International Journal of Clinical Oncology

, Volume 24, Issue 11, pp 1440–1448 | Cite as

Neoadjuvant chemotherapy followed by radical hysterectomy for stage IB2-to-IIB cervical cancer: a retrospective cohort study

  • Lei Li
  • Ming WuEmail author
  • Shuiqing Ma
  • Xianjie Tan
  • Sen Zhong
Original Article



This study was to evaluate the surgical and survival effects of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) for cervical cancer with stages IB2 to IIB of FIGO 2009 staging.


From February 2, 2001 to November 11, 2015, 428 patients received NAC followed by RH in a tertiary hospital, in which all the major procedures were performed by one surgeon. Surgical and survival outcomes were evaluated between the NAC and primary RH groups.


A total of 279 (65.2%) patients received NAC, and the overall clinical and complete pathological response rates were 65.9% and 10.8%, respectively. Compared with primary RH patients, NAC patients had more advanced stages, higher recurrence rate, longer median duration of RH, and more median estimated blood loss. After adjusted with baseline risk factors, no significant differences in progression-free or overall survival were observed between the NAC and primary RH groups. However, the responders to NAC had better survival outcomes.


There were no surgical or survival benefits of NAC for patients with cervical cancer of stages IB2 to IIB except for the responders to NAC.


Neoadjuvant chemotherapy Locally advanced cervical cancer Radical hysterectomy Adjuvant therapy 



Locally advanced cervical cancer


Neoadjuvant chemotherapy


Overall survival


Para-aortic lymph nodes


Fluorouracil and cisplatin


Progression-free survival


Pelvic lymph node


Radical hysterectomy


Paclitaxel and carboplatin


Paclitaxel and cisplatin


Author contributions

LL: assistant surgeon, protocol/project development, data management, data analysis, and manuscript drafting; MW: major surgeon and manuscript editing; SM, XT, SZ: assistant surgeons and data management.


This work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (no. CAMS-2017-I2M-1-002). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest to disclose.

Supplementary material

10147_2019_1510_MOESM1_ESM.docx (16 kb)
Supplementary file1 (DOCX 15 kb)
10147_2019_1510_MOESM2_ESM.xls (174 kb)
Supplementary file2 (XLS 174 kb)


