# Survival Impact of Neoadjuvant Chemotherapy With Bevacizumab Followed by Radical Hysterectomy for Locally Advanced Cervical Cancer With Lymph Node Metastasis: Insights From a Single-Institution Experience

## TL;DR

A treatment combining chemotherapy with bevacizumab and surgery improved survival and reduced tumor size in advanced cervical cancer patients with lymph node metastasis.

## Contribution

Demonstrates the feasibility and efficacy of neoadjuvant chemotherapy with bevacizumab followed by surgery in high-risk cervical cancer patients.

## Key findings

- All six patients showed substantial tumor regression after neoadjuvant chemotherapy with bevacizumab.
- Three out of six patients achieved a pathological complete response.
- Five patients remained recurrence-free with no deaths after a median follow-up of 25.5 months.

## Abstract

Objective: To evaluate the therapeutic efficacy of neoadjuvant chemotherapy (NAC) with bevacizumab prior to radical hysterectomy in locally advanced cervical cancer with lymph node metastasis.

Methods: This single-institution, retrospective study was conducted at Kumamoto University Hospital (Kumamoto, JPN). The medical records of six consecutive patients with stage IIIC cervical cancer who received NAC with bevacizumab followed by radical hysterectomy were reviewed. Patients were treated between January 2022 and January 2024, with follow-up continuing through April 2025. Treatment responses, survival outcomes, and perioperative outcomes, including surgical complications and adverse events, were analyzed.

Results: All six patients had tumors ≥4 cm with parametrial invasion (T2b); two had stage IIIC1r and four had IIIC2r disease. All patients completed three to four cycles of platinum-based NAC with bevacizumab and subsequently underwent radical surgery. Substantial tumor regression after NAC was observed in all cases, and notably, pathological complete response was achieved in three patients (50.0%). At a median follow-up of 25.5 months, five patients (83.3%) remained recurrence-free, and no deaths had occurred. One patient with pelvic nodal recurrence underwent complete resection followed by concurrent chemoradiotherapy, achieving sustained disease-free status. All surgeries were completed without severe perioperative complications. No severe bevacizumab-related adverse events were observed.

Conclusion: The NAC with bevacizumab followed by radical hysterectomy was feasible, well tolerated, and demonstrated promising efficacy in patients with locally advanced cervical cancer accompanied by lymph node metastasis. This strategy demonstrated remarkably high clinical response and survival outcomes, along with favorable perioperative safety, supporting its potential as a multimodal treatment option for selected high-risk patients.