Introduction To evaluate the clinical and surgical response of neoadjuvant(NACT) followed by radical hysterectomy, as well as recurrence rates and overall survival, in patients with locally advanced cervical cancer treated at Kigali University Teaching Hospital in Rwanda.

Methods Retrospective descriptive study: data collected from eligible patients FIGO stage IB2-IIA2, some exceptional stage IIB. Patients treated with neoadjuvant carboplatin/paclitaxel chemotherapy every 3 weeks for 3–4 cycles before radical hysterectomy. Clinical response, recurrence and survival rates were determined.

Results Between May 2016 and October 2018, 57 patients underwent NACT and 43(75.4%) were candidates for radical hysterectomy after clinical assessment. Median age was 56 years. 39(90.7%) patients received 3 cycles of NACT, 4(9.3%) received 4 cycles. Only 14% were HIV positive. FIGO stages were IB2 (32.6%), IIA1(27.9%), IIA2(30.2%) and IIB(9.3%). Mean tumor size before and after NACT was 5.9 cm and 2.07 cm, respectively. Thirty-eight(88.4%) patients underwent radical hysterectomy as planned. 5(11.6%) had surgery aborted due to metastatic disease, four(10.5%) had microscopic metastasis on final pathology. These nine(20.9%) patients were referred for adjuvant chemoradiation. Five(13.1%) patients showed no residual disease on final pathology. Mean time for follow up was 34.4 months. 32/41(78%) patients showed no evidence of recurrence, 8/41(19.5%) had documented recurrence and 2/43(4.7%) were lost to follow up. One and 2-year overall survival rates were 95.1% and 87%, respectively.

Conclusion/Implications Neoadjuvant chemotherapy with radical hysterectomy is a feasible treatment option for locally advanced cervical cancer in limited resource settings. It can be an alternative treatment option in countries without radiation facilities if gynecologists skilled at radical surgery are available.