Neoadjuvant Chemotherapy Followed By Radical Surgery Versus Chemotherapy Followed By Chemoradiotherapy In Patients With Stage ⅡA-ⅢA Cervical Carcinoma

Purpose: The optimal therapy strategy for locally advanced cervical cancer is uncertain,and whether neoadjuvant chemotherapy(NACT)followed by radical surgery(RS)could replace the standard concurrent chemoradiation(CCRT)is controversial.Therefore,we retrospectively evaluated clinical outcomes and adverse effects of patients treated in two ways and tried to provide some basis for clinical decision making.Methods: Patients diagnosed with stage IIA-IIIA cervical carcinoma according to International Federation of Gynecology and Obstetrics criteria(FIGO)in our institution from January 2013 to June 2018 were enrolled in this study.Patients were treated with NACT+RS or NACT+ CRT.Patients in NACT+RS group received one to four cycles of chemotherapy before radical hysterectomy.Pelvic lymphadenectomy was executed if necessary.In CRT group,external beam radiotherapy plus intracavitary brachytherapy was given to patients as standards.The primary end points were overall survival(OS)and disease-free survival(DFS).The secondary end points were short-term and long-term adverse effects.The Kaplan Meier method and COX regression to evaluate FIGO stage,Tumour size,lymph node status,KPS score,Hemoglobin level influencing DFS and OS in multivariable and univariate analyses.Results: In total,277 patients who underwent NACT+RS and 272 patients who received NACT+CRT were enrolled.The rate of post-operative adjuvant radiotherapy in the surgery group was 68.2%.OS rates of 1 year were 99.1% v.97.5%(P=0.208)in NACT+RS group and NACT+ CRT group,and 3 years OS rates were 93.3% v 86.1%(P=0.057).Meanwhile,DFS rates of 1 year were 95.6% v 92.5%(P=0.161),while3-years DFS rates were 84.7% v 80.1%(P=0.322)for two groups separately.Referring to short-term adverse events,NACT+RS Group had a lower rate of rectal(P <0.05)toxicity.In terms of long-term adverse events,there was no statistical significant difference between two groups no matter for bladder or vaginal complications.35 patients in the NACT+RS group got urinary disturbances and 27 patients got edema of the affected lower limbs.Univariate analyses revealed that KPS scores and FIGO stage were significant factors contributing to OS(P<0.05),FIGO stage was the negative independent prognostic factor of DFS(P<0.05).Multifactorial analysis did not show significant factors affecting survival outcomes.Conclusion: For patients with stage IIA-IIIA cervical cancer,NACT+RS did not show an improvement on survival outcomes or long-term adverse events compared with NACT+CRT.It needs more randomized trials to investigate its role in locally advanced cervical cancer.