Neoadjuvant Chemotherapy in the Treatment of Cervical Cancer

The treatment of cervical cancer has seen great advances since the first radical hysterectomy was performed by Ernst Wertheim in 1898. Breakthroughs in surgical techniques, including total laparoscopic approaches, sentinel lymph node mapping, and fertility-sparing procedures have dramatically reduced the morbidity of definitive treatment, while preserving oncologic outcomes. Increasingly conservative approaches are being proposed, based on individual patient and tumour characteristics. Cervical cancer was previously thought to be chemo-resistant, and therefore chemotherapy was used only for recurrent or metastatic disease. However, after responses were noted to platinum-based regimens (Friedlander et al., 1983, 1984), interest in the use of chemotherapy was reignited, particularly in the neoadjuvant setting. Whether prior to surgery or radiotherapy, the use of neoadjuvant chemotherapy in cervical cancer has been actively studied, in multiple settings and diverse patient populations, showing promise with acceptable toxicity profiles. In this chapter, the use of neoadjuvant chemotherapy in the treatment of cervical cancer will be reviewed. The rationale will be explored followed by the evidence for its effectiveness prior to surgery, radiotherapy, and fertility-sparing procedures. An approach to patient selection will be provided, and chemotherapeutic regimens will be compared, concluding with areas of ongoing and future research.