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

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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.

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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

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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.

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Author notes

  1. Satya Narayan

    Present address: PG Boys Hostel, PBM Hospital Campus, Bikaner, 334003, Rajasthan, India

Authors and Affiliations

  1. Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003, Rajasthan, India

    Satya Narayan, Akhil Kapoor, Mukesh Singhal & Ramesh Purohit

  2. Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan, India

    Neeti Sharma, Shankar Lal Jakhar, Harvindra Singh Kumar & Ajay Sharma

  3. PBM Hospital, Bikaner, Rajasthan, India

    Rajani Sharma

  4. Sardar Patel Medical College, Bikaner, Rajasthan, India

    Narendra Kumar

  5. Department of Medical Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan, India

    Surendra Beniwal

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Corresponding author

Correspondence to Satya Narayan.

Additional information

Satya Narayan is a Resident at Acharya Tulsi Regional Cancer Treatment and Research Institute; Akhil Kapoor is a Resident at Acharya Tulsi Regional Cancer Treatment and Research Institute; Mukesh Singhal is a Resident at Acharya Tulsi Regional Cancer Treatment and Research Institute; Ramesh Purohit is a Resident at Acharya Tulsi Regional Cancer Treatment and Research Institute; Neeti Sharma is an Assosiate Professor at Acharya Tulsi Regional Cancer Treatment and Research Institute; Rajani Sharma is a Health Professional at PBM Hospital; Narendra Kumar is an MBBS Student at Sardar Patel Medical College; Shankar Lal Jakhar is an Assistant Professor at Acharya Tulsi Regional Cancer Treatment and Research Institute; Surendra Beniwal is an Assistant Professor Acharya Tulsi Regional Cancer Treatment and Research Institute; Harvindra Singh Kumar is a Senior Professor at Acharya Tulsi Regional Cancer Treatment and Research Institute; and Ajay Sharma is a Senior Professor at Acharya Tulsi Regional Cancer Treatment and Research Institute.

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Narayan, S., Sharma, N., Kapoor, A. et al. Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience. J Obstet Gynecol India 66, 385–390 (2016). https://doi.org/10.1007/s13224-015-0698-5

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  • DOI: https://doi.org/10.1007/s13224-015-0698-5

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