Effectiveness of neoadjuvant chemotherapy followed by radical surgery in young patients with locally advanced cervical cancer

To investigate the efficacy and survival benefit of neoadjuvant chemotherapy (NACT) followed by type C radical surgery in patients with locally advanced cervical cancer (LACC) and moderate risk factors for recurrence. The clinical and pathological data of 338 cases with stage IB3 and IIA2 cervical carcinoma who received NACT followed by radical surgery from January 2008 to December 2018 were collected. In line with the clinical response, the patients were divided into a chemotherapy-effective group (n = 309) and a chemotherapy-ineffective group (n = 29), and the clinical and pathological characteristics of the two groups were compared. Survival was analyzed using the Kaplan-eier method. After NACT and surgical resection, 309 (91.4%, 309/338) patients experienced a clinical response. Fewer patients had a maximum tumor diameter ≥5 cm in the chemotherapy-effective group compared with the chemotherapy-ineffective (p = 0.021). The 5-year progression-free survival (PFS) and overall survival (OS) rates were higher in the chemotherapy-effective group (86.29% and 85.75%, respectively) than in the chemotherapy-ineffective group (77.64% and 75.56%, respectively; p < 0.001). Among patients with high-risk and moderate-risk factors, the 5-year PFS and OS rates were higher in the patients who received chemotherapy (95.90% and 94.81%) than in those who received CCRT (78.06% and 77.25%, respectively; p < 0.001). NACT followed by surgical resection may be an appropriate treatment strategy for young patients with LACC, allowing them to avoid radiochemotherapy and the resultant damage to ovarian and vaginal function. A future prospective study of this treatment strategy is warranted.

Locally advanced cervical cancer; Neoadjuvant chemotherapy; Young patients; Risk factors

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