Randomized Phase III Study Comparing Neoadjuvant Chemotherapy Followed by Surgery Versus Chemoradiation in Stage IB2-IIB Cervical Cancer: EORTC-55994

EORTC-55994 Study Group, Gemma G. Kenter*, Stefano Greggi, Ignace Vergote, Dionyssios Katsaros, Juliusz Kobierski, Heleen van Doorn, Fabio Landoni, Jacobus van der Velden, Nicholas Reed, Corneel Coens, Iske van Luijk, Nicoletta Colombo, Elzbietta van der Steen-Banasik, Nelleke Ottevanger, Antonio Casado

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)

Abstract

PURPOSEThis multicenter trial by the European Organisation for Research and Treatment of Cancer Gynecological Cancer Group was motivated by conflicting evidence on the value of neoadjuvant chemotherapy before surgery compared with concomitant chemoradiotherapy (CCRT) in stage IB2-IIB cervical carcinoma.METHODSBetween May 2002 and January 2014, 626 patients with International Federation of Gynecology and Obstetrics stage IB2-IIb were randomly assigned between neoadjuvant chemotherapy followed by surgery (NACT-S; n = 314) and standard CCRT (n = 312). The primary end point was 5-year overall survival (OS) rate. Secondary end points were progression-free survival, OS, toxicity, and health-related quality of life (HRQOL).RESULTSAfter a median follow-up of 8.7 years, 198 patients (31.6%) died. Age, stage, and cell type were balanced in both arms. Protocol treatment was completed in 223 of 314 (71%) patients in NACT-S and 257 of 312(82%) in CCRT arms. Main reasons for incomplete protocol treatment were toxicity (30 of 314; 9.6%) and progressive disease (21 of 314; 6.7%) in the NACT-S arm and toxicity (23 of 312; 7.4%) and patient refusal (13 of 312; 4.2%) in the CCRT arm. Additional radiotherapy after completed NACT-S was given to 107 patients (48%), and additional surgery to 20 patients (8%) after completed CCRT. Short-term adverse events (AEs) â ‰¥grade 3 occurred more frequently with NACT-S (41% v 23%), and long-term AEs â ‰¥grade 3 more often with CCRT (21% v 15%). The 5-year OS was not significantly different between NACT-S (72%; 95% CI, 66 to 77) and CCRT (76%; 95% CI, 70 to 80).CONCLUSIONThis trial failed to demonstrate superiority in favor of the NACT-S arm but resulted in acceptable morbidity and HRQOL in both arms.

Original languageEnglish
Pages (from-to)5035-5043
Number of pages9
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume41
Issue number32
DOIs
Publication statusPublished - 10 Nov 2023

Bibliographical note

Publisher Copyright:
© American Society of Clinical Oncology.

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