Concurrent Chemo-Radiotherapy Plus Adjuvant Hysterectomy Versus Neo-Adjuvant Chemotherapy Plus Radical Hysterectomy for Treatment of Bulky Early Stage Cancer Cervix in Sexually Active Women

Background: Radiotherapy has a definite role in treating bulky early stage cancer cervix. However the sexual problems as a consequence of pelvic irradiation require revision of this line of treatment and searching for a comparable alternative especially in sexually active women. Neo-adjuvant chemo¬therapy is expected to downsize and downstage the tumor thus rendering the definitive radical surgery easier and improving its outcome.Patients and Method: This study included forty three patients under the age of forty five years and sexually active with bulky cancer cervix, FIGO stages were IB 1, 1B2 and IIA. They were previously untreated and with good perfor¬mance status. The patients were allocated into two groups. Group I: (23 patients) received concurrent chemoradiation using weekly Cisplatin-Gemcitabine regimen at doses 40mg/ m2 and 125mg/m2 respectively for six weeks. Concurrent external beam irradiation to the whole pelvis was delivered up to a total dose 5040 cGy in 28 fractions (5 fractions per week, 180 cGy fraction) followed by completion hysterectomy three to four weeks later. Group II: (20 patients) for whom neo-adjuvant chemotherapy was administered for 6 cycles at 21 days intervals. Each cycle consisted of cisplatin intravenous infusion (100 mg/m2) on day 1 and 5-fluorouracil intravenous infusion (1,000 mg/m2/day) for 4 days from day 2. Three to four weeks after the last chemotherapy, patients underwent radical hysterectomy.Results: Pre-operative response rates evaluation revealed significantly better response rates following concurrent radio- chemotherapy (Group I) than chemotherapy alone (Group II) {CR 30% Vs 15%; PR 61% Vs 55% respectively}. Hematological toxicity rates were higher in group 11 than in group I, but with no statistically significant differences. Diarrhea, cystitis, proctitis and dyspareunea were noted in significantly higher number of patients in group I than in group 11. Higher rates of sexual problems were noted in Group I than in Group II. The differences were statistically significant regarding decreased libido (78.3% Vs 15.8%), dryness (60.9%, Vs 15.8%) and dyspareunea (47.8% Vs 10.5%). There were no significant statistical differences regarding rates of treatment failure (local and distant) as well as survival between both arms.Conclusions: Neo-adjuvant chemotherapy followed by definitive surgery is safe and well tolerated. Radiotherapy improved tumor response when added to chemotherapy. The lower response rates with chemotherapy alone may be suc-cessfully compensated by more radical surgery in young females with stages IB to IIA cancer cervix to avoid side effects of pelvic irradiation especially sexual problems with no negative effects regarding recurrence rates and short-term survival.