What is the Best Initial Treatment for Stage IB3 to IIB Cervical Cancer?

The standard treatment in patients with stage IB3–IIB cervical cancer is concomitant chemoradiation (CTRT). Neoadjuvant chemotherapy followed by surgery (NACT-surgery), recently reported in comparison with CTRT in two phase III randomized trials, has been proposed as an alternative treatment in these patients. The two studies were similarly designed with a few differences. Their results, in aggregate, show that disease-free survival (DFS) is significantly superior with CTRT compared to NACT-surgery while overall survival (OS) is not significantly different with these two treatments. In the NACT-surgery arms of TMH and EORTC studies, 28% and 24% patients could not undergo surgery, respectively, and 44.6% and 27% patients received radiotherapy, respectively. Although the benefit of CTRT seemed to be concentrated in patients with stage IIB, there is no suggestion that NACT-surgery results in better outcome in any stage. Therefore, CTRT should be the standard of care in patients with locally advanced cervical cancer.