Introduction: Cervical cancer remains a significant public health problem affecting middle-aged women, particularly in less resourced countries. Three-dimensional conformal radiotherapy (3DCRT) is still a commonly used radiotherapy technique in countries with fewer resources. This study was conducted to compare the long-term efficacy and safety of neoadjuvant chemotherapy before radical surgery (NCRS) and concurrent chemoradiotherapy (CCRT) for FIGO 2018 stage IB3/IIA2 cervical squamous cell carcinoma in a resource-limited setting where only a 3DCRT radiotherapy technique was accessible.
Methods: This retrospective study encompassed a cohort of 300 patients diagnosed with FIGO 2018 stage IB3/IIA2 cervical squamous carcinoma, who received treatment at Tianjin Central Hospital of Gynecology Obstetrics (Tianjin, China) from January 2011 to December 2016. The primary data utilized in this study can be accessed online without any restrictions. The clinical outcomes and incidence rates of adverse effects in 137 patients with stage IB3/IIA2 cervical squamous cell carcinoma who underwent neoadjuvant chemotherapy followed by radical surgery (NCRS) with those of 163 patients who underwent concurrent chemoradiotherapy (CCRT) were compared. None of these patients had received adjuvant chemotherapy or adjuvant radiotherapy after surgery or CCRT. Propensity score matching analysis was used to match the two groups, considering factors such as age, anemia, tumor diameter, degree of pathological differentiation, and clinical stage, to enable further statistical comparisons. Survival analysis was conducted using Kaplan—Meier curves, log-rank tests, and Cox proportional hazards regression analyses. Additionally, chi-squared tests were employed to compare the incidence rates of recurrence and adverse effects between the two groups.
Results: Propensity score matching identified 103 matched pairs of patients. The NCRS and CCRT groups displayed 5-year overall survival (OS) rates of 85.4% and 91.2%, respectively, with no statistically significant difference (p = 0.19). Additionally, the NCRS and CCRT groups exhibited 5-year disease-free survival (DFS) rates of 76.7% and 89.3% (p = 0.02), and the recurrence rates were 20.4% and 9.7% (P = 0.03), respectively. Notably, the CCRT group exhibited a higher incidence of early adverse events (including myelosuppression, gastrointestinal, and urinary complications) compared to the NCRS group. This difference was observed in both any-grade adverse events (79.6% vs 35.9%, p < 0.001) and grade-3 adverse events (15.5% vs 0.03%, p = 0.005). There was no statistically significant disparity observed between the two groups in relation to late adverse events. In the multivariate analysis of clinicopathologic characteristics for OS, stage IIA2 (HR 8.51; p = 0.037) emerged as an independent risk factor, while histologic grade 2–3 (HR 4.88; p = 0.03) and anemia (HR 2.76; p = 0.025) were identified as independent risk factors for DFS.
Conclusion: Although the incidence of early side effects was increased in patients treated with CCRT, patients had significantly higher DFS rates and lower recurrence rates compared to those treated with NCRS. In patients with FIGO 2018 stage IB3/IIA2 squamous cervical cancer, CCRT seems to be a better option compared to NCRS in a resource-limited setting where only a 3DCRT radiotherapy technique was available.
