The Therapeutic Value Of Neoadjuvant Chemotherapy On Locally Advanced Cervical Cancer

Cervical cancer is a common gyneocologic malignancy in woman wordwide.In recent years,locally advanced cervical cancer has a increasing tendcy,and the age of those patients became more and more young during the last20years. Even with the progress in surgical and radiotherapy techniques,the porgnosis of bulky and advanced uterine cervical cancer is poor,since bulky tumors are asstociated with a high incidence of lymph node metastasis as well as in lymphatic vascular space invasion.Neoadjuvant chemothrapy(NACT) draw considerable attention as a new stategy for locally advanced uterin cervical cancer. We collected41patients with cervical cancinoma in a stage Ib2-IIa,another60patients as the same stages of cervical cancer who had not underwent NACT as control,and explored the short-term therapeutic effect of NACT in cervical cance.Purpose:To evaluate the short-term therapeutic efficacy of neoadjuvant chemotherapy for locally advanced cervical cancer.Methods:We reviewed the clinical records of patients with cervical carcinoma in stage Ⅰb2-Ⅱa who were admitted in the shandong unversity qilu hospital from January2011to February2013.The patients were divided into NACT group and surgery group.The patients in NACT group were treated with2cycles of cisplatin plus Paclitaxel every3weeks,then they were evulated the reduction of tumor size and underwent surgery after2-4weeks of NAC. The other60patients as control group were directly treated with radical surgery.The estimation of tumor size and side effects of the neoadjuvant chemotherapy was done after chemotherapy, we compared the pelvic lymph node metastasis,the deep stromal invasion rate,lymphovascular space invasion,parametrial involvement and the postive rate of the incisal margin in neoadjuvant chemotherapy group to the surgery group.Results:The response rate to NACT is satisfying (CR+PR=73.16%),including9.76%(4/41) with a complete response (CR) and63.41%(26/41) achieved partial response(PR),and stable disease(SD) was observed in21.95%(9/41).There were two paitents had disease progression.Postopratively pelvic lymph node metastasis rate were29.26%in NACT group,while30.77%showed in the surgry group(p>0.05).the lymphovascular spase invasion rate of the NACT group was lower than that of the control group (10.25%vs41.67%, p<0.05).The rates of deep stromal invasion was found41.67%in of the NACT group.contrasting to46.67%(p>0.05)in the sugry group.There were no significant difference observed in positive rate of the incisal margin and parametrial involvement. No signmcantly different observed in the time of operation(2.83h±0.53vs3.30h±0.64h) and blood loss during operation (1037.50ml±386.53mlvsl391.43ml±487.11ml) between the two groups.(P>0.05).Conclusion:Neoadjuvant chemotherapy in locally advanced, stage Ⅰb2-Ⅱa cervical carcinoma patients could improve the short-term efficacy compared to control group.However, the long-term survival benfite also needs randomized controlled trials to confirm.