353 Dose-dense NACT followed by CCRT in locally advanced cervical cancer: feasibility and safety

Introduction/Background* First-line treatment for locally advanced cervical cancer (LACC) is concurrent platinum chemoradiation therapy (CCRT) followed by cervico-vaginal brachytherapy (BT). Neoadjuvant chemotherapy (NACT) followed by CCRT+BT has been proposed as an alternative scheme, but its feasibility is still investigational. The aim of this study was to evaluate safety and efficacy of this treatment. Methodology In our Institution 30 patients with LACC have been treated between 2016-19. They received 6 cycles of weekly NACT with Carboplatin AUC 2 and Paclitaxel 80mg/mq, followed by CCRT (pelvic EBRT (45Gy) weekly Cisplatin 40mg/mq followed by cervico-vaginal BT-HDR (10Gy). Primary endpoints were 3-year overall survival (OS) and progression-free survival (PFS) while secondary endpoints were safety and toxicity. Result(s)* The most frequent histological type was squamous cell carcinoma (80%) and G3-grading (66,7%). 9/30 patients had FIGO III stage. Radiological complete response (CR) after NACT was 3,3% while partial response (PR) was 86,6%; only 1 patient had progressive disease (PD). 21 patients (70%) received more than 4 cycles of concurrent Cisplatin during EBRT, while 8 received less than 4 cycles. After a median follow-up of 36.7 months 3-year OS and PFS values were 71.8% and 65.2%, respectively. Patients with higher values of haemoglobin pre-CCRT (i.e.>10 g/dl) reported a superior 3-year OS value (i.e. 70%, n=25) vs 50% for patients with Local and lymph-node recurrence occurred in 30% and 23% of patients while distant-metastasis in 10% of patients. Only 1 patient experienced G3 anaemia after NACT while 3 cases of G3 haematological toxicity after CCRT+BT-HDR were observed. One patient had G3 neurotoxicity after NACT and 3 patients experienced G3 nausea and diarrhoea after CCRT+BT-HDR. Conclusion* In our study NACT followed by CCRT+BT resulted to be a feasible treatment. Our data are consistent with the published literature in term of feasibility and safety and the NACT could by synergic with CCRT in the treatment of LACC.