Neoadjuvant Chemotherapy Reduces Adjuvant Radiation Therapy in Patients with Locally Advanced Cervical Cancer

Background: To investigated whether carboplatin-paclitaxel neoadjuvant chemotherapy (NACT) benefits patients with locally advanced cervical cancer (LACC) through avoiding or delaying postoperative radiation. Methods: Patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB2-IIA2 who received carboplatin-paclitaxel chemotherapy followed by radical surgery (NACT group) or received primary radical surgery (PRS group) between 2007 and 2017 at our hospital were included. Their clinicopathological characteristics, treatments and follow-up data were retrospectively collected and analyzed. The clinical outcomes, including adjuvant radiation, progression-free survival (PFS), and overall survival (OS), were compared between the groups. Results: There were 197 and 217 patients included in the NACT group and PRS group, respectively. The baseline characteristics were significantly different between the groups, with more patients with more advanced tumor stages and larger tumor sizes in the NACT group. Postoperative pathology examination revealed lower incidences of deep stromal invasion in the NACT group than in the PRS group. More importantly, the cumulative postoperative radiation rate was significantly lower in the NACT group ( P = 0.041), while the differences in 5-year OS and PFS were not statistically significant between the groups. Conclusions: NACT reduces the pathological risk factors and adjuvant radiation without compromising survival in patients with LACC, which may protect younger patients from radiation-related side effects and subsequently improve the quality of life.