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Neoadjuvant Chemotherapy Followed by Chemoradiation: Is it Tolerable and Efficient in Management of Locally Advanced Cervical Cancer?

Abstract

Heba Abdallah

Background: Chemoradiation is the standard of care for management of locally advanced cervical cancer, but failure to control systemic disease occurs in one third of patients. Neoadjuvant chemotherapy (NACT) has been investigated in management of locally advanced cervical cancer in order to improve its prognosis. We assessed the tolerability and response rate of weekly NACT with paclitaxel and carboplatin before radical concurrent chemoradiation (CRT).
Methods: Single arm phase II trial of 50 patients with locally advanced cervical cancer (stage IB2-IVA). Patients received weekly paclitaxel (80 mg/ m2 ) and carboplatin AUC2 for six cycles followed by CRT (weekly cisplatin 40 mg/m2 , 50.4 Gray over 28 fractions plus brachytherapy).
Results: A total of 50 patients were recruited. Baseline characteristics were: median age at diagnosis 56 years, 92% squamous, 8% adenocarcinoma, FIGO stage IB2 ( 4%), II (28%), IIIA (28%), IIIB (12%), IVA (28%). Complete or partial response rate was 88.3% post NACT and 72.1% post CCRT. The median follow up was 12 months. Grade 3 toxicities were 14.8% during NACT and 13.8% during CCRT.
Conclusion: Dose-dense weekly NACT with paclitaxel and carboplatin followed by CRT achieved a good response rate. It is feasible with acceptable toxicity of NACT and high compliance to radiotherapy.