title: Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience.
abstract: BACKGROUND
  The present study summarizes the results of treatment in the form of disease-free survival and overall survival in bulky stage IB2 and locally advanced (stages II-IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of NACT followed by CCRT in one arm and CCRT in the other arm.
  
  
  METHODS
  This retrospective study analyzed 713 cervical cancer patients who were treated at our center during 2007 and 2008; out of 713 patients, data of 612 patients have been compared. The patients' data were analyzed retrospectively. Patients had undergone PF 28.6 %, TPF 21.5 %, and only CCRT 49.9 %. Majority of patients were in the age group 41-50 years, while stage wise, mainly stage IIIb and IIb. Disease-free survival was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan-Meier method. All statistical calculations were done with SPSS Statistics version 20.0.
  
  
  RESULTS
  For cancer cervix NACT versus CCRT, the DFS rate was at 5 years (58.3 vs. 41.8 % p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS as compared to definitive CCRT, respectively, TPF (hazard ratio (HR) = 0.248, 95 % confidence interval (CI) 0.123-0.500; p < 0.001), PF (HR = 0.445, 95 % CI 0.266-0.722; p = 0.002). The results of univariate stage, age, and multivariate study show that stage hemoglobin level, interval between external-intracavitary radiation, and type of neoadjuvant chemotherapy were the factors affected survival cervical patients treated with radiation. The grade 3/4 hematologic toxicities were more in the NACT group than CCRT (p < 0.001) while the non-hematological toxicity was not significant; the TPF group experienced more toxicity than PF (p = 0.029). This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy. The grade 3/4 hematologic toxicities were more in NACT groups than CCRT (p < 0.001); the TPF group experienced more toxicity than PF (p = 0.029).
  
  
  CONCLUSIONS
  TPF/PF as NACT is feasible and produces impressive responses in cancer cervix.
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003 Rajasthan India ; PG Boys Hostel, PBM Hospital Campus, Bikaner, 334003 Rajasthan India.
authors.forename: Satya
authors.initials: S
authors.lastname: Narayan
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Neeti
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003 Rajasthan India.
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: PBM Hospital, Bikaner, Rajasthan India.
authors.forename: Rajani
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Sardar Patel Medical College, Bikaner, Rajasthan India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003 Rajasthan India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singhal
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003 Rajasthan India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Purohit
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Shankar Lal
authors.initials: SL
authors.lastname: Jakhar
authors.affiliation: Department of Medical Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Surendra
authors.initials: S
authors.lastname: Beniwal
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Harvindra Singh
authors.initials: HS
authors.lastname: Kumar
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
keywords: Cervical cancer; Disease-free survival; Hematological; Neoadjuvant chemotherapy