19P Neoadjuvant chemotherapy followed by radical surgery vs chemoradiotherapy in patients with cervical cancer (stage IIB, FIGO 2018)

Abstract

Improving the results of treatment of patients with stage IIB cervical cancer by introducing the most effective, less toxic chemoradiotherapy at one of the phases of complex or combined treatment. This study based on a prospective analysis of 215 women diagnosed with stage IIB cervical cancer. The median age was 47 years (28-64). The patients were divided into two groups: the NACT+S group, 105 patients who recive 2-3 cycles of neoadjuvant chemotherapy (paclitaxel+carboplatin) followed by surgical treatment. Radiotherapy (1,8 Gy, 45 Gy ± SIB on the metastatically involved lymph nodes 2,2 Gy, 55 Gy) was performed 1-2 months after surgical treatment. Patients also received cycles of cisplatin (40 mg/m2), administered once every week. The second group (CRT group) included 110 patients who underwent radiotherapy (regime was same with NACT+S = 1,8 Gy, 45 Gy ± SIB 2,2 Gy, 55 Gy). Brachytherapy was performed for all patients (6 Gy x 5 fr, to point A 30 Gy). The median follow-up was 23 months (8-38). In the NACT+S group, thrombocytopenia and neutropenia of the 3 - 4 degree were more common than in the CRT group (6.6% and 7.6% vs. 0.9% and 0.9%, respectively; p = 0.026; p = 0.015). However, there was no significant difference between the two groups studied in relation to the 3 - 4 degree of radiation toxicity of the GI and genitourinary system. 26 cases of disease progression (24.8%) occurred in the NACT+S group, and 15 events (13.6%) occurred in the CRT group; the corresponding 3-year DFS rates were 75.2% and 86.4%, respectively (HR 1.83; 95% CI 1.99-3.40; p = 0.05). Nineteen patients (18.1%) died in the NACT+S group, and 18 patients (15.5%) died in the CRT group, with corresponding 3-year indicators of OS was 81.9% and 84.5%, respectively (HR 1.11; 95% CI from 0.58 to 2.14; p = 0.736). Cisplatin-based chemoradiation resulted in superior DFS compared with neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer. In the NACT+S group, thrombocytopenia and neutropenia grade 3 or 4 at a higher rate than in the concomitant CRT group. Despite this, there was no significant difference between the two study groups with 3-year indicators of OS and respect to grade 3 or 4 GI and bladder toxicities.