Advertisement

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

Abstract

Background

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.

Results

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).

Conclusion

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

Keywords

Cervical cancer Neoadjuvant chemotherapy Disease-free survival Hematological 

Abbreviations

CCRT

Concurrent chemo-radiotherapy

CI

Confidence interval

CTCAE

Common Terminology Criteria for Adverse Events

DFS

Disease-free survival

ECOG

Eastern Cooperative Oncology Group

FIGO

Federation of Gynecology and Obstetrics

HR

Hazards ratio

NACT

Neo-adjuvant chemotherapy

PF

Platin/5-FU

RT

Radiotherapy

RTOG

Radiation Therapy Oncology Group

TPF

Taxol/Platin/5-FU

Notes

Acknowledgments

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.

References

  1. 1.
    Sankaranarayanan R, Ferlay J. Worldwide burden of gynecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20:207–25.CrossRefPubMedGoogle Scholar
  2. 2.
    WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre): Summary report on HPV and cervical cancer statistics in India 2007. http://www.who.int/hpvcentre. Assessed 1 May 2008.
  3. 3.
    FIGO staging for cancer cervix uteri. UICC manual for classification of malignant tumors. Berlin: Springer; 1987.Google Scholar
  4. 4.
    Woo YJ, Byun JM, Jeong DH, et al. Prognosis of stage IIb cervical cancer among treatment regimens: radical hysterectomy versus neoadjuvant chemotherapy followed by radical hysterectomy versus concurrent chemoradiotherapy. Korean J Obstet Gynecol. 2012;55:913–9.CrossRefGoogle Scholar
  5. 5.
    NCI Issues Clinical Announcement on Cervical Cancer, Chemotherapy Plus Radiation Improves Survival: http://www.nih.gov/news/pr/feb99/nci-22.htm.
  6. 6.
    Lukka H, Hirte H, Fyles A, et al. Concurrent cisplatin-based chemotherapy plus RT for cervical cancer: a meta-analysis. Clin Oncol. 2002;14:203–12.CrossRefGoogle Scholar
  7. 7.
    Vikas Fotedar V, Seam RK, Gupta MK, et al. Neoadjuvant chemotherapy followed by radiotherapy versus radiotherapy alone in locally advanced carcinoma cervix: a prospective randomized study. J Dental Med Sci. 2013;4:58–63.Google Scholar
  8. 8.
    Saha A, Mukherjee A. Role of neoadjuvant chemotherapy in cancer cervix: a brief review. Clin Cancer Investig J. 2013;2:281–6.CrossRefGoogle Scholar
  9. 9.
    Turan T, Yıldırım BA, Tulunay G, et al. Experience in stage IB2 cervical cancer and review of treatment. J Ger Gynecol Assoc. 2010;11:27–37.Google Scholar
  10. 10.
    Zanetta G, Lissoni A, Pellegrino A, et al. Neoadjuvant chemotherapy in locally advanced uterine cervical cancer: correlation between pathological response and survival. Proc Am Soc Clin Oncol. 1998;17:352–5.Google Scholar
  11. 11.
    Taneja A, Rajaram S, Agarwal S, et al. “Quick Cycle” neoadjuvant chemotherapy in squamous cell carcinoma of cervix. Indian J Pharmacol. 2005;37:320–4.CrossRefGoogle Scholar
  12. 12.
    Sardi JE, Giaroli A, Sananes C, et al. Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol. 1997;67:61–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Metaanalysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer. 2003;39:2470–86.CrossRefGoogle Scholar
  14. 14.
    McCormack M, Kadalayil L, Hackshaw A, et al. A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer. British J of Cancer. 2013;108:2464–9.CrossRefGoogle Scholar

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

Personalised recommendations