919P - Pros and cons of adding of neoadjuvant chemotherapy to standard concurrent chemoradiotherapy in cervical cancer: A regional cancer center experience

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Cervical Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Satya Narayan
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors S. Narayan1, A. Kapoor2, P.K. Bagri1, M.K. Singhal3, R. Sharma4, R.K. Nirban1, D. Singh1, S. Maharia1, G. Singh1, P. Kumari1, K. Harsh1, N. Sharma1, S.L. Jakhar1, S. Beniwal5, H.S. Kumar1, A. Sharma1, M. Bardia1
  • 1Radiation Oncology, Acharya Tulsi Cancer Treatment & Research Institute, 334003 - Bikaner/IN
  • 2Radiation Oncology, Acharya Tulsi Cancer Treatment & Research Institut, 334001 - Bikaner/IN
  • 3Radiation Oncology, Acharya Tulsi Cancer Treatment & Research Institute, 334001 - Bikaner/IN
  • 4Health Professional, Acharya Tulsi Cancer Treatment & Research Institute, 334003 - Bikaner/IN
  • 5Medical Oncology, Acharya Tulsi Cancer Treatment & Research Institute, 334003 - Bikaner/IN

Abstract

Aim

According to GLOBOCAN 2012, cancer of the uterine cervix is the fourth most common cancer among women worldwide with more than one-fifth of all such cancer cases being diagnosed in India. The present study summarizes the results of treatment in the form of disease free survival (DFS) and overall survival (OS) in bulky stage I (IB2) and locally advanced (stages II-IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) in one arm and CCRT in the other arm.

Methods

713 cervical cancer patients were treated at our center from July 2007 to October 2008. The patients' data were analyzed retrospectively. Patients underwent cisplatin-fluoruracil (PF 28.6%), taxane-cisplatin-fluorouracil (TPF 21.5%), and only CCRT (49.9%). The majority of patients were in the age group 41-50 years, while stage wise, they were mainly stage IIIb (53.3%) and IIb (21.6%). DFS was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan-Meier method. All statistical calculations were done with SPSS Statistics version 20.0.

Results

For cancer of the cervix treated with NACT vs. CCRT, the DFS rate at 3 years was 58.3% vs. 41.8%( p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS compared with definitive CCRT, TPF [hazard ratio (HR) =0.248, 95% confidence interval (CI): 0.123-0.500; p < 0.001], PF (HR = 0.445, 95% CI:0.266-0.722; p = 0.002). Median OS was 48.6 months in CCRT while in NACT, it was 52.9 months. Thus, the OS was superior by 8.8% in the NACT arm. The grade 3/4 hematologic toxicities were more in NACT groups than CCRT (p < 0.001); the TPF group experienced more toxicity than PF (p = 0.029).

Conclusions

TPF/PF as NACT is feasible and produces impressive responses in cancer of the cervix. The study suggests that the TPF regimen is better than PF. TPF can be used as optional neoadjuvant chemotherapy, but the hematological toxicity is more in the taxane-based regimen.

Disclosure

All authors have declared no conflicts of interest.