The Role Of Neoadjuvant Chemotherapy In Radical Radiotherapy For Cervical Cancer

Background and Purpose:Cervical cancer is a recognized public health problem in the world,which poses a serious threat to women’s health.Because the onset of the disease is concealed,most of the patients are in local advanced stage when they are found.According to the latest NCCN guidelines,pelvic external irradiation±concurrent platinum-containing chemotherapy+brachytherapy is the standard treatment for locally advanced cervical cancer(LACC),with significant therapeutic effect.However,the local focus of LACC is difficult to control,there are many high-risk factors for prognosis,and it is prone to distant metastasis,and the treatment effect is not satisfactory.It is urgent to further study how to improve the treatment effect of LACC patients.Neoadjuvant chemotherapy is considered to be effective in reducing tumor volume,improving periuterine invasion and controlling micrometastasis.Further research has found that neoadjuvant chemotherapy has the possibility of improving the efficacy of radiotherapy for cervical cancer patients.The reason is that the application of neoadjuvant chemotherapy makes the tumor more sensitive to radiotherapy and has higher radiation transmission efficiency,which makes it possible to improve the efficacy of neoadjuvant chemotherapy before radical radiotherapy for locally advanced cervical cancer patients.The European Society for Medical Oncology ESMO issued the 2017 clinical practice guide for cervical cancer,which recognized the application value of the treatment scheme of NACT+radical surgery in areas where radiotherapy resources are scarce.The treatment method of NACT+radical surgery can benefit the survival of some LACC patients;The latest cervical cancer treatment guidelines issued by the National Comprehensive Cancer Network(NCCN)in 2023 also described this situation,and more accurately mentioned that some patients with stage Ⅱ B were the main application of this treatment plan.However,neoadjuvant chemotherapy has not been included in the recommended treatment plan for patients with cervical squamous cell carcinoma or adenocarcinoma.The purpose of this study is to explore the status of neoadjuvant chemotherapy in radical radiotherapy for cervical cancer,and compare the short-term efficacy,long-term survival,and toxicity of patients receiving neoadjuvant chemotherapy with those without neoadjuvant chemotherapy after radical radiotherapy.Material and Method(s):According to statistics,from July 2017 to June 2022,she was first treated in the Sino-Japanese Friendship Hospital of Jilin University,and was diagnosed as a locally advanced cervical cancer patient.She received EBRT ±concurrent platinumcontaining chemotherapy+MRI-IGBT radical radiotherapy in the radiotherapy department.They were divided into neoadjuvant chemotherapy group(NACT)and non-neoadjuvant chemotherapy group(RT)according to whether they received neoadjuvant chemotherapy.Both patients in the NACT group and RT group received EBRT ± concurrent platinum-containing chemotherapy+MRI-IGBT radical radiotherapy,and ensured that the EQD2 of HR-CTV D90 in all patients reached85 Gy.After completing the treatment plan,patients in the NACT group and RT group were regularly followed up,collected relevant data,and compared the recent efficacy of the two groups of patients in the NACT group and RT group to achieve complete response(CR),partial response(PR),stable disease(SD)The number and constituent ratio of patients with progressive disease(PD);Calculate objective response rate(ORR);Long-term survival indicators such as overall survival(OS),progression-free survival(PFS),local control(LC),and distant metastasis-free survival(DMFS)were compared between the two groups.Observe,record and follow up the bone marrow suppression,skin reaction,mucosal reaction,digestive reaction,urinary reaction and other conditions of the patients from the first day after the start of radiotherapy to the90 th day after the end of radiotherapy,and grade them according to the RTOG acute radiation injury grading standard(RTOG),and grade the early toxic and side effects of radiotherapy in the two groups of patients;90 days after the completion of radiotherapy,the patients were followed up with late rectal reaction and late bladder reaction,and were graded according to the standard scheme for grading late radiation injury(RTOG/EORTC)to evaluate the side effects related to late radiotherapy in the two groups.Results:1.114 people were included in the study,including 36 in the NACT group and 78 in the RT group.The median total treatment time in NACT group was 117.50 days(92.25～149.25 days),and the median total treatment time in RT group was 63.00 days(58.75～72.00 days).2.Relevant indicators of patients’ short-term efficacy: there were 36 patients in the NACT group,19 patients(52.78%)had short-term efficacy CR,17 patients(47.22%)had PR,and the ORR in the NACT group was 100.00%;The total number of patients in RT group was 78,of which 32(41.03%)patients achieved CR,46(57.69%)patients achieved PR,and the ORR of RT group was 100.00%,p=0.241.There was no statistical difference between CR、PR、ORR of NACT group and RT group.3.Long-term survival related indicators of patients: the OS of NACT group and RT group at one year,two years and three years were 94.4% 、94.9%(p=0.095),86.1% 、88.5%(P=0.850),83.3% 、87.2%(P=0.727);The PFS of NACT group and RT group at one year,two years and three years were 91.7% 、87.2%(p=0.095),77.8% 、78.2%(p=0.850)and 75.0% 、86.9%(p=0.727),respectively;The one-year,two-year and three-year LC of NACT group and RT group were 94.4% 、 97.4%(p=0.482),94.4% 、97.4%(p=0.482)and 91.7% 、96.2%(p=0.396),respectively;The DMFS of NACT group and RT group in one year,two years and three years were94.4% 、97.4%(p=0.482),94.4% 、97.4%(p=0.482)and 91.7% 、96.2%(p=0.396),respectively;There was no statistical difference.4.Toxic and side effects related to early and late radiotherapy: There was no difference in the incidence of bone marrow suppression,skin reaction,mucosal reaction,digestive reaction and urinary reaction related to the toxic and side effects related to early radiotherapy between NACT group and RT group;There was no difference in the incidence of rectal side effects related to radiotherapy between NACT group and RT group;There were significant differences in the incidence and toxicity of bladder side effects associated with advanced radiotherapy between NACT group and RT group,19.44% vs 5.13%(p=0.017)and 63.08 vs 54.92(p=0.017),respectively.Concluson:1.Based on the prolonged total treatment time and worsening bladder side effects,it is not recommended to apply neoadjuvant chemotherapy in locally advanced cervical cancer.2.Pelvic external irradiatio ± synchronous platinum chemotherapy + bracherapy remains the standard treatment method for locally advanced cervical cancer.