The Role of Neo-Adjuvant Chemotherapy in Stage Iv-a Cervical Cancer: Its Impact on Tumour Response and Qol

Background and objectives: Concurrent chemoradiation is the standard of care in locally advanced carcinoma cervix, but stage IV-A patients are usually candidates for palliation due to extensive local disease and poor performance status. We designed this pilot study to evaluate the role of NACT in such patients and see if denitive chemoradiation is feasible in good responders to NACT. Secondary endpoint was QOL assessment. Methods: All the patients received 3 cycles of NACT (Inj Paclitaxel175mg/m2+CDDP 75mg/m2) x 3 weekly, followed by response assessment. Patients with at least PR were given denitive chemoradiation followed by brachytherapy. Response assessment and QOL were documented 3 months post treatment. After NACT 13.3% had CR and 66.7% had PR ≥50% (p value-0.001) and 3 months p Result: ost treatment 69.2% had CR and 30% had PR≥50% (p value-<0.001) which is suggestive of good response that is statistically signicant. The most common toxicity encountered during NACT was neutropenia (53.2%) followed by nausea/vomiting (46%) and in patients receiving chemo-radiation commonly reported toxicity was diarrhoea (38.4%) followed by hyponatremia (30.7%). Quality of life assessment done using EOTC QLQ30 shows that there is signicant improvement in physical activity (p value-0.001), emotional quotient (p value-0.008) and social interaction (p value-0.036). EORTC QLQCX24 particularly for assessment of symptoms pertaining to cervical cancer shows signicant improvement in pedal edema, bleeding pv, discharge pv, menopausal symptoms and body image (p value-0.0043). Our study shows that stage IV-A Conclusion: cervical cancer patients with relatively good performance status can be given denitive treatment and thereby chance of cure, if the initial response to tumour debulking by NACT is good. NACT with taxane/platinum combination seems an effective option for cytoreduction with good compliance. Majority of these patients have complete response and good QOL post treatment.