Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience

  • Satya NarayanEmail author
  • Neeti Sharma
  • Akhil Kapoor
  • Rajani Sharma
  • Narendra Kumar
  • Mukesh Singhal
  • Ramesh Purohit
  • Shankar Lal Jakhar
  • Surendra Beniwal
  • Harvindra Singh Kumar
  • Ajay Sharma
Original Article



The present study summarizes the results of treatment in the form of disease-free survival and overall survival in bulky stage IB2 and locally advanced (stages II–IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of NACT followed by CCRT in one arm and CCRT in the other arm.

Materials and Methods

This retrospective study analyzed 713 cervical cancer patients who were treated at our center during 2007 and 2008; out of 713 patients, data of 612 patients have been compared. The patients' data were analyzed retrospectively. Patients had undergone PF 28.6 %, TPF 21.5 %, and only CCRT 49.9 %. Majority of patients were in the age group 41–50 years, while stage wise, mainly stage IIIb and IIb. Disease-free survival was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan–Meier method. All statistical calculations were done with SPSS Statistics version 20.0.


For cancer cervix NACT versus CCRT, the DFS rate was at 5 years (58.3 vs. 41.8 % p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS as compared to definitive CCRT, respectively, TPF (hazard ratio (HR) = 0.248, 95 % confidence interval (CI) 0.123–0.500; p < 0.001), PF (HR = 0.445, 95 % CI 0.266–0.722; p = 0.002). The results of univariate stage, age, and multivariate study show that stage hemoglobin level, interval between external-intracavitary radiation, and type of neoadjuvant chemotherapy were the factors affected survival cervical patients treated with radiation. The grade 3/4 hematologic toxicities were more in the NACT group than CCRT (p < 0.001) while the non-hematological toxicity was not significant; the TPF group experienced more toxicity than PF (p = 0.029). This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy. The grade 3/4 hematologic toxicities were more in NACT groups than CCRT (p < 0.001); the TPF group experienced more toxicity than PF (p = 0.029).


TPF/PF as NACT is feasible and produces impressive responses in cancer cervix.


Cervical cancer Neoadjuvant chemotherapy Disease-free survival Hematological 



Concurrent chemo-radiotherapy


Confidence interval


Common Terminology Criteria for Adverse Events


Disease-free survival


Eastern Cooperative Oncology Group


Federation of Gynecology and Obstetrics


Hazards ratio


Neo-adjuvant chemotherapy






Radiation Therapy Oncology Group





The authors would like to thank the Department of Oncology. The authors also express their gratitude to Teachers and PG Students of the department: Dr. Saroj, Dr. Kamlesh Harsh, Dr. Sitaram, Dr. Raj K Nirban, Dr. Parmilla Khatri, Dr. Guman Singh, Dr. Murali, Dr. Tanya, and Dr. Rajesh.

Compliance with ethical requirements and Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper. The research is independent and impartial. The author(s) declare that they have no conflict of interest.


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Copyright information

© Federation of Obstetric & Gynecological Societies of India 2015

Authors and Affiliations

  • Satya Narayan
    • 1
    • 6
  • Neeti Sharma
    • 2
  • Akhil Kapoor
    • 1
  • Rajani Sharma
    • 3
  • Narendra Kumar
    • 4
  • Mukesh Singhal
    • 1
  • Ramesh Purohit
    • 1
  • Shankar Lal Jakhar
    • 2
  • Surendra Beniwal
    • 5
  • Harvindra Singh Kumar
    • 2
  • Ajay Sharma
    • 2
  1. 1.Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research InstituteSardar Patel Medical CollegeBikanerIndia
  2. 2.Department of Radiation OncologyAcharya Tulsi Regional Cancer Treatment & Research InstituteBikanerIndia
  3. 3.PBM HospitalBikanerIndia
  4. 4.Sardar Patel Medical CollegeBikanerIndia
  5. 5.Department of Medical OncologyAcharya Tulsi Regional Cancer Treatment & Research InstituteBikanerIndia
  6. 6.PG Boys HostelBikanerIndia

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