Objective: To report the efficacy and toxicity of neoadjuvant
chemotherapy (NACT) before standard concurrent chemo radiation (CCRT) in locally
advanced carcinoma of cervix. Methods: Between January 2007 and
December 2016, 75 patients with locally advanced cervical cancer treated with
neoadjuvant chemotherapy comprising carboplatin area under curve (AUC) 5 and
Paclitaxel 175 mg/m followed by chemo radiotherapy 45–59 Gy in 25–28
fractions with concurrent cisplatin and high dose rate (HDR) brachytherapy at our
institution were analyzed. Clinical response rate, disease free survival, overall
survival and toxicity was evaluated and documented using European organization
for research and treatment of cancer (EORTC) criteria. Results: Baseline characteristics were median age at diagnosis 48 years; 86% squamous,
and 14% adenocarcinoma histology; The international Federation of Gynecology and
Obstetrics (FIGO) stage IB2–IIB (47%), III–IVA (53%). 64% had nodes involved
and 84% had primary more than 4 cm in diameter. Complete or partial response rate
was (95%) post-NACT and 92% (95% CI: 71–94) post-CRT. The median follow-up
was 39.1 months. Overall and progression-free survivals at 4 years were 77% and
80% respectively. Grade ¾ hematological toxicities were 7%
during NACT (11% hematological, 9% non-hematological) and 8% during CRT. The
most common non hematological toxicity was diarrhea in 10%. The delayed
toxicities at 24 months or later after CRT completion were rectal (11%), bladder
(3%), and vaginal (28%). Conclusion: Neoadjuvant chemotherapy
in locally advanced cervical cancer offers a favorable paradigm as reflected by
acceptable toxicity and is associated with a high response rate in locally
advanced cervical cancer. However, further randomized clinical trials are needed
to support this evidence.