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Original Research

Open Access

Neoadjuvant chemotherapy with paclitaxel and carboplatin followed by definitive chemoradiation in locally advanced cervical carcinoma. Experience of a cancer hospital in Pakistan

  • Tabinda Sadaf1,*,
  • Samreen Javed1
  • Asma Rashid1
  • Muhammad Atif Mansha1
  • Samaha Nawaz1
  • Aqueel Shahid1
  • Raheel Mukhtar1

1Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 54000 Lahore, Pakistan

DOI: 10.31083/j.ejgo4206179 Vol.42,Issue 6,December 2021 pp.1236-1241

Submitted: 09 July 2021 Accepted: 04 August 2021

Published: 15 December 2021

*Corresponding Author(s): Tabinda Sadaf E-mail: tabindas@skm.org.pk

Abstract

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/m22 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.

Keywords

Neoadjuvant chemotherapy (NACT); Locally advanced cervical cancer; Radiotherapy

Cite and Share

Tabinda Sadaf,Samreen Javed,Asma Rashid,Muhammad Atif Mansha,Samaha Nawaz,Aqueel Shahid,Raheel Mukhtar. Neoadjuvant chemotherapy with paclitaxel and carboplatin followed by definitive chemoradiation in locally advanced cervical carcinoma. Experience of a cancer hospital in Pakistan. European Journal of Gynaecological Oncology. 2021. 42(6);1236-1241.

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