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Neoadjuvant Chemotherapy Followed by Chemoradiation in Cervical Carcinoma: A Review
Carla Rameri Alexandre Silva de Azevedo1, Luiz Claudio Santos Thuler, Maria Julia Goncalves de Mello
1*Instituto de Medicina Integral Prof. Fernando Figueria (IMIP), Recife, Brazil; †Clinica Multihemo/Oncoclinicas do Brasil, Recife, Brazil; ‡Universidade Federal do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; §Faculdade Pernambucana de Saude, Recife, Brazil; ¶Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; #D'or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
Objective:
Cervical cancer is a public health problem. A large proportion of patients have locally advanced (LA) disease at presentation and for this group, neoadjuvant chemotherapy (NACT) has an undefined role in the era of chemoradiotherapy. In countries with restricted access to radiotherapy, NACT may precipitate patients' access to an effective treatment approach. We carried out a systematic review to evaluate available data about NACT followed by chemoradiation.
Methods:
Studies evaluated the use of NACT followed by chemoradiotherapy. Search strategy was performed in MEDLINE, LILACS, and Cochrane Library from 2003 to 2013. Conference proceedings of American Society of Clinical Oncology annual meeting, International Journal of Gynecological Cancer Society biennial meeting, and European Society of Gynecological Oncology biennial meeting were also reviewed. Key words used were "cervical uterine cancer," "cervical uterine neoplasm," "neoadjuvant therapy," "neoadjuvant treatment," and "locally advanced." Data collected included author information, year of publication, study design, number of participants, eligibility criteria, treatment, response rate (RR), disease-free survival, overall survival, and toxicities.
Results:
Initial searches retrieved 7670 references. There were 7 eligible trials. Only 2 studies were published and a total of 323 participants were recruited. Patients with LA disease were eligible in most of them. Neoadjuvant chemotherapy consisted of paclitaxel combined with a platinum compound. Compliance was more than 90% in published trials. Response rate to NACT ranged from 67.8% to 70%. Major toxicity was hematological. Survival was evaluated in different points in time. Overall survival was up to 93% in 2 years, and in a poor prognostic group, 81% of patients were alive after 22 months. However, we must interpret these results with caution because of data limitation.
Conclusions:
Our result raises the possibility of NACT as an alternative upfront treatment for these patients with a small risk of disease progression. In countries where radiotherapy network is limited, randomized clinical trials should clarify its role.
