| Objective:This study is to investigate the clinical efficacy,long-term survival as well as toxicity of lobaplatin combined with paclitaxel neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for stage IIB~IIIB cervical squamous cell cancer,and analyze the influence of different factors on the prognosis.Methods:From January 2014 to December 2016,155 cases of FIGO IIB-IIIB stage were selected in the Department of Breast and Gynecology,Cancer Hospital,and all patients were confirmed to be cervical squamous cell carcinoma by pathologic diagnosis.Lobaplatin combined with paclitaxel neoadjuvant chemotherapy: paclitaxel 175mg/ m2,ivgtt,d1;lobaplatin 30mg/ m2,ivgtt,d2;for 2 cycles with an interval of 21 days between them.Then they received concurrent chemoradiotherapy,Radiotherapy consisted of 50.4 Gy and chemotherapy consisted of paclitaxel 175mg/ m2 and lobaplatin 30mg/ m2(2 cycles with an interval of 28 days)and followed by brachytherapy.After that,to observe its short-term efficacy,toxicity and side effects,long-term survival rate and prognostic factors.Results:155 cases of patients,with a median age of 50 years,94 cases in stage IIB,11 cases in stage IIIA,and 50 cases in stage IIIB.Of the 155 patients,153(98.8%)completed two cycles of neoadjuvant chemotherapy,and 2(1.2%)failed to undergo the second cycle due to persistent grade 3-4 hematological toxicity.After neoadjuvant chemotherapy,7 cases were CR(4.5%),102 cases were PR(65.8%),44 cases were SD(28.4%),2 cases were PD(1.3%),ORR was 70.3%,and DCR was 98.7%.Univariate analysis of neoadjuvant chemotherapy ORR in 155 cases of cervical cancer by χ2 test,the results showed that there were statistically significant differences between different groups of lymph node metastasis,tumor maximum diameter,and hemoglobin value before treatment,the P values are <0.001,0.002,and 0.001,respectively.Multivariate analysis using binary logistic regression analysis showed that lymph node metastasis,tumor maximum diameter,and hemoglobin value before treatment were independent influencing factors of ORR rate after neoadjuvant chemotherapy,with P values of 0.002,0.022,and 0.009,respectively.Of the 155 patients,129(83.2%)completed two cycles of concurrent chemotherapy,26(16.7%)did not receive the second cycle of chemotherapy,and 15(9.6%)patients did not complete radiation therapy.After concurrent chemoradiotherapy,85 cases were CR(54.8%),64 cases were PR(41.3%),5 cases were SD(3.2%),1 case was PD(0.7%),ORR was 96.1%,DCR was 99.4%.Univariate analysis of concurrent chemoradiotherapy OR in 155 cases of cervical cancer by χ2 test,the results showed that there were statistically significant differences between different groups of FIGO clinical stage,lymph node metastasis,hemoglobin value before treatment,number of concurrent chemotherapy cycles,and whether or not to complete EBRT + brachytherapy,with P values of 0.005,0.002,0.029 and 0.006,<0.001,respectively..Multivariate analysis using binary logistic regression analysis showed that FIGO clinical stage,lymph node metastasis,whether or not to complete EBRT + brachytherapy are independent influencing factors of CR rate,P values were 0.021,0.034,and 0.017,respectively.The general 1-,3-,and 5-year overall survival rates and progression-free survival rates of the 155 patients were 92.3%,77.4%,69.9% and 90.3%,74.2%,63.8%,respectively.The results of the Log-rank test showed that there were significant differences in the PFS between different groups of FIGO clinical stage,lymph node metastasis,pre-treatment hemoglobin level,concurrent chemotherapy cycles,and whether or not to complete EBRT + brachytherapy(P<0.05).The results of the Log-rank test showed that there were significant differences in the OS between different groups of FIGO clinical stage,lymph node metastasis,concurrent chemotherapy cycles,and whether or not to complete EBRT+ brachytherapy(P<0.05).Multivariate Cox hazards regression analysis illustrated that FIGO clinical stage,lymph node metastasis,pre-treatment hemoglobin level,concurrent chemotherapy cycles,and whether or not to complete EBRT + brachytherapy were independent risk factors affecting PFS(P<0.05)and the FIGO clinical stage,lymph node metastasis,concurrent chemotherapy cycles were independent risk factors affecting OS(P<0.05).The incidence of grade 3-4 adverse events during neoadjuvant chemotherapy was 20%(31/155),18.7%(29/155)were hematological toxicity,and 1.3%(2/155)were non-hematological.The incidence of grade 3-4 adverse events during concurrent chemotherapy was approximately 45%(70/155),hematological adverse events were 42%(65/155),and non-hematological were 3%(5/155).Conclusion:This study shows that lobaplatin combined with paclitaxel neoadjuvant chemotherapy followed by concurrent chemoradiotherapy is an effective way in treating stage IIB ~ IIIB cervical squamous cell cancer.It has higher efficiency,higher OS and PFS rates in 5 years.The lymph node metastasis is an independent risk factor both affecting ORR after neoadjuvant chemotherapy and CR after concurrent chemoradiotherapy.The FIGO clinical stage,lymph node metastasis,concurrent chemotherapy cycles were independent risk factors both affecting OS and PFS.During neoadjuvant chemotherapy and concurrent chemotherapy,although the incidence of hematological toxicities was high,no death-related toxicities occurred,and the recent toxicities were tolerable. |
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