CCRT between September 2011 and September 2014. Neoadjuvant chemotherapy included paclitaxel plus cisplatin (TP group; 62 patients) or paclitaxel plus loplatin (TL group; 58 patients), which were administered three weekly, and cisplatin or loplatin, which were administered weekly for synchronous chemotherapy. External beam radiation therapy (50.4–56.35 Gy/28 f, 180–215 cGy/f, 5 f/w) was followed by intracavitary brachytherapy (5 Gy per fraction, mostly 5 fractions, Ir192 based).

Results

One hundred twenty women were included in the analysis. The complete/partial response rate was 99.2% after treatment. The one-year, three-year, and five-year survival rates were 99.2%, 82.5%, and 70.8%, respectively. In the TP and TL groups, the three-year and five-year survival rates were 85.5% vs 77.6% and 75.8% vs 65.5%, respectively, with no significant difference. The 5-year overall survival (OS) rates between patients with stage IIB and stage IIIB disease were not significantly different (69.2% vs 64.7%). In the TP group, grade 3 or 4 digestive reactions were more frequent than those in the TL group. Leukopenia, neutropenia, and thrombocytopenia were more common in the TL group. No significant difference was found in anemia, radiation enteritis, radiation proctitis, or radiation cystitis between the groups.

Conclusion

Lobaplatin may be used as an alternative drug for patients with severe digestive system reactions or contraindications to cisplatin, but hematological toxicity must be considered, particularly in dose-intensive schemes. Neoadjuvant chemotherapy followed by concurrent chemotherapy and radiotherapy (NACT-CCRT) warrants further prospective study in cervical cancer patients with a wide range of tumor invasion (eg, mass size ≥5 cm or stage IIIB).

Keywords:

• cervical cancer
• neoadjuvant chemotherapy
• survival benefit
• side effects

Abbreviations

NACT, neoadjuvant chemotherapy; CCRT, concurrent chemotherapy and radiotherapy; RT, radiotherapy; 3D-CRT, 3-dimensional conformal radiation therapy; IMRT, intensity modulated radiotherapy; IGRT, image guided radiotherapy; GTV, gross tumor volume; CTV, clinical target volume; TP, paclitaxel plus cisplatin; TL, paclitaxel plus loplatin; OS, overall survival; NCCN, National Comprehensive Cancer Network; FIGO, International Federation of Gynecology and Obstetrics; KPS, Karnofsky Physical Status; ECOG, Eastern Cooperative Oncology Group; RECIST, Response Evaluation Criteria in Solid Tumors; CTCAE, Common Terminology Criteria for Adverse Events; RTOG, radiotherapy cooperation group; CR, complete response; PR, partial response; RR, response rate; SR, survival rate; DFS, disease-free survival; FDA, Food and Drug Administration; BCT, Brachytherapy; NCI, National Cancer Institute.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. However, the authors do not intend to share any data besides what is included in the manuscript.

Ethics Approval and Informed Consent

We have obtained permission from the dataset owners (the Affiliated Cancer Hospital of Guizhou Medical University and the Guizhou Provincial People’s Hospital) to use the information in databases/repositories for the current retrospective study. We confirmed that the data were anonymized or maintained with confidentiality. This study followed the guidelines outlined in the Declaration of Helsinki.

Consent for Publication

This study is a retrospective and comprehensive data analysis. There is no information to identify the corresponding patient in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Xue Tian and Feiyue Yang are co-first authors in this study. The authors report no conflicts of interest in this work.