Neoadjuvant chemotherapy and radical surgery compared to radical surgery alone in bulky stage IB–IIA cervical cancer

Aim The aim of this study was evaluation of the efficacy of neoadjuvant chemotherapy (NACT) and radical hysterectomy on long-term survival in stage IB–IIA locally advanced cervical cancer as compared with radical surgery alone. Methods We reviewed all patients with cervical cancer stage IB–IIA who were treated with two treatment modalities, i.e. NACT followed by radical hysterectomy and lymphadenectomy, and radical hysterectomy alone between March 1996 and March 2004. There were 22 patients in the NACT group (group 1) and 160 patients in the immediate radical surgery group (group 2). All patients in group 1 were followed for more than 108 months, and long-term survival and factors affecting recurrence were evaluated. Results Nineteen patients in the NACT arm underwent radical surgery. Pelvic lymph node metastasis was found in 8 patients in this group and in 36 in the radical surgery group. Eighteen patients in the NACT group and 96 patients in the radical surgery group were scheduled for adjuvant postoperative chemoradiation. During the 9-year follow-up, recurrence rate was 47.1% and 30.2% in NACT and control groups, respectively. In the NACT group lymph node metastasis was a significant independent risk factor for recurrence. Overall survival in the NACT arm was not statistically significantly lower than the control arm (p = 0.06). Conclusion NACT did not improve long-term overall survival of bulky early-stage cervical cancer patients compared to primary radical surgery.