Multidisciplinary Therapy And Laboratory Study After Radical Surgery In High-Risk Cervical Cancer Patients

Background Cervical carcinoma remains the leading cause to death amonggynecological cancers in developing countries. About 35 percent patientswith clinical stage Ib-IIa recurr or metastasize after radicalhysterectomy and pelvic lymphadenectomy. How to detect the high riskpatients and take individual multidisciplinary therapy to improve theirlong-term survival and quality of life is a dilemma waiting us to settle.Some clinical studies were reported in other countries. However, resultswere still in controversial. There has no prospective clinical studyreported in China yet. Our study concentrated on the concurrentchemotherapy and radiotherapy for the patients with positive pelvic lymphnode to determine whether our treatment can improve their disease-freesurvival and what are the prognostic factors. The detection of micrometastasis of lymph node can help us to selecthigh-risk patients and take active treatment to decrease the localrecurrence and distant metastasis. In this study, we used reversetranscription polymerase chain reaction (RT-PCR) to determine theexpression of CK19 and HPV16 mRNA in the pelvic lymph nodes of cervicalcancer patients and discussed the clinical significancePart I Multidisciplinary therapy after radical surgeryin cervical cancer patients with positive pelvic lymph node Purpose To study the modality of multidisciplinary therapy and prognosis ofcervical cancer patients with positive pelvic lymph node. Methods From January 2000 to June 2003, 107 patients with clinical stage Ib-II 5高危宫颈癌患者根治术后综合治疗和实验研究(FIGO) were enrolled as the research arm. All the patients were undertakenWertheims-Meigs'surgery (radical hysterectomy and pelviclymphadenectomy) and were histologically confirmed to be pelvic lymphnode involvement. Patients received the first cycle of systemicchemotherapy two weeks later. Then they received external-beamradiotherapy plus weekly DDP chemotherapy(30-40mg). The third to eighthcycles of chemotherapy were scheduled after completion of radiotherapy,and immunotherapy were combined. Chemotherapy regimen consistedcisplatin(DDP) + 5-Fluorouracil(5-FU) + Bleomycin(BLM) for squamouscarcinoma, and cisplatin(DDP) + 5-Fluorouracil(5-FU) + Epirubincin(E-ADM)for adenocarcinoma. The patients with one positive pelvic lymph node wereperformed 4 cycles. However, 6 cycles of chemotherapy every three weeksand another 3 cycles of continual chemotherapy every two months wereadministered to the patients with two or more than two positive pelviclymph nodes or positive common iliac node and para-aortic lymph node(PALN).Postoperative external beam irradiation was delivered to patients with6MV X-ray by parallel-opposed (anteroposterior) technique. A dose of 45Gywas prescribed in 25 equal fractions to the isocentor with 1.8Gy dailyfraction. Patients with two or more than two positive pelvic lymph nodes,positive common iliac node and PALN received an additional 40-50Gy to thePALN chain area. Patients with positive vaginal margin were given extraintracavitary brachytherapy with 30Gy high-dose rate at 0.5cm below thevaginal mucosa. Immunomodulators thymopentin ,interferon or tranditionalChinese medicine were administered after the chemoradiotherapy. From January 1990 to June 2003, 108 patients with clinical stage Ib-IIwere classified as the control arm. All these patients were undertakenWertheims-Meigs'surgery. However they received no adjuvant therapy oronly adjuvant radiotherapy or just adjuvant chemotherapy. Data analysis was performed with SPSS10.0 statistical package. Thesurvival curves were constructed by Kaplan-Meier method. The differencesin survival were compared with Log-rank test. Multivariate analyses wereperformed with the Cox proportional hazard model.