Objectives To evaluate the role of dose-dense neoadjuvant chemotherapy(NACT) with paclitaxel and carboplatin before surgery in locally advanced cervical cancer(LACC).
Methods Patients with LAAC (Stage Ib2-IVa) undergoing dose-dense NACT at the European Institute of Oncology, Milan from July 2014 to February 2019 were identified. Patients received weekly dose-dense carboplatin (AUC2 or AUC2.7) and paclitaxel (80 or 60 mg) for 6–9 cycles followed by surgery. Radiological response was evaluated by RECIST. Pathologic response was evaluated based on the final pathology report.
Results A total of 68 patients meeting inclusion criteria were included. Baseline characteristics are displayed in Table 1. According to FIGO stage(2018), the stage distribution of disease was the following: 18(26.5%) stage IB2, 28(41.2%) stage IB3, 6(8.8%) stage IIA, 6(8.8%) stage IIB, 10(14.8%) stage IIIC1. According to RECIST criteria, 6(8.8%) had complete response, 49(72.0%) partial response, 12(17.6) stable disease, 1(1.5%) progressive disease. After NACT, 13(19.1%) patients were deemed inoperable and received chemoradiation(CRT). Among the 55 (80.9%) undergoing surgery, 7(12.7%) had pathologic complete response. Due to the presence of positive lymph nodes and/or close resection margins, 17(31%) received postoperative radiotherapy. Among the remaining 37(67.3%) avoiding additional radiotherapy, during a median follow-up of 36 months(range 6–63), the recurrence rate was 13.5% (5/37).
Conclusions Dose-dense NACT achieved a good response rate. Although CRT remains the standard treatment of LACC, dose-dense NACT followed by surgery can be considered an alternative approach and allows to avoid radiotherapy in over 50% of the patients without affecting recurrence rate.
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