Comparison of Neoadjuvant Chemotherapy Plus Concurrent Chemoradiotherapy vs. Concurrent Chemoradiotherapy Alone in Locally Advanced Cervical Cancer Under 2018FIGO Staging Correction

Abstract

<h3>Purpose/Objective(s)</h3> According to NCCN guidelines, concurrent chemoradiation (CCRT) is the standard care for locally advanced cervical cancer (LACC) patients, but the benefit of neoadjuvant chemotherapy (NACT) before CCRT for LACC patients is still controversial, especially based on 2018FIGO staging,This study is designed to answer the question by comparing the efficacy and toxicities of neoadjuvant chemotherapy with concurrent chemoradiation (NACT+CCRT) versus concurrent chemoradiation (CCRT) alone in LACC under 2018FIGO staging correction. <h3>Materials/Methods</h3> Patients with stage IB2, IIA2, IIB-IVA (2009 FIGO staging) cervical cancer were retrospectively reviewed from January 2013 to January 2017 in China. All patients were re-staged after 2018FIGO staging correction. All patients were treated with IMRT to 50.4 Gy with concurrent weekly cisplatin 40 mg/m² followed by intra-cavitary brachytherapy. The primary endpoint was progression free survival (PFS), and the secondary endpoints included overall survival (OS), tumor response by RECIST 1.1 criteria, and toxicities. Survivals were calculated with Kaplan-Meier method. The differences between survivals were calculated with Log-rank test. Toxicities were analyzed using the χ2 test. All statistical tests were two-sided. <h3>Results</h3> A total of 432 patients were identified and 406 were eligible for analysis. The 2009FIGO staging of IB2 in 81, stage IA2 and IIB in 119, stage III in 119, stage IV in 87 were corrected into 2018FIGO staging which IB3 in 58, stage IIA2 and IIB in 75, stage III in 186, and stage IV in 87. No patients were down-staged. 201 patients were treated with NACT+CCRT and 205 with CCRT. With a median follow-up of 58.6 months, 5-year PFS was 60.3% in the NACT+CCRT arm, and was 57.6% in the CCRT arm. There was no significant difference in 5-year PFS between two arms (p=0.287). 5-year OS was 68.8% and 65.0% in the NACT+CCRT arm and CCRT+ACT arm, respectively. There was no statistical difference in 5-year OS between two arms (p=0.301). Multivariate analysis showed that pathological type, FIGO stage and pelvic nodes status were associated with OS and PFS. The CR and PR in NACT group was similar to the CCRT group (196/201 versus 193/205, p=0.090). There were higher acute systemic side effects in the NACT+CCRT arm. The result of subgroup analysis showed that PFS in stage III in NACT+CCRT group was significantly higher than that in CCRT group (57.6% vs 45.4%, P=0.048), but OS had no significant difference (71.9% vs 56.3%, P=0.053). In stage III, the curative effect of IIIC1 was better than that of IIIA-B and IIIC2, with 5-year OS of 81.9%, 61.7% and 37.5% (P=0.004), and 5-year PFS of 62.6%, 48.8% and 38.4% (P=0.031), respectively. <h3>Conclusion</h3> For LACC patients with 2018 FIGO correction stage, neoadjuvant chemotherapy plus concurrent cisplatin chemoradiation did not improves RR, PFS and OS. There were more toxicities for the neoadjuvant chemotherapy group. Further research and longer follow up is needed, especially for the staging IIIC1 LACC patients.