Neoadjuvant Chemotherapy plus Radical Surgery in Locally Advanced Cervical Cancer: Retrospective Single-Center Study

SIMPLE SUMMARY: NACT has been used in the setting of trials and obtained satisfactory results in LACC but, according to the 2018 ESGO guidelines, neoadjuvant chemotherapy followed by radical surgery is a controversial alternative. Several pretreatment variables have been found to correlate with the clinical outcome of patients treated with NACT plus radical hysterectomy, such as FIGO stage, tumor size, and lymph node status. Further studies are needed on NACT that analyze the role in the different risk subclasses of patients. The aim of the present study was to analyze pathological responses in patients with locally advanced cervical cancer (LACC) who underwent neoadjuvant platinum-based chemotherapy (NACT) followed by radical hysterectomy. Neoadjuvant chemotherapy followed by radical surgery cannot be considered a standard of care in patients with locally advanced cervical cancer, particularly in the subgroup with pre-NACT imaging suspected for LND metastases. ABSTRACT: Background: Several pretreatment variables have been found to correlate with the clinical outcome of patients treated with NACT plus radical hysterectomy, such as FIGO stage, tumor size, and lymph node status. Methods: A single-center retrospective observational study to evaluate the use of NACT in LACC, particularly in the lymph-node-positive subpopulation. The study, conducted at the Maternal and Child Department of “Cannizzaro Hospital” in Catania, included patients treated between 2009 and 2019. Multivariate analysis was performed to analyze responses to NACT according to clinicopathologic parameters. Kaplan–Meyer disease-free survival (DFS) and overall survival (OS) curves were generated according to different lymph node status subgroups. Results: A total of 151 consecutive patients were enrolled in the study. Significant independent risk factors for response to NACT were preoperative tumor diameter, parametrium involvement, and lymphoma vascular space invasion (LVSI). T initial diameter at NMR was found to be the independent prognostic predictor for general (p = 0.024) and lymph node (LND) response (p = 0.028). Tumors between 2 and 6 cm have a better response to NACT than tumors > 6 cm, and LVSI absence was an independent prognostic factor for LND response to NACT. Survival DFS and OS curves were significant for positive vs. negative pathologic LND. Conclusions: Neoadjuvant chemotherapy followed by surgery cannot be considered a standard of care in patients with locally advanced cervical cancer, particularly in the subgroup with pre-NACT imaging suspected for LND metastases.