Introduction/Background Concurrent chemoradiotherapy (CCRT) is the standard of care for locally advanced cervical cancer. However, a significant number of women develop local and/or systemic relapse. Limited studies suggest that neoadjuvant chemotherapy (NACT) may improve efficacy, with 3 year overall survival (OS) of 67% in a recent Phase II study (McCormack M, et al; 2013). In the West of Scotland Cancer Network (WoSCAN), 3-weekly NACT has been used for over a decade in high-risk women. A previous local study in 2012 demonstrated 55% of NACT patients proceeded to CCRT. This study aimed to identify the proportion of patients proceeding to definitive CCRT following NACT in the real-world setting and evaluate survival.
Methodology Data were collected retrospectively from electronic clinical records of WoSCAN patients who commenced NACT between January 2012 and December 2016. Statistical analysis was performed using R®. OS was estimated using Kaplan-Meier method and Cox’s proportional-hazards models used to estimate unadjusted hazard ratios (HR).
Results 126 patients were identified; median age was 45 years (range 22–75). The majority had at least FIGO Stage II disease (91.3%) and squamous pathology (85.7%). Para-aortic nodes were present in 10.4% and 4.8% had Stage IVB disease (encompassed within a radical field). NACT regimens consisted primarily of Cisplatin/Paclitaxel (62.7%) or Carboplatin/Paclitaxel (34.9%); a median of 3 cycles were administered. 85.7% proceeded to CCRT, 11.1% received radiotherapy (RT) only, and 3.2% progressed or defaulted. 3 year OS was 74.2% (95% CI 66.4–82.9). Treatment with RT only, significantly increased the death hazard (Unadjusted HR 2.35 (95% CI 1.15–4.79)).
Conclusion Almost 90% of patients proceeded to CCRT. Survival compares favourably with recent Phase II data illustrating that NACT followed by CCRT is a feasible approach for locally advanced cervical cancer, especially in women with bulky disease. Preliminary data are encouraging, but results of Phase III INTERLACE trial are still awaited.
Disclosure This study was funded by the Scottish Government. The authors declare no competing interests.
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