Top Line: Are neoadjuvant chemotherapy and surgery better than chemoradiation for IB2, IIA2, and IIB cervical cancer?
The Study: Concurrent chemoradiation and adjuvant brachytherapy is considered the standard treatment for bulky cervical cancer. However, surgery is also an option in this population with adjuvant therapy guided by pathologic findings. We’ve previously seen a trial from Tata Memorial that compared CRT with neoadjuvant chemo and surgery in patients with IB2-IIB disease. That trial found that 5-year DFS was significantly higher with CRT (77% v 69%). EORTC 55994 was a large randomzied trial that also compared CRT with nCT and surgery. It included 626 patients with FIGO (2014) IB2, IIA2, or IIB cervical cancer. This basically represents larger tumors (>4cm) that are still potentially resectable. They were randomized to CRT (cisplatin + 50 Gy pelvic RT followed by brachytherapy) or neoadjuvant cisplatin-based chemo followed by surgery. Adjuvant chemoradiation was recommended for positive nodes, positive margins, or parametrial invasion. The trial was designed to show the superiority of nCT + surgery. While 94% of CRT patients complete radiation, only 76% of patients in the surgery arm actually made it to surgery. Furthermore, 48% of surgery patients required adjuvant chemoradiation. At 5 years, nCT + surgery did not significantly improve OS (72% v 76%). The rate of PFS at 5 years was significantly lower in the surgery arm (57% v 66%). Subset analyses found that OS and PFS trended better in multiple groups with CRT compared to surgery. Patients in the nCT + surgery arm had significantly higher acute grade 3-4 toxicity (41% v 23%) while late toxicity was higher with CRT (21% v 15%).
TBL: EORTC 55994 found that neoadjuvant chemotherapy followed by surgery (followed by chemoradiation in half of patients) for IB2-IIB cervical cancer does not improve survival and may have inferior progression free survival compared to standard chemoradiation. | Kenter, J Clin Oncol 2023
The Study: Concurrent chemoradiation and adjuvant brachytherapy is considered the standard treatment for bulky cervical cancer. However, surgery is also an option in this population with adjuvant therapy guided by pathologic findings. We’ve previously seen a trial from Tata Memorial that compared CRT with neoadjuvant chemo and surgery in patients with IB2-IIB disease. That trial found that 5-year DFS was significantly higher with CRT (77% v 69%). EORTC 55994 was a large randomzied trial that also compared CRT with nCT and surgery. It included 626 patients with FIGO (2014) IB2, IIA2, or IIB cervical cancer. This basically represents larger tumors (>4cm) that are still potentially resectable. They were randomized to CRT (cisplatin + 50 Gy pelvic RT followed by brachytherapy) or neoadjuvant cisplatin-based chemo followed by surgery. Adjuvant chemoradiation was recommended for positive nodes, positive margins, or parametrial invasion. The trial was designed to show the superiority of nCT + surgery. While 94% of CRT patients complete radiation, only 76% of patients in the surgery arm actually made it to surgery. Furthermore, 48% of surgery patients required adjuvant chemoradiation. At 5 years, nCT + surgery did not significantly improve OS (72% v 76%). The rate of PFS at 5 years was significantly lower in the surgery arm (57% v 66%). Subset analyses found that OS and PFS trended better in multiple groups with CRT compared to surgery. Patients in the nCT + surgery arm had significantly higher acute grade 3-4 toxicity (41% v 23%) while late toxicity was higher with CRT (21% v 15%).
TBL: EORTC 55994 found that neoadjuvant chemotherapy followed by surgery (followed by chemoradiation in half of patients) for IB2-IIB cervical cancer does not improve survival and may have inferior progression free survival compared to standard chemoradiation. | Kenter, J Clin Oncol 2023