Comparison of Compliance and Response for Neoadjuvant Chemotherapy Followed by Concurrent Chemo Radiation Versus Chemo Radiation Alone in Carcinoma Cervix Figo Stage Iva- A Single Institution Experience.

Abstract

Aims/Objectives: Cervical cancer is the second most cancer in women in India. Patients presenting with stage IVa have 5 year survival rates of only 16% and are not able to complete the full course of radiation due to advance disease. The aim of this retrospective study is to study the compliance of the stage IVa patients to neoadjuvant chemotherapy (NACT) followed by concurrent chemo radiotherapy and their completion of radical dose of radiation and subjective response in comparison to patients without NACT. Materials and Methods: We retrospectively studied stage IVa cervical cancer patient's case sheets from January 2019 to June 2020. The patients are divided in to 2 arms: Arm-A : 11 patients - who received NACT with Paclitaxel 175mg/m2 and carboplatin AUC 6 every 3 weeks of 4 cycles followed by external beam radiotherapy(EBRT) of 50 Gy/25 fractions with weekly cisplatin of 40 mg/m2, followed by brachytherapy of 700cGy of 3 fractions. Arm-B: 9 patients-who received external beam radiotherapy (EBRT) of 50 Gy/25 fractions with weekly cisplatin of 40 mg/m2, followed by brachytherapy of 700cGy of 3 fractions. The compliance to complete radical dose of radiotherapy with concurrent chemotherapy and response in patients with and without NACT were compared Results: Arm A: 10 patients (91%) completed radical dose of RT and weekly cisplatin, one patient (9%) defaulted for EBRT, all patients tolerated 4 cycles of NACT. During 3 months follow up 1 patient (9%) developed liver secondaries and 1 patient (9%) developed other complication (jejunal obstruction) 2 patients suffered dysuria(18%) and 7 (64%) patients asymptomatic. Arm B: 4 patients (44.5%) completed radical dose of RT and 5 patients (55.5%) defaulted radiation [one for EBRT and 4 for HDR] During 3 months follow up one patient (11%) developed liver secondaries and 1(11%) developed uraemia and died (both these patients completed radical dose), 2 (22.2%) patients with dysuria,2 (22.2%) patients with bleeding p/v and 3(33.3%) patients are asymptomatic. Patients who defaulted for radical dose of concurrent RT were more in arm -B (55%) when compared to arm- A(9%) More patients are asymptomatic in arm-A(64%) than arm-B(33%). Conclusions: Response and compliance to treatment was better in the patients who received NACT followed by concurrent chemo radiation and are able complete treatment and majority of them are asymptomatic. From this it may be concluded that NACT may be considered in stage IVa cervical cancer. However a prospective trial with large number of patients is needed to come to a conclusion.