The role of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer, or 40 years of walking in the evidence desert

The study of the role of neoadjuvant chemotherapy (NACT) began with pioneering works in the early 1980s and has been ongoing for over 40 years. During this period, numerous randomized clinical trials have been conducted, many scrupulous meta-analyses have been performed, and clinical guidelines have been revised more than once. However, the results available at the moment can hardly be regarded as completely satisfying. After 40 years of walking in the desert of evidence-based medicine, we have no clear knowledge about the basic things: is there a place for NACT in the treatment of cervical cancer? If so, when and to whom should it be prescribed? What to do when the tumor response to chemotherapy is far from being satisfactory? The clinical application of NACT remains largely intuitive, based on extrapolation of available knowledge from other areas of oncology. The authors look at the future of NACT in the treatment of cervical cancer with cautious optimism, and invite the readers to recall the main points of the study of this method to help them understand where to go next.