Surgery, radiotherapy or sometimes both were the best treatments for locally advanced cervical cancer. This is cancer that has spread beyond the cervix (neck of the womb) into the surrounding tissues, such as the vagina, sides of the pelvis or nearby lymph nodes. The exact choice of treatment would have depended on the size and location of the tumour and the preferences of the woman and her doctor.
Nowadays, women with this type of cancer may be given combined chemotherapy (drug treatment) and radiotherapy (x-rays that kill cancer cells) at the same time. Or, they may have surgery (to remove the womb) as well as this combined chemotherapy and radiotherapy. However, giving chemotherapy before these treatments (neoadjuvant chemotherapy) might have a similar benefit, but have less side effects than giving the treatments at the same time.
This review aimed to assess the benefits and risks of giving chemotherapy before surgery, before radiotherapy or before both treatments.
Our first comparison was based on 18 trials and 2074 women. The women who were given chemotherapy either more than a fortnight apart or with a less intense dose of cisplatin before their radiotherapy, did not live as long as those who were only given radiotherapy. However, women given chemotherapy either less than a fortnight apart or with a more intense dose of cisplatin before their radiotherapy, seemed to live longer than those who were only given radiotherapy. These second results are based on less data and are not so convincing. There were very few serious side effects that continued long after treatment and they seemed to be similar whether chemotherapy was given or not.
Our second comparison was based on 5 trials and 872 women. The women who were given chemotherapy before surgery seemed to live longer than those who were only given radiotherapy. However, there was a small amount of data, there were differences between results of trials and other treatments were used. Therefore, it is not clear if the benefit might be for reasons other than the chemotherapy.
Further assessment of neoadjuvant chemotherapy in randomised trials is required. It may be valuable to compare it to a combined chemotherapy and radiotherapy approach or even to use neoadjuvant chemotherapy together with combined chemotherapy and radiotherapy.