Chemo-radiotherapy after neoadjuvant chemotherapy and radical hysterectomy in women with stage IB-IIB cervical cancer: Do we need to change the therapeutic approach? a cohort study

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Abstract Background: Chemo-radiotherapy is recommended as the standard treatment for advanced cervical cancer, and neoadjuvant chemotherapy (NACT) can be beneficial for patients on long radiotherapy waiting lists. In this study, we aimed to evaluate the need for chemo-radiotherapy after NACT and radical hysterectomy in women with stage IB-IIB cervical cancer. Methods: This study is a retrospective cohort study. All patients of gynecologic oncology clinic of Imam Khomeini Hospital, Tehran, Iran who were diagnosed with stage IB-IIB cervical cancer and were treated with NACT and radical hysterectomy between 2010 and 2020, were included in this study. The records of all patients who met the inclusion criteria were evaluated during the study period. The interested outcomes and progression-free survival (PFS) were assessed. Results: In this study, clinical files of 613 patients with cervical cancer were studied and among them, 63 patients (10.2% of patients) underwent NACT. Eighteen patients (33.3%) did not require another treatment modality after chemotherapy and radical hysterectomy, while 66.7% (36 cases) of patients needed chemo-radiotherapy after NACT and radical hysterectomy, and recurrence was observed in 11.6% (5 cases) of patients. The 1-, 5- and 10-year PFS rate was 97.6% (95% CI: 84.2-99.6), 89.5% (95% CI: 74.4-95.9) and 89.5% (95% CI: 74.4-95.9), respectively. Conclusions: It can be concluded that a significant percentage of patients who are candidates for NACT followed by radical hysterectomy, would require another modality of treatment, which is chemo-radiotherapy; therefore, it is recommended that by conducting prospective studies, in addition to investigating this issue, the choice of the first method of patients treatment in these stages should be reconsidered so that the patient does not suffer from two treatments and related complications, and patients undergo chemo-radiotherapy from the beginning.