Introduction/Background*To report outcomes of non metastatic advanced cervical cancer patients treated with neoadjuvant chemotherapy (NACT) followed by chemoradiation/radiation.
Methodology 104 patients treated between January 2015 and December 2019 were analyzed and restaged as per FIGO 2018. RECIST criteria v1.1 was used to assess response to NACT and toxicity was assessed using CTCAE v4.0. Survival analysis was done using Kaplan-Meir method. Univariate and multivariate analysis was done using Log-rank test and Cox-regression model respectively.
Result(s)*104 patients (median age: 52 years) of advanced cervical cancer (92% SCC) received NACT for following reasons: bulky pelvic nodes (n=20), bulky para-aortic nodes (n=10), bulky pelvic + para-aortic nodes (n=31), bladder invasion (n=43). Baseline median pelvic and para-aortic nodal size was 2.5 cm (range: 1-8) and 1.8 cm (range: 1-3.5) respectively. Baseline median tumor infiltration size into bladder on cystoscopy was 3 cm (range 0.5-7). NACT regimen was Paclitaxel (175 mg/m2) and Carboplatin (AUC 5) 3 weekly IV infusion for 3 (median) cycles (range: 1-6). Post NACT completion, 9 (8.6%) defaulted from subsequent treatment, 8 (7.7%) were labeled as best supportive care, 1 received palliative chemotherapy for progressive disease and 13 (12.5%) patients received palliative RT. 73 (70.2%) patients received radical pelvic EBRT (median dose of 46Gy/23Fr) of which 68 (93.1%) received brachytherapy boost (median dose 21Gy/3Fr). 32 (43.8%) and 28 (38.3%) patients also received extended field RT (EFRT) and nodal boost (median dose 5.4Gy/3Fr) respectively. 64 (87.6%) patients received concurrent cisplatin. On univariate analysis, patients with comorbidities, bladder invasion, pelvic nodal disease, NACT dose reduction, incomplete radical treatment post-NACT and pelvic nodal size ≥ 2.5cm at baseline had poor outcomes (table 1). On multivariate analysis, none of the variables reached levels of significance. At median follow-up of 26 months (IQR: 11-45), 34 patients had died of disease, 51 were alive, of which 34 were disease-free. The 2 year LC, RC, DMC, DFS and OS for the entire cohort was 75%, 68%, 72%, 48% and 60% respectively whereas for the patents who completed NACT and radical local treatment was 92%, 82%, 76%, 62% and 75% respectively (figure 1).
Conclusion*NACT followed by radiation therapy in non metastatic advanced cervical cancer is a feasible option with good survival outcomes and acceptable toxicity.
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