Étude comparative de la chimiothérapie néoadjuvante suivie de radiochimiothérapie concomitante versus radiochimiothérapie exclusive dans les cancers du col de l’utérus localement avancés au CHU de Treichville (Côte d’Ivoire)

Introduction: Cervical cancer remains a major public health problem in sub-Saharan Africa. In Côte d’Ivoire, limited access to radiotherapy has led to the use of “bridging” neoadjuvant chemotherapy (NACT) before concurrent chemoradiotherapy (CCRT) in patients diagnosed at a locally advanced stage. This study compared NACT followed by CCRT with CCRT alone in locally advanced cervical cancer. Methods: We conducted a retrospective analytical study in the Oncology Department of Treichville University Hospital from January 2019 to December 2024, including patients with FIGO 2018 stage IB3–IVA cervical cancer treated with either NACT followed by CCRT or CCRT alone. Statistical analyses used the chi-square and Fisher’s exact tests, the Kaplan-Meier method, the log-rank test and Cox regression (significance threshold p < 0.05). Results: Seventy-six patients were included: 33 (43.4%) in the NACT + CCRT group and 43 (56.6%) in the CCRT-alone group. The median age was 54.1 years, and FIGO stages IIIC and IVA accounted for 50% of cases. Paclitaxel–carboplatin (AUC 5) was the most frequently used neoadjuvant regimen. The complete response rate was similar in both groups (69.7% versus 69.8%; p = 1.00). The median time to recurrence was 18 and 20 months, respectively (p = 0.125). Overall survival was significantly better in the CCRT-alone group in univariate analysis (p < 0.01), but this difference was no longer significant after adjustment (aHR = 1.42; 95% CI: 0.81–2.49; p = 0.22). Advanced FIGO stage (IIIC–IVA) was the only independent predictor of mortality (aHR = 2.10; 95% CI: 1.05–4.20). The main toxicities of NACT were anaemia, neutropenia and peripheral neuropathy. Conclusion: In our setting, NACT before CCRT did not improve overall survival compared with CCRT alone. It may nevertheless be a bridging option for patients with very advanced disease when access to radiotherapy is delayed.