Around the world, cervical cancer is the second most common cancer in women. Screening (with smear tests) has led to a decrease in the number of women with cervical cancer in some countries, but large numbers of women still die from the disease every year.
Where the cancer has not spread outside the cervix (early stage disease) women may have an operation to remove it by taking out the cervix, womb, the fallopian tubes, and maybe other nearby tissues (radical surgery). Or they might have treatment with x-rays from outside and inside the body (radical radiotherapy). Both of these treatments have been shown to be as good as each other. If the tumour is bigger, or has spread to tissues around the cervix (locally advanced disease) women may also get chemotherapy (drug treatment) at the same time as radiotherapy (chemoradiation).
Giving chemotherapy before radical surgery (neoadjuvant chemotherapy) might shrink the tumour. This could make surgery easier. It may also help to remove any tiny tumours that cannot be easily seen. A previous review found that women receiving chemotherapy before radical surgery lived longer than women who underwent radical radiotherapy. However, we don't know whether giving chemotherapy before radical surgery is better than radical surgery on its own.
This review was based on six trials that included 1072 women. Using the information available from the trials on the effects of chemotherapy, we found that giving chemotherapy before surgery helped women to live longer without cancer. It also seemed to help stop the disease from spreading. But it was not clear if chemotherapy made it easier to operate on the tumour. It was also not clear if chemotherapy helped to stop the cancer recurring, or if it helped women live longer in general. The type of drugs used or how they were given did not have any effect on the overall results. Also, results were similar in women with early stage and more advanced stages of disease.
In one of the trials, all women also recveived radiotherapy after surgery (post-operative radiotherapy). In the other trials, one third to two thirds of women got this post-operative radiotherapy. We are not sure how this extra treatment affects the results. It can also give women more side-effects.
Although neoadjuvant chemotherapy seems to have some effect on cervical cancer it is not clear that it helps women to live longer. However, if new drugs or new drug combinations are shown to have promising results, it may be worth doing more trials of neoadjuvant chemotherapy before surgery with these new treatments.