Neoadjuvant chemotherapy in cervical cancer: a narrative review

Cervical cancer continues to be a major global health challenge, particularly in resource-limited settings. Neoadjuvant chemotherapy has been proposed as a strategy to improve oncologic and reproductive outcomes in selected patients, offering an alternative or complement to standard treatments. This narrative review summarizes current evidence on the use of neoadjuvant chemotherapy in cervical cancer, analyzing its rationale, potential benefits, and limitations across different clinical scenarios. Neoadjuvant chemotherapy may contribute to tumor size reduction, facilitate fewer radical interventions, and delay definitive treatment in special situations such as pregnancy, without compromising oncologic safety. In the context of locally advanced disease, recent high-quality evidence supports its role as an induction approach prior to chemoradiation, with significant survival benefits. However, when followed by surgery alone, neoadjuvant chemotherapy has not demonstrated superiority over standard concurrent chemoradiotherapy and is not routinely recommended. For patients desiring fertility preservation, neoadjuvant chemotherapy followed by conservative surgery may be feasible, although recurrence risk remains a relevant consideration. Overall, while neoadjuvant chemotherapy offers a personalized treatment pathway in carefully selected patients, its application should be guided by multidisciplinary evaluation. Further prospective studies are needed to establish its long-term efficacy and define its place in contemporary cervical cancer management.