| Background:ⅡB cervical cancer refers to the cervical cancer that has paratalactic infiltration but has not spread to the pelvic cavity.According to the clinical guidelines for NCCN cervical cancer,concurrent radiotherapy and chemotherapy(radical radiotherapy+chemotherapy)is recommended as the preferred treatment mode for middle and advanced(ⅡB stage and above)cervical cancer.However,there are many complications in radical radiotherapy,so some patients want surgical treatment in clinical application.Therefore,in patients with stage ⅡB cervical cancer,in addition to concurrent chemoradiotherapy,there is still a treatment mode of neoadjuvant chemotherapy to shrink the tumor before radical surgery and adjuvant radiotherapy or chemotherapy after surgery.Therefore,radical hysterectomy combined with complementary therapy after neoadjuvant chemotherapy has become one of the treatment options for a considerable number of patients with locally advanced cervical cancer in recent years.However,there is still a lack of comparison in the treatment of stage ⅡB cervical cancer between concurrent chemotherapy and radiotherapy with neoadjuvant chemotherapy followed by surgery combined with supplementary treatment,and there are some contradictions and differences between the reported results.Objective:to compare the treatment effect,side effects and prognosis of combined chemoradiotherapy and preoperative neoadjuvant chemotherapy for stageⅡB cervical cancer,and to analyze the factors influencing the prognosis.Methods:collected in January 2010 to January 2014 in the×× of hospital patients with cervical squamous cell carcinomas ⅡB period 282 cases of clinical data and follow-up,Patients were divided into two groups according to different treatment modes:concurrent chemoradiotherapy group(CRRT)in 123 cases,cervical cancer radical surgery after neoadjuvant chemotherapy(NACT+RH group)159 cases,compared to two kinds of treatment efficacy,adverse reactions,and carries on the survival and prognostic analysis.Results:through the analysis of the collected data,found that after the treatment,when the choice of young patients,tumor diameter>4 cm patients tend to choose treatment pattern,neoadjuvant chemotherapy combined surgery patients with lymph node metastasis tend to choose chemoradiation therapy,However,because the relevant recent complications can be closely monitored during the treatment period and timely detected and treated accordingly,no sustained damage or fatal cases have occurred,which has little impact on the long-term survival and quality of life of patients,and therefore has little impact on the selection of treatment options.CCRT group had a significantly higher incidence of radioactive cystitis and radioactive enteritis than NACT+RH group,while there was no significant difference in the incidence of lower limb edema between the two groups.However,only 90(56.6%)patients in the NACT+RH group received supplementary radiotherapy,and the dose of postoperative adjuvant radiotherapy was significantly smaller than that of radical radiotherapy,leading to this difference.The local recurrence rate in the CRRT group was higher than that in the NACT+RH group.Although the difference between the two groups was statistically insignificant(P=0.557>0.05),it also suggested that the NACT+RH group might have potential advantages in controlling local tumor recurrence.Finally,the two groups of patients survival analysis and subgroup survival analysis found that CRRT with NACT+RH group of disease-free survival(DFS)and overall survival(OS),were not statistically significant,NACT+RH and divided into NACT(AC)+ RH and NACT(IC)+RH group,and are compared with those of survival CCRT group respectively,between the three groups of disease-free survival(DFS)and overall survival(OS)than there is still no statistical significance.The NACT+RH group was divided into the adjuvant radiotherapy group(N ACT+RH+ACR)and the adjuvant chemotherapy group(NACT+RH+AC)according to their postoperative treatment methods,and their survival status was compared with that of the CCRT group.However,the disease-free survival(DFS)and total survival time(OS)of the NACT+RH+AC group were better than those of the NACT+RH+ACR group.Conclusion:①Recent complications in the concurrent chemoradiotherapy group were less than those in the neoadjuvant chemotherapy combined with surgery group,but the follow-up treatment and patient survival were not significantly affected by monitoring and treatment.②Long-term complications such as radioactive cystitis and radioactive enteritis were more in the concurrent chemoradiotherapy group than in the neoadjuvant chemotherapy combined with surgery group,and the patients’ quality of life was relatively poor.③The local recurrence rate of concurrent chemoradiotherapy(CCRT)group was higher than that of neoadjuvant chemotherapy combined with surgery group,suggesting that neoadjuvant chemotherapy combined with surgery has certain advantages in reducing local tumor recurrence.However,the disease-free survival(DFS)and total survival time of the two groups were compared,and it was found the survival rate of patients in the neoadjuvant chemotherapy combined with surgery group was not improved.④the adverse factors of survival were tumor diameter,lymph node metastasis and tumor differentiation.In conclusion,there is no significant difference in survival between the concurrent chemoradiotherapy group and the neoadjuvant chemoradiotherapy combined with surgery group,but neoadjuvant chemoradiotherapy combined with surgery group can increase the chance of operation,reduce the complications associated with radical radiotherapy,and improve the quality of life of patients. |
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