Comparison of Neoadjuvant Chemotherapy Followed by Radical Surgery with Chemoradiation in Stage IB2 to IIB of Cervical Cancer

Background: The management of locally advanced cervical cancer (stages IB2 to IIB) remains controversial, particularly in regions with limited radiotherapy (RT) resources. While chemoradiation therapy (CRT) is the standard treatment in many Western countries, neoadjuvant chemotherapy followed by radical surgery (NACT-RS) has emerged as an alternative approach. Objectives: The comparative effectiveness and safety of NACT-RS versus CRT in terms of side effects and recurrence rates remain unclear, necessitating further investigation. Methods: A cohort study was conducted from 2020 to 2023, involving 68 patients with cervical carcinoma (stages IB2 to IIB). The patients were stratified into two treatment groups: Neoadjuvant chemotherapy followed by radical surgery (N = 17) and CRT (N = 51). The study compared pathology reports, short-term treatment complications, and one-year recurrence rates between the two groups. Results: Minor complications occurred in 41.2% of the NACT-RS group and 39.2% of the CRT group (P = 0.886), while major complications were observed in 23.5% and 25.5% of the groups, respectively (P = 0.872). All NACT-RS patients responded to chemotherapy with significant tumor size reduction (47.7 ± 8.0 vs. 11.2 ± 8.6, P < 0.001) and resolution of vaginal involvement. During the one-year follow-up, no recurrences were observed in the NACT-RS group, compared to eight out of 51 (16.7%) in the CRT group (P = 0.186). Conclusions: The similar short-term complication rates and potentially lower one-year recurrence rate in the NACT-RS group suggest that this approach may be a viable alternative to CRT, particularly for young patients with bulky tumors and in areas with limited RT facilities.