NAC Followed by RH for the Treatment of LACC

Neoadjuvant Chemotherapy Followed by Radical Hysterectomy for the Treatment of Locally Advanced Cervical Cancer: A Prospective Cohort Study

This cohort study is to evaluate the role of neoadjuvant chemotherapy (NAC) in the treatment of locally advanced cervical cancer (LACC). Sixty patients with LACC (FIGO 2009 stage IB2 to IIB) will be enrolled. After informed consents, they would accept the imaging evaluation of pelvic magnetic resonance imaging (MRI) and positron emission tomography (PET). After excluding cases of distant metastasis, they will accept two cycles of NAC (paclitaxel 175 mg/m2 and cisplatin 70 mg/m2, on day 1, once for three weeks). Then a second MRI is performed to evaluate the imaging response. For patients achieving objective response, radical hysterectomy (RH, via laparoscopy or laparotomy) and an evaluation of pathologic response are performed. For patients without objective imaging response, the choice of concurrent chemoradiotherapy or radical hysterectomy will be discussed. After RH, adjuvant therapy will be given according to the RH pathologic results. The primary objectives consist of (1) the objective imaging response after NAC; (2) the objective pathologic response after RH. The secondary objectives consist of (1) disease-free survival and overall survival after various therapy modalities; (2) severe adverse effects of NAC; (3) the effects of NAC on the surgical outcomes.

Neoadjuvant Chemotherapy, Locally Advanced Cervical Cancer, Radical Hysterectomy, Objective Response, Laparoscopy, Laparotomy, Concurrent Chemoradiotherapy, Adjuvant Therapy, Systematic Chemotherapy

Patients in group B receive neoadjuvant chemotherapy but don't achieve imaging response, and they accept concurrent chemoradiotherapy

Patients in group B receive neoadjuvant chemotherapy but don't achieve imaging response, and they accept radical hysterectomy

Two cycles of neoadjuvant chemotherapy (paclitaxel 175 mg/m2 and cisplatin 70 mg/m2, on day 1, once for three weeks).

First imaging evaluation consists of pelvic magnetic resonance imaging (MRI) and positron emission tomography (PET)

The third cycles of neoadjuvant chemotherapy (paclitaxel 175 mg/m2 and cisplatin 70 mg/m2, on day 1, once for three weeks).

Inclusion Criteria: Confirmed primary adenocarcinoma, squamous cell carcinoma or adenosquamous carcinoma of the uterine cervix FIGO stage IB2 to IIB Type II or III radical hysterectomy or trachelectomy Performance status of Eastern Cooperative Oncology Group (ECOG) 0-1 Aged 18 years to 45 years Well cardiopulmonary, liver and kidney functions for neoadjuvant chemotherapy Signed an approved informed consents Exclusion Criteria: Not satisfying any of the inclusion criteria