Neoadjuvant Chemotherapy Followed by Surgery/Chemoradiotherapy Versus Radical Chemoradiotherapy in Stage IB2, IIA2, IIB Locally Advanced Cervical Carcinoma: A Retrospective Multicenter Study of 388 Patients

Abstract Purpose: The present study aimed to compare the oncologic outcomes and side effects between neoadjuvant chemotherapy followed by surgery/chemoradiotherapy and radical chemoradiotherapy for locally advanced cervical carcinoma (LACC).Methods: We conducted a retrospective review of patients with LACC (IB2, IIA2 and IIB stages) from six hospitals between June 2007 and January 2017. Results: A total of 388 patients were included, in which 278 patients received radical chemoradiotherapy (Standard group), and 110 patients received neoadjuvant chemotherapy. 65 patients of the 110 received radical hysterectomy (Surgery group), and 45 received chemoradiotherapy (Neo-Ra group). The 5-year overall survival (OS) in Surgery group (92.5%) was similar to that of the Standard group (84.9%), but both groups had higher OS rates than Neo-Ra group (75.6%). The 5-year disease-free survival (DFS) and progression-free survival (PFS) showed no differences among the three groups, respectively. There were no significant differences for grades 1-3 gastrointestinal and genitourinary toxicities among the three groups. No patient had grade 4 adverse effects. In multivariate analysis, tumor regression (CR vs. PR+SD+PD), pathological type (squamous cancer vs. non-squamous cancer) and lymph node metastasis (positive vs. negative) were considered as independent predictors of OS. Furthermore, besides above factors, the maximum diameter of tumors and adjuvant chemotherapy were also considered as significant prognostic factors for DFS and PFS.Conclusion: These findings showed that neoadjuvant chemotherapy followed by radical hysterectomy as a feasible and reliable therapy, resulting in encouraging oncologic outcomes and low side effects when compared to those obtained by standard chemoradiotherapy for IB2, IIA2, IIB stage cervical carcinoma patients.