Abstract
BACKGROUND: Since 1999, platinum based chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer patients, but the estimated increase in overall survival (OS) over a 5-year period was only 6% in patients treated with CRT versus radiotherapy alone.There have been no additional developments in the treatment of locally advanced cervical cancer(LACC) patients since CRT introduction and approximately 30-40% of those patients failed to achieve complete response to CRT. Therefore, alternative approaches are needed to improve the outcome for such patients. NACT with Weekly paclitaxel and carboplatin for 4 - 6 weeks as dose-dense chemotherapy prior to CRT could be one such potential approach. METHODS: A phase II, prospective , non randomized study was conducted at the Clinical Oncology Department of Ain Shams University hospital. 42 patients diagnosed with locally advanced cervical cancer patients (FIGO 2018 stage IIB to IVA ) and were treated by NACT carboplatin (AUC2) and paclitaxel (80 mg/m 2) for 4 - 6 week, then they proceeded to definitive CCRT (with a dose of 45-50.4 Gy) with weekly cisplatin followed by brachytherapy. Response rate and toxicity were the primary endpoints and Survival were the secondary endpoints. RESULTS: Median age at diagnosis - 48 years ; 90% (38/42 ) of cases diagnosed with squamous cell carcinoma and 9% (4/42) diagnosed with other histologies; 38% (16/42) had FIGO stage IIB , 40% (17/42) with stage IIIC, 7% (3/42) stage IIIB, 7% (3/42) with stage IVA, 5% (2 /42) with stage 2A and only 1 case diagnosed with stage 3A. 42 patients were evaluated.The overall response rate post-NACT was 71% and 61% developed complete response rate (CR) at end of all treatment course. Grade 3and 4 adverse events during NACT were most common, with hematological toxicity occurring in 21% of patients. There were no treatment- related deaths. The 9-month and 12-month overall survival rates were 94% and 84% , respectively. CONCLUSION: NACT with dose dense protocol, followed by CCRT, is a treatment option for locally advanced cervical cancer with controllable adverse events and agood response rate.