## Neoadjuvant Chemotherapy for Cervical Cancer **Key Point:** Cisplatin and paclitaxel (TP regimen) is the preferred neoadjuvant chemotherapy for locally advanced cervical cancer when surgery is planned after chemotherapy. ### Rationale for Neoadjuvant Approach Neoadjuvant chemotherapy in stage IIIB cervical cancer aims to: 1. Reduce tumor burden and parametrial involvement 2. Improve resectability for radical hysterectomy 3. Treat occult micrometastases 4. Potentially improve overall survival compared to surgery or radiation alone ### Cisplatin + Paclitaxel (TP) Regimen | Parameter | Details | | --- | --- | | **Cisplatin dose** | 75 mg/m² IV on day 1 | | **Paclitaxel dose** | 175 mg/m² IV over 3 hours on day 1 | | **Cycle length** | 21 days | | **Number of cycles** | 3–4 cycles preoperatively | | **Mechanism** | Synergistic: paclitaxel stabilizes microtubules; cisplatin causes DNA cross-linking | | **Response rate** | 60–70% objective response | **High-Yield:** The TP regimen is superior to cisplatin monotherapy in neoadjuvant settings because: - Paclitaxel adds cytotoxic activity and enhances cisplatin efficacy - Better tumor downstaging compared to single-agent cisplatin - Established in gynecologic oncology (ovarian, endometrial, and cervical cancers) ### Advantages Over Alternatives - **vs. Cisplatin alone:** TP provides superior response and downstaging - **vs. Carboplatin-gemcitabine:** TP has stronger evidence in cervical cancer; carboplatin is less radiosensitizing - **vs. Topotecan-cisplatin:** TP is the preferred combination; topotecan is reserved for recurrent/metastatic disease **Clinical Pearl:** After 3–4 cycles of TP, restaging imaging (CT/MRI pelvis) is performed to assess response before proceeding to radical hysterectomy and pelvic lymphadenectomy. [cite:Park 26e Ch 10]
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