Neoadyuvant chemotherapy followed by chemorradiation in locally-advanced squamous cervical cancer

Introduction Although there has not been a direct comparison between neoadjuvant chemotherapy followed by chemor-radiation with the standard treatment of concurrent chemor-radiation, neoadjuvant chemotherapy is active in squamous cervical cancer. Material and methods In this open label 1 arm phase two trial we accrued 19 patients from 2007 to 2011 diagnosed with squamous cervical cancer deemed to be unresectable and poor candidates to concurrent chemor-radiation. Patients had to be over 18 years of age, give informed consent, have a PS0-1 and adequate organ function. They received neoadjuvant chemotherapy with paclitaxel 80mg/m2 and cisplatin33mg/m2 days 1,7,15/28 for two cycles and then external radiation in 1.8 Gy/ fraction with concurrent cisplatin 40mg/m2/weekly followed by brachytherapy in 5-6 applications. After completion of neoadjuvant treatment and after concurrent chemor-radiation patients were evaluated by RECIST 1,1 criteria for tumor response with a CT scan and pelvic MNR and data of dose intensity and toxicity was accrued. Results Median age at diagnosis was 51 years (27 to 72 years); all the patients had PS1 due to local pain, asthenia or genital discharge. Neoadjuvant treatment was feasible in all patients with manageable toxicities; the dose intensity delivered was 97% of the preplanned dose. Only 2 episodes of grade III anemia were observed. In the first radiologic evaluation 4 patients had a complete response, 12 had partial response and 3 disease stabilization. Patients received external radiotherapy in fractions of 1.8 Gy achieving a dose of 66 GY in patients that could not receive brachytherapy. Mean EQD2C for those who did (68%) was 72 GY. Only 68% of the patients received the full preplanned concomitant dose due to toxicity, mainly grade III anemia and diarrhea. In the second radiological evaluation 9 patients had a complete response, 9 partial and only 1 stable disease. At a mean of 24 months of follow up only 5 patients (26%) thus far have developed recurrent disease, all of the recurrences were simultaneously local as well as systemic. Conclusion Our weekly cisplatin-paclitaxel regimen has been demonstrated to be feasible and effective in terms of dose delivery, tolerance and radiological responses without compromising definitive treatment with chemor-radiation. Disclosure All authors have declared no conflicts of interest.