Neoadjuvant Chemotherapy Followed by Radical Surgery versus Concurrent Chemo-Radiotherapy in the Treatment of Locally Advanced Cervical Cancer: A Multicenter Retrospective Analysis

Abstract

Objectives

This study aims to evaluate oncological outcomes in women affected by locally advanced cervical cancer (LACC) treated by neoadjuvant chemotherapy before radical surgery (NACT + RS) or concurrent chemo-radiotherapy (CCRT).

Methods

This was a multicenter retrospective analysis of data related to women with LACC (FIGO stage IB2-IVA), who were treated by NACT + RS or CCRT between November 2006 and January 2018. The first endpoints were the evaluation of disease-free survival (DFS) and overall survival (OS); univariate and multivariate analyses were performed for identifying the prognostic factors independently associated with these oncological outcomes.

Results

Overall, 106 women were included in the analysis; 55 of them (51.9%) underwent NACT + RS and 51 (48.1%) CCRT, respectively. Patients in the NACT + RS group had a significant better five-year DFS and five-year OS than those in the CCRT group (77.4% vs. 33.4%, p < .001 and 93.8% vs. 56.5%, p = .003). In the multivariate analyses, treatment choice (NACT + RS or CCRT) was the only independent prognostic factor for predicting both DFS (HR = 3.954; 95 CI = 1.898–8.236; p < 0.001) and OS (HR = 5.330; 95 CI = 1.563–18.178; p = 0.008).

Conclusions

This retrospective study demonstrated an improved survival outcome for patients undergoing NACT + RS compared with those undergoing CCRT. Our findings seem to support the use of NACT before RS as an effective alternative option to CCRT standard therapy.

KEYWORDS:

• Cancer
• cervical cancer
• disease-free survival
• overall survival
• locally advanced cervical cancer
• radical surgery
• chemo-radiotherapy
• treatment choice

Acknowledgments

All procedures performed in this study involving human patients have been done according to the ethical standards of the institutional and/or national research committee. Moreover, all procedures were done following the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All study research followed regulations and relevant guidelines. All the patients gave their informed consent for collecting and using their data for research purposes.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This paper was funded by Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 × 1000 anno 2019.