Volume 38

Number 1 January 2025

Neoadjuvant Chemotherapy Prior to Radical Hysterectomy versus Radical Surgery Alone for Stage IB2–IIA2 Bulky Cervical Cancer

DOI: https://doi.org/10.47648/jmsr.2025.v3801.01

Noor-E-Ferdous1 , Sabera Khatun2 , Ashrafunnesa3 , Farzana Sharmin4 , Latifa Akter5 , Zaheen Naveed Haque6

Abstract

Background: The optimal management of bulky early-stage cervical cancer (tumor >4 cm) remains controversial. Neoadjuvant chemotherapy (NAC) before radical hysterectomy has been proposed to reduce tumor burden, improve operability, and potentially decrease postoperative morbidity; however, its comparative effectiveness versus primary surgery is uncertain. This study compared clinical characteristics, tumor response, surgical outcomes, and pathological findings between patients receiving NAC followed by radical hysterectomy and those undergoing primary radical surgery (PS) alone in stage IB2–IIA2 bulky cervical cancer. Methods: We retrospectively reviewed patients with stage IB2 or IIA2 cervical cancer with tumor size >4 cm on magnetic resonance imaging treated between November 2016 and September 2018. Patients receiving paclitaxel plus platinum-based NAC followed by radical hysterectomy were compared with those undergoing PS during the same period. Tumor response was assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Surgical parameters and pathological outcomes were analyzed. Results: A total of 97 patients were included (NAC: n=50; PS: n=47). Baseline age and weight were comparable. Tumor size distribution differed significantly (p<0.001), with larger tumors (5–6 cm) more common in the NAC group. NAC was associated with shorter operative time (157±29 vs 204±24 minutes; p<0.001) and lower estimated blood loss (472±139 vs 870±183 mL; p<0.001). Resectability rates were higher with NAC (92% vs 80.9%; p=0.189). Parametrial and paravaginal involvement differed significantly between groups (p<0.001), whereas lymphovascular space invasion did not (p=0.651). Within the NAC group, Grade 2 tumors showed higher response rates (p=0.001), and responders were older than non-responders (p=0.012). Conclusion: NAC prior to radical hysterectomy may enhance surgical feasibility in bulky cervical cancer without compromising pathological outcomes. Further prospective studies are needed to determine long-term oncologic benefits.

Keywords: Neoadjuvant Chemotherapy, Radical Hysterectomy, FIGO stage IB2–IIA2, Radical Surgery, Bulky Cervical Cancer


  1. Associate Professor, Department of Gynecological Oncology

    Bangladesh Medical University (BMU), Dhaka

  2. Professor, Department of Gynecological Oncology

    Bangladesh Medical University (BMU), Dhaka

  3. Professor, Department of Gynecological Oncology

    Bangladesh Medical University (BMU), Dhaka

  4. Associate Professor, Department of Obstetrics and Gynecology

    Bangladesh Medical University (BMU), Dhaka

  5. Associate Professor, Department of Obstetrics and Gynecology

    Bangladesh Medical University (BMU), Dhaka

  6. Medical Student

    Holy Family Red Crescent Medical College, Dhaka

Download PDF File Cite

Volume 38, Number 1 January 2025
Page: 03-09