PT  - JOURNAL ARTICLE
AU  - Caruso, Giuseppe
AU  - Bruni, Simone
AU  - Lapresa, Mariateresa
AU  - De Vitis, Luigi A
AU  - Parma, Gabriella
AU  - Minicucci, Valentina
AU  - Betella, Ilaria
AU  - Schivardi, Gabriella
AU  - Peccatori, Fedro
AU  - Lazzari, Roberta
AU  - Cliby, William
AU  - Aletti, Giovanni Damiano
AU  - Zanagnolo, Vanna
AU  - Maggioni, Angelo
AU  - Colombo, Nicoletta
AU  - Multinu, Francesco
TI  - Dose-dense neoadjuvant chemotherapy before radical surgery in cervical cancer: a retrospective cohort study and systematic literature review
AID  - 10.1136/ijgc-2023-004928
DP  - 2024 Jan 01
TA  - International Journal of Gynecologic Cancer
PG  - 47--57
VI  - 34
IP  - 1
4099  - http://ijgc.bmj.com/content/34/1/47.short
4100  - http://ijgc.bmj.com/content/34/1/47.full
SO  - Int J Gynecol Cancer2024 Jan 01; 34
AB  - Objective To evaluate the role of dose-dense neoadjuvant chemotherapy followed by radical hysterectomy in reducing adjuvant radiotherapy in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB1-IB2/IIA1 cervical cancer with disrupted stromal ring and as an alternative to concurrent chemoradiotherapy in FIGO 2018 stages IB3/IIA2.Methods This was a retrospective cohort study including patients with FIGO 2018 stage IB1-IIA2 cervical cancer undergoing dose-dense neoadjuvant chemotherapy at the European Institute of Oncology in Milan, Italy between July 2014 and December 2022. Weekly carboplatin (AUC2 or AUC2.7) plus paclitaxel (80 or 60 mg/m2, respectively) was administered for six to nine cycles. Radiological response was assessed by Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 criteria. The optimal pathological response was defined as residual tumor ≤3 mm. Kaplan–Meier curves were used to estimate survival rates. A systematic literature review on dose-dense neoadjuvant chemotherapy before surgery for cervical cancer was also performed.Results A total of 63 patients with a median age of 42.8 years (IQR 35.3–47.9) were included: 39.7% stage IB-IB2/IIA1 and 60.3% stage IB3/IIA2. The radiological response was as follows: 81% objective response rate (17.5% complete and 63.5% partial), 17.5% stable disease, and 1.6% progressive disease. The operability rate was 92.1%. The optimal pathological response rate was 27.6%. Adjuvant radiotherapy was administered in 25.8% of cases. The median follow-up for patients who underwent radical hysterectomy was 49.7 months (IQR 16.8–67.7). The 5-year progression-free survival and overall survival were 79% (95% CI 0.63 to 0.88) and 92% (95% CI 0.80 to 0.97), respectively. Fifteen studies including 697 patients met the eligibility criteria for the systematic review. The objective response rate, operability rate, and adjuvant radiotherapy rate across studies ranged between 52.6% and 100%, 64% and 100%, and 4% and 70.6%, respectively.Conclusions Dose-dense neoadjuvant chemotherapy before radical surgery could be a valid strategy to avoid radiotherapy in stage IB1-IIA2 cervical cancer, especially in young patients desiring to preserve overall quality of life. Prospective research is warranted to provide robust, high-quality evidence.All data relevant to the study are included in the article or uploaded as supplementary information.