Clinical Analysis Of Locally Adanced Cancer Preoperative Neoadjuvant Chemotherapy

Background: Cervical cancer remains the second most common malignancy inwomen worldwide. According to statistics compiled by the International Agency forResearch of Cancer, there are about500,000new cases of cervical cancer every year,and over80%of the new cases occur in developing countries. In China, there areapproximately135,000new cases every year, and among these70%are diagnosed atadvanced stages. In recent years, its incidence is rising, radical operation of cervicalfor stage of Ia2-II cervical cancer treatment effect is certain,but the treatment of locallyadvanced cervical cancer is still in dispute, such a neoplasm not easy to control, surgeryis difficult, and postoperative is easy relapse and metastasis, the five-year survival rateafter simple surgery or radiation therapy is low, and remain a high mortality rate.Toimprove the above situation, scholars both at home and abroad have used neoadjuvantchemotherapy (NACT) in the treatment of locally adanced cervical cancer,and haveobtained satisfactory clinical curative effect. So in this paper,we will discusse NACTfor locally adanced cervical cancer treatment, from which short-term curative effectand the long-term outcome.Objective: Explore effect of Neoadjuvant chemotherapy in stage of Ib2-IIa2cerical cancer treatment short-term curative effect and the long-term outcome,in order toevaluate the clinical effect of neoadjuvant chemotherapy in stage of Ib2-IIa2.Methods: we retrospectively analyzed106patients that is treated in Dalianmaternity hospital from November of2005to December of2009,which are stage of Ⅰ b2-Ⅱ a2locally adanced cervical cancer,that receive the surgical treatment of radicalhysterectomy and pelvic lymph node dissections. According to whether NACTpreoperative,all patients are divided into two groups: NACT group and controlgroup.All NACT groups have51cases patients, among them there are18cases stage ofIb2,33cases stage of IIa2; all control groups have55cases patients, among them thereare17cases stage of Ib2,38cases stage of IIa2, All of the patients do abdominal radicalhysterectomy and pelvic lymph nodes dissections. Compare the two groups ofoperation time, peri-operative bleeding and postoperative pathologic such as lymphnode metastasis rate, lymphatic vascular involvement, and the patient surial compared,etc, to evaluate the clinical effect of neoadjuvant chemotherapy in stage of Ib2-IIa2.Results: Preoperative chemotherapy group cases which are treated neoadjuvantchemotherapy,the tumor volume have different levels of narrow, clinical effective ratewas66.7%, reduce the clinical stages, won the chance to surgery, all neoadjuvantchemotherapy patients, has7cases are CR (13.7%),27cases are PR (53%),17cases areSD (33.3%),there is no patients PD. NACT group and control group operation time(176.73±5.197min:167.76±5.338min), intraoperative hemorrhage (759.80±50.643ml:765.45±34.861ml) of comparative differences not statistically significant (p>O.05). New adjuvant chemotherapy group and control group patients lymph nodemetastasis rate were35.3%(18/51) and60%(33/55), two groups of comparisons aresignificant difference (P=0.01, P <0.05); New adjuvant chemotherapy group of thecut edge positive and the incidence of the palace involved were9.8%(5/51) and5.9%(3/51), the corresponding the control group were9.1%(5/55) and5.5%(3/55), twogroups of comparisons have statistically significant difference (P <0.05). NACT groupof3years of survival rate was89.7%, the control group of3years of survival rate was70.5%.the survival curves show two groups of OS differences are statisticallysignificant (P=0.005, P <0.05), two groups of PFS difference was statisticallysignificant (P=0.014, P <0.05). And in many factor analysis, only pelvic lymph nodemetastasis and simple operation is independent risk factors for low OS (HR,23.892;95%CI,3.069to185.98; P=0.002and HR,5.505;95%CI,1.414to21.434; P=0.014).Conclusions: Locally advanced cervical cancer (cancer diameter>4CM)preoperative neoadjuvant chemotherapy treatment is safe and effective, obviously toshrink the tumor volume, reduce the clinical stages, for surgical patients can’t win thesurgery opportunity, at the same time, reduce the lymphatic vascular involvement and pelvic lymph node metastasis, but does not affect the operation time and peri-operativebleeding, improve the3-year survival, improve PFS and OS, reducing the postoperativerecurrence and metastasis, and is worth for clinical application.