Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Maternal and Child Health and Urological Sciences; Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy.
Int J Gynecol Cancer. 2024 Jan 5;34(1):47-57. doi: 10.1136/ijgc-2023-004928.
To evaluate the role of dose-dense neoadjuvant chemotherapy followed by radical hysterectomy in reducing adjuvant radiotherapy in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB1-IB2/IIA1 cervical cancer with disrupted stromal ring and as an alternative to concurrent chemoradiotherapy in FIGO 2018 stages IB3/IIA2.
This was a retrospective cohort study including patients with FIGO 2018 stage IB1-IIA2 cervical cancer undergoing dose-dense neoadjuvant chemotherapy at the European Institute of Oncology in Milan, Italy between July 2014 and December 2022. Weekly carboplatin (AUC2 or AUC2.7) plus paclitaxel (80 or 60 mg/m, respectively) was administered for six to nine cycles. Radiological response was assessed by Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 criteria. The optimal pathological response was defined as residual tumor ≤3 mm. Kaplan-Meier curves were used to estimate survival rates. A systematic literature review on dose-dense neoadjuvant chemotherapy before surgery for cervical cancer was also performed.
A total of 63 patients with a median age of 42.8 years (IQR 35.3-47.9) were included: 39.7% stage IB-IB2/IIA1 and 60.3% stage IB3/IIA2. The radiological response was as follows: 81% objective response rate (17.5% complete and 63.5% partial), 17.5% stable disease, and 1.6% progressive disease. The operability rate was 92.1%. The optimal pathological response rate was 27.6%. Adjuvant radiotherapy was administered in 25.8% of cases. The median follow-up for patients who underwent radical hysterectomy was 49.7 months (IQR 16.8-67.7). The 5-year progression-free survival and overall survival were 79% (95% CI 0.63 to 0.88) and 92% (95% CI 0.80 to 0.97), respectively. Fifteen studies including 697 patients met the eligibility criteria for the systematic review. The objective response rate, operability rate, and adjuvant radiotherapy rate across studies ranged between 52.6% and 100%, 64% and 100%, and 4% and 70.6%, respectively.
Dose-dense neoadjuvant chemotherapy before radical surgery could be a valid strategy to avoid radiotherapy in stage IB1-IIA2 cervical cancer, especially in young patients desiring to preserve overall quality of life. Prospective research is warranted to provide robust, high-quality evidence.
评估在国际妇产科联合会（FIGO）2018 年分期为 IB1-IB2/IIA1 宫颈癌中，使用密集剂量新辅助化疗（剂量递增的顺铂联合紫杉醇方案）继以根治性子宫切除术，以减少辅助放疗的作用，并作为 FIGO 2018 年 IB3/IIA2 期同步放化疗的替代方案。
这是一项回顾性队列研究，纳入了在意大利米兰欧洲肿瘤研究所接受密集剂量新辅助化疗的 FIGO 2018 年 IB1-IIA2 期宫颈癌患者。每 3 周接受一次卡铂（AUC2 或 AUC2.7）联合紫杉醇（80 或 60mg/m2）治疗，共 6-9 个周期。采用实体瘤反应评估标准（RECIST）v1.1 标准评估放射学反应。最佳病理反应定义为残留肿瘤≤3mm。使用 Kaplan-Meier 曲线估计生存率。还对宫颈癌术前密集剂量新辅助化疗的系统文献进行了综述。
共纳入 63 例患者，中位年龄为 42.8 岁（IQR 35.3-47.9）：39.7%为 IB-IB2/IIA1 期，60.3%为 IB3/IIA2 期。放射学反应如下：客观缓解率 81%（17.5%完全缓解，63.5%部分缓解），稳定疾病 17.5%，进展疾病 1.6%。手术可切除率为 92.1%。最佳病理缓解率为 27.6%。25.8%的患者接受了辅助放疗。接受根治性子宫切除术的患者中位随访时间为 49.7 个月（IQR 16.8-67.7）。5 年无进展生存率和总生存率分别为 79%（95%CI 0.63-0.88）和 92%（95%CI 0.80-0.97）。15 项研究共纳入 697 例符合条件的患者，纳入了系统评价。研究中的客观缓解率、手术可切除率和辅助放疗率分别在 52.6%-100%、64%-100%和 4%-70.6%之间。
在 IB1-IIA2 期宫颈癌中，在根治性手术前使用密集剂量新辅助化疗（剂量递增的顺铂联合紫杉醇方案）可能是一种避免放疗的有效策略，尤其是在希望保留整体生活质量的年轻患者中。需要前瞻性研究提供强有力的高质量证据。
