On the lack of demonstrated clinical benefit of neoadjuvant cisplatinum therapy for cervical cancer

Purpose: This study ascertains the benefit and detriment of cis-platinum-based regimes for advanced cervical cancer using standard response parameters as well as a methodology to separate potential effects of radiosensitization and effects of control of occult systemic metastases. Materials and Methods: In addition to conventional response criteria used to analyze three recently published randomized studies, the efficacy of neoadjuvant chemotherapy is measured with a statistical model to calculate potential improvement in survival offered by perfect local and distant control. Results: Neoadjuvant chemotherapy either did not affect or it impaired survival in the three trials. Evidence of altered failure patterns was obtained. In particular, local control was compromised by neoadjuvant chemotherapy. Conclusion: Failure patterns are altered by treatment as well as by standard prognostic factors. Neoadjuvant chemotherapy may decrease survival. Possible reasons include the limited efficacy of cis-platinum alone and in combination with other therapeutic agents, accelerated repopulation caused by neoadjuvant therapy, delay in initiation of radiotherapy by neoadjuvant chemotherapy, low statistical power of published studies, and tumor heterogeneity. Curative modalities such as surgery and radiotherapy must not be compromised by neoadjuvant chemotherapy.