Neoadjuvant Chemotherapy in the Treatment of Cervical Cancer
Bibliographic record
Abstract
While surrogate markers of treatment effectiveness might suggest neoadjuvant chemotherapy is of benefit, what is of greatest interest to patients and clinicians is whether neoadjuvant chemotherapy confers a survival advantage. The following studies, presented individually and later analyzed collectively, sought to compare patients receiving neoadjuvant chemotherapy prior to surgery versus surgery alone. All patients underwent a staging laparotomy. If the tumour was found to be resectable, a radical hysterectomy, with para-aortic lymphadenectomy, was performed, followed by whole pelvis radiotherapy (50 Gy). Conversely, if the cancer was found to be unresectable, patients received 50-60 Gy to the whole pelvis followed by 25-35 Gy of intracavitary treatment. Two hundred and five patients were randomized, 102 to neoadjuvant chemotherapy and 103 to the control arm. For all patients, improved overall survival was noted in those receiving neoadjuvant chemotherapy compared to controls (81% vs. 66% at 8 years, p = 0.05). While pathologic risk factors such as lymph node metastases (19% vs. 2%, p = 0.04) and vascular space invasion (38% vs. 2%, p = 0.007) were significantly improved in patients with stage IB1 disease receiving neoadjuvant chemotherapy, there was no difference in overall survival at 8 years in this subgroup (82% with neoadjuvant chemotherapy versus 77% control). Patients with stage IB2 disease, however, demonstrated improved overall survival following neoadjuvant chemotherapy (80% versus 61% at 9 years, p < 0.01). This benefit was driven by an increased rate of operability (100% (61/61) versus 86% (48/56), p < 0.01) and possibly an improvement in pathologic risk factors in those receiving neoadjuvant chemotherapy compared to controls. Of all patients with resectable tumours, greater survival was noted in those who had received neoadjuvant chemotherapy (81% vs. 69% at 7 years, p = 0.05). The incidence of high-risk pathologic features was similar between controls and patients who did not respond to neoadjuvant chemotherapy. In those who responded, however, there were significantly fewer with lymph node metastases (6% vs. 40%, p < 0.0001), vascular space invasion (10% vs. 60%, p = 0.009) and parametrial involvement (2% vs. 34%, p = 0.001). Neoadjuvant chemotherapy appeared beneficial in decreasing the incidence of pelvic recurrences for those patients with stage IB2 disease (23% vs. 6%, p < 0.01). However, rates of distant metastases were the same for stage IB patients overall. The authors concluded that in patients with stage IB1 disease there was no difference in operability or survival, and minimal difference in pathologic features, suggesting limited benefit of neoadjuvant chemotherapy in this patient population. However, patients with stage IB2 disease had a significant increase in operability, and survival. While offering an alternative to radical radiotherapy in patients with stage IB2 disease, all patients in this study underwent adjuvant radiotherapy. Therefore, those receiving neoadjuvant chemotherapy underwent triple modality treatment in order to derive benefit. How their survival would compare to the current standard treatment of chemoradiotherapy is also unclear. There were methodological issues in this study; violation of intention-to-treat analysis took place, with the exclusion of 3 control and 2 neoadjuvant www.intechopen.com
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".