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30. CrossRefGoogle Scholar
  2. 2.
    Chen W, Zheng R, Baade PD et al (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132. CrossRefPubMedGoogle Scholar
  3. 3.
    deSouza NM, Soutter WP, Rustin G et al (2004) Use of neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer: monitoring tumour shrinkage and molecular profile on magnetic resonance and assessment of 3-year outcome. Br J Cancer 90:2326–2331. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Panici PB, Bellati F, Plotti F et al (2008) Neoadjuvant chemotherapy followed by radical surgery in patients affected by vaginal carcinoma. Gynecol Oncol 111:307–311. CrossRefGoogle Scholar
  5. 5.
    Katsumata N, Yoshikawa H, Kobayashi H et al (2013) Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102). Br J Cancer 108:1957–1963. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yang Z, Chen D, Zhang J et al (2016) The efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer: a randomized multicenter study. Gynecol Oncol 141:231–239. CrossRefPubMedGoogle Scholar
  7. 7.
    Kim HS, Sardi JE, Katsumata N et al (2013) Efficacy of neoadjuvant chemotherapy in patients with FIGO stage IB1 to IIA cervical cancer: an international collaborative meta-analysis. Eur J Surg Oncol 39:115–124. CrossRefPubMedGoogle Scholar
  8. 8.
    Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration (2010) Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev 26:CD008285. CrossRefGoogle Scholar
  9. 9.
    Minig L, Patrono MG, Romero N et al (2014) Different strategies of treatment for uterine cervical carcinoma stage IB2–IIB. World J Clin Oncol 5:86–92. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cervical cancer. Version 2.2019—October 12, 2018. Accessed 15 Dec 2018
  11. 11.
    Nama V, Angelopoulos G, Twigg J et al (2018) Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer. Cochrane Database Syst Rev 10:CD011478. CrossRefPubMedGoogle Scholar
  12. 12.
    Gupta S, Maheshwari A, Parab P et al (2018) Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol 36:1548–1555. CrossRefPubMedGoogle Scholar
  13. 13.
    Cibula D, Abu-Rustum NR, Benedetti-Panici P et al (2011) New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol Oncol 122:264–268. CrossRefPubMedGoogle Scholar
  14. 14.
    Querleu D, Morrow CP (2008) Classification of radical hysterectomy. Lancet Oncol 9:297–303. CrossRefPubMedGoogle Scholar
  15. 15.
    Li L, Ma S, Tan X et al (2019) The urodynamics and survival outcomes of different methods of dissecting the inferior hypogastric plexus in laparoscopic nerve-sparing radical hysterectomy of type C: a randomized controlled study. Ann Surg Oncol 26:1560. CrossRefPubMedGoogle Scholar
  16. 16.
    Pecorelli S, Zigliani L, Odicino F (2009) Revised FIGO staging for carcinoma of the cervix. Int J Gynecol Obstet 105:107–108. CrossRefGoogle Scholar
  17. 17.
    Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216CrossRefGoogle Scholar
  18. 18.
    Testa AC, Moro F, Pasciuto T et al (2018) PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. Ultrasound Obstet Gynecol 52:110–118. CrossRefPubMedGoogle Scholar
  19. 19.
    Obermair A, Gebski V, Frumovitz M et al (2008) A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol 15:584–588. CrossRefPubMedGoogle Scholar
  20. 20.
    Common Terminology Criteria for Adverse Events (CTCAE) v4.03. National Cancer Institute. Accessed 15 Dec 2018
  21. 21.
    Shimada M, Nagao S, Fujiwara K et al (2016) Neoadjuvant chemotherapy with docetaxel and carboplatin followed by radical hysterectomy for stage IB2, IIA2, and IIB patients with non-squamous cell carcinoma of the uterine cervix. Int J Clin Oncol 21:1128–1135. CrossRefPubMedGoogle Scholar
  22. 22.
    Gadducci A, Landoni F, Cosio S et al (2018) Neoadjuvant platinum-based chemotherapy followed by radical hysterectomy for stage Ib2–IIb adenocarcinoma of the uterine cervix—an Italian Multicenter Retrospective Study. Anticancer Res 38:3627–3634. CrossRefPubMedGoogle Scholar
  23. 23.
    Tsubamoto H, Maeda H, Kanazawa R et al (2013) Phase II trial on neoadjuvant intravenous and trans-uterine arterial chemotherapy for locally advanced bulky cervical adenocarcinoma. Gynecol Oncol 129:129–134. CrossRefPubMedGoogle Scholar
  24. 24.
    Junker P, Puppe J, Thangarajah F et al (2018) Neoadjuvant therapy of cervical carcinoma with the angiogenesis inhibitor bevacizumab: a single-centre analysis. Geburtshilfe Frauenheilkd 78:768–774. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rydzewska L, Tierney J, Vale CL et al (2012) Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev 12:CD007406. CrossRefPubMedGoogle Scholar
  26. 26.
    Mossa B, Mossa S, Corosu L et al (2010) Follow-up in a long-term randomized trial with neoadjuvant chemotherapy for squamous cell cervical carcinoma. Eur J Gynaecol Oncol 31:497–503PubMedGoogle Scholar
  27. 27.
    Kokka F, Bryant A, Brockbank E et al (2015) Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced cervical cancer. Cochrane Database Syst Rev 4:CD010260. CrossRefGoogle Scholar
  28. 28.
    Wen H, Wu X, Li Z et al (2012) A prospective randomized controlled study on multiple neoadjuvant treatments for patients with stage IB2 to IIA cervical cancer. Int J Gynecol Cancer 22:296–302. CrossRefPubMedGoogle Scholar
  29. 29.
    Shoji T, Takatori E, Furutake Y et al (2016) Phase II clinical study of neoadjuvant chemotherapy with CDDP/CPT-11 regimen in combination with radical hysterectomy for cervical cancer with a bulky mass. Int J Clin Oncol 21:1120–1127. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Mahmoud O, Einstein MH (2018) Which patients with cervical squamous cell carcinoma might benefit from neoadjuvant chemotherapy? J Clin Oncol 36:1543–1547. CrossRefPubMedGoogle Scholar
  31. 31.
    Marchetti C, De Felice F, Di Pinto A et al (2018) Survival nomograms after curative neoadjuvant chemotherapy and radical surgery for stage IB2–IIIB cervical cancer. Cancer Res Treat 50:768–776. CrossRefPubMedGoogle Scholar
  32. 32.
    Pergialiotis V, Rodolakis A, Christakis D et al (2013) Laparoscopically assisted vaginal radical hysterectomy: systematic review of the literature. J Minim Invasive Gynecol 20:745–753. CrossRefPubMedGoogle Scholar
  33. 33.
    Bentivegna E, Maulard A, Pautier P et al (2016) Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 106:1195–1211. CrossRefPubMedGoogle Scholar
  34. 34.
    Plante M (2015) Bulky early-stage cervical cancer (2–4 cm lesions): upfront radical trachelectomy or neoadjuvant chemotherapy followed by fertility-preserving surgery: which is the best option? Int J Gynecol Cancer 25:722–728. CrossRefPubMedGoogle Scholar
  35. 35.
    Li J, Wang LJ, Zhang BZ et al (2011) Neoadjuvant chemotherapy with paclitaxel plus platinum for invasive cervical cancer in pregnancy: two case report and literature review. Arch Gynecol Obstet 284:779–783. CrossRefPubMedGoogle Scholar
  36. 36.
    Fruscio R, Villa A, Chiari S et al (2012) Delivery delay with neoadjuvant chemotherapy for cervical cancer patients during pregnancy: a series of nine cases and literature review. Gynecol Oncol 126:192–197. CrossRefPubMedGoogle Scholar
  37. 37.
    Tang J, Tang Y, Yang J et al (2012) Chemoradiation and adjuvant chemotherapy in advanced cervical adenocarcinoma. Gynecol Oncol 125:297–302. CrossRefPubMedGoogle Scholar
  38. 38.
    Lan M, Chen C, Huang Y et al (2017) Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in nasopharyngeal carcinoma patients with cervical nodal necrosis. Sci Rep 7:42624. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Ferrandina G, Palluzzi E, Gallotta V et al (2018) Neo-adjuvant platinum-based chemotherapy followed by chemoradiation and radical surgery in locally advanced cervical cancer (Lacc) patients: a phase II study. Eur J Surg Oncol 44:1062–1068. CrossRefPubMedGoogle Scholar
  40. 40.
    Ferrandina G, Corrado G, Vitrano G et al (2018) Dose-dense paclitaxel/carboplatin as neo-adjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer: a prospective phase II study. Cancer Chemother Pharmacol 83:431. CrossRefPubMedGoogle Scholar
  41. 41.
    Ramirez PT, Frumovitz M, Pareja R et al (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379:1895–1904. CrossRefPubMedGoogle Scholar
  42. 42.
    Melamed A, Margul DJ, Chen L et al (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379:1905–1914. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPeking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical ScienceBeijingChina

Personalised recommendations