Neoadjuvant chemotherapy with paclitaxel and carboplatin followed by definitive chemoradiation in locally advanced cervical carcinoma. Experience of a cancer hospital in Pakistan

Objective: To report the efficacy and toxicity of neoadjuvant chemotherapy (NACT) before standard concurrent chemo radiation (CCRT) in locally advanced carcinoma of cervix. Methods: Between January 2007 and December 2016, 75 patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy comprising carboplatin area under curve (AUC) 5 and Paclitaxel 175 mg/m2${}^2$ followed by chemo radiotherapy 45–59 Gy in 25–28 fractions with concurrent cisplatin and high dose rate (HDR) brachytherapy at our institution were analyzed. Clinical response rate, disease free survival, overall survival and toxicity was evaluated and documented using European organization for research and treatment of cancer (EORTC) criteria. Results: Baseline characteristics were median age at diagnosis 48 years; 86% squamous, and 14% adenocarcinoma histology; The international Federation of Gynecology and Obstetrics (FIGO) stage IB2–IIB (47%), III–IVA (53%). 64% had nodes involved and 84% had primary more than 4 cm in diameter. Complete or partial response rate was (95%) post-NACT and 92% (95% CI: 71–94) post-CRT. The median follow-up was 39.1 months. Overall and progression-free survivals at 4 years were 77% and 80% respectively. Grade ¾ hematological toxicities were 7% during NACT (11% hematological, 9% non-hematological) and 8% during CRT. The most common non hematological toxicity was diarrhea in 10%. The delayed toxicities at 24 months or later after CRT completion were rectal (11%), bladder (3%), and vaginal (28%). Conclusion: Neoadjuvant chemotherapy in locally advanced cervical cancer offers a favorable paradigm as reflected by acceptable toxicity and is associated with a high response rate in locally advanced cervical cancer. However, further randomized clinical trials are needed to support this evidence.

Neoadjuvant chemotherapy (NACT); Locally advanced cervical cancer; Radiotherapy

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