Background: Cervical cancer is the second most common cancer in women. It is responsible for 530,000 new cancer patients annually (9% of all new cancers diagnosed in women). (1)
Concurrent chemoradiotherapy (CCRT) is considered the standard treatment for locally advanced cancer cervix. A systematic review and meta-analysis of data showed survival benefits, better local and distant control of CCRT when compared with radiotherapy alone. (3, 4, 5)
However, CCRT is associated with considerable early toxicities, particularly gastrointestinal and hematological ones. Further, many studies showed significant rates of late side effects. The study of Tan, Zahra, 2008, and Green et al, 2001, showed grade 3/4 late sequelae in the range of18.3% to 22%, and included urinary, and, or bowel complications. (5, 6)
Rationale of neoadjuvant chemotherapy:
Several studies showed that neoadjuvant chemotherapy is effective in reducing tumor size, expediting micrometastasis, improving operability and surgical downstaging. Further, giving chemotherapy alone then surgery is associated with less side effects than giving chemotherapy and radiotherapy at the same time. (7, 8)
Many systemic reviews and meta-analysis showed benefits of neoadjuvant chemotherapy in terms of survival and toxicities. A recent systemic review showed neoadjuvant chemotherapy was associated with 5 year mean PFS of 61.9%, and 5 year OS of 72.8%. These results were comparable with CCRT in terms of survival, and early toxicities. Further, neoadjuvant chemotherapy had better late tocixity profile.
Till now, no published studies compared between neoadjuvant chemotherapy and CCRT.
Aim of the proposed study:
To assess the survival benefit, toxicities including long term toxicities for neoadjuvant chemotherapy versus CCRT in locally advanced cancer cervix.
Primary end point was survival benefits, and toxicities including long term related ones.