title: Is neo-adjuvant chemotherapy a better option for management of cervical cancer patients of rural India?
abstract: OBJECTIVE
  To explore alternate modality of treatment in patients of advanced cancer cervix by neo-adjuvant chemotherapy (NACT) followed by External Beam Radiotherapy (ERT) and Brachytherapy (BT). Short- (6 months) and long- (12 months) term follow-up data from these patients were compared with the retrospective data from an urban cancer centre, where standard protocol of concurrent chemo-radiotherapy is practiced.
  
  
  METHODS
  Two hundred patients of advanced cervical cancer, treated at our rural cancer centre between January 2007 and December 2007, were included in the study arm (Group A). These patients received three cycles of neo-adjuvant chemotherapy with Cisplatin, Bleomycin, and Vincristine before External-Beam Radiotherapy (EBT) followed by brachytherapy. Patients in the control arm (Group B) of an urban cancer centre, received EBT with weekly concomitant Cisplatin, followed by brachytherapy. Short- (6 months) and long- (12 months) term follow-up data from our patients were compared with the retrospective data from the urban cancer centre.
  
  
  RESULTS
  Complete response rate was comparatively higher among patients of Group A, also correspondingly proportion of patients showing progressive disease and stable disease was lower among them. Local treatment failure was 87.5% among patients from Group A and 94.4% in Group B patients. Concomitant chemoradiation (CRT) was associated with more GI toxicities.
  
  
  CONCLUSIONS
  Our result suggests NACT arm is as effective as CRT arm in respect of complete response with less pelvic failure and G.I toxicities. Further follow-up data are needed before arriving at a definite conclusion.
authors.affiliation: Department of Radiotherapy, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: G A
authors.initials: GA
authors.lastname: Dastidar
authors.forename: P
authors.initials: P
authors.lastname: Gupta
authors.forename: B
authors.initials: B
authors.lastname: Basu
authors.forename: A
authors.initials: A
authors.lastname: Basu
authors.forename: J K
authors.initials: JK
authors.lastname: Shah
authors.forename: S L
authors.initials: SL
authors.lastname: Seal
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D001918:Brachytherapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007194:India; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012424:Rural Population; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy
chemical_list: D001761:Bleomycin; D002945:Cisplatin