Real-World Outcomes of Weekly Paclitaxel-Carboplatin-Based Chemoradiotherapy Versus Cisplatin-Based Chemoradiotherapy for FIGO Stage IB2-IVA Cervical cancer: A Retrospective Observational Study.

AIM: We compared outcomes and toxicities of weekly paclitaxel plus carboplatin-based (wTC) and cisplatin-based (CDDP) concurrent chemoradiotherapy (CCRT) in FIGO stage IB2-IVA cervical cancer cases. METHODS: We retrospectively reviewed patients with FIGO stage IB2-IVA cervical cancer who underwent definitive-intent CCRT at our institution between 2009 and 2024. To reduce temporal confounding, the primary analysis was restricted to 2015-2024, when both regimens were available, and a sensitivity analysis included the entire period. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: The primary analysis included 54 patients (wTC, n = 27; CDDP, n = 27). Baseline characteristics were balanced. The 3-year PFS rates were 53.5% and 77.4% in the wTC and CDDP groups, respectively (p = 0.078), and the 3-year OS rates were 76.4% and 75.4%, respectively (p = 0.882). The treatment regimen was not significantly associated with OS, whereas tumor diameter ≥ 6 cm was associated with worse OS. In the sensitivity analysis (wTC, n = 84; CDDP, n = 27), PFS and OS did not differ significantly between groups. Creatinine increased was more severe in the CDDP group, whereas neutropenia was more severe in the wTC group. CONCLUSIONS: No significant differences in survival outcomes were observed between wTC-CCRT and CDDP-CCRT in patients with FIGO stage IB2-IVA cervical cancer. The study was not designed to establish equivalence or non-inferiority. wTC-CCRT may be considered for selected patients unable to receive cisplatin, although its comparative efficacy remains uncertain.