The Clinical Retrospective Study Of Preoperative And Preradiotherapy Intra-arterial Neoadjuvant Chemotherapy For Patients With Metaphase Or Advanced Cervical Carcinoma

Purpose: To investigate the curative effect and clinical meaning of use cisplatin + Pirarubicin + 5- Fu scheme intra-arterial neoadjuvant chemotherapy treated patients with metaphase or advanced cervical carcinoma. (1) To evaluate the feasibility of radical hysterectomy and plevic lymphadenectomy for patients with cervical carcinoma stage IIb after neoadjuvant chemotherapy. ( 2) To evaluate the curative efficacy of the intra-arterial neoadjuvant chemotherapy before radiochemotherapy to the patients with advanced cervical cancer.Methods1 .Collected 24 patiens within cervical carcinoma stage IIb between 2004.1 and 2006.1 who had the curation of chemotherapy to intervene in ultraselection pair of side uterus artery in our academy .The pathological diagnosis of all cases before treatment was pointed out for squamous cell carcinoma, and all cases admitted to hospital without any treatment. The chemotherapy schedule is cisplatin 75mg/m~2, pirarubicin 40-60 mg/m~2 and 5- FulO～30mg/Kg, with the chemotherapy to intervene in ultraselection pairs of side uterus artery and the hydration of 3 days in routine. According to condition and curative effect, the chemotherapy was carried out from 1 to 3 courses selectly. About 3 weeks after the last course of intra-arterial neoadjuvant chemotherapy ,oprating with laparoscopic radical hysterectomy and pelvic lymphadenetomy with abdominoscope.. And the radiotherapy with the pelvis was aided after the operation. Observed the recent curative effection , the side reaction and the factors of influencing the curative effection of intra-arterial neoadjuvant chemotherapy, and compared with 45 patiens within cervical carcinoma stage I b or II a who had the same operation, to evaluate the feasibility , complication and the factors influencing the prognosis of the patients who had had the operation with laparoscopic radical hysterectomy and pelvic lymphadenetomy with abdominoscope..2. Collected 22 patiens within cervical carcinoma stage IIIa to IVa between 2004.1 and 2006.1 who had the curation of chemotherapy to intervene in ultraselection pairs of side uterus artery, including 8 cases of IIIa, 13 cases of IIIb and one case of IVa . Pathology type: 21 issues of squamous cell carcinoma, 1 issues of adenocarcinoma. According to condition and curative effect, all patients carried out from 1 to 3 courses of chemotherapy alternatively and then were given a radical cure radiotherapy ,chemotherapy scheme and method were the same as above. The radical cure radiotherapy was carried out ten days after the last time of chemotherapy, adopting 6MV-X ray linear accelerator to radiate the whole pelvis out-of-body, 2Gy every time and 5 times every week, it was changed to radiate the surrounding of pelvic cavity separated by grid in the middle of the ventral aspect of pelvic cavity when the radiotherapy dosage (DT) reached 30Gy, DT =15- 20Gy.Inserted intracavitary afterloading radiotherapy during this period, adopted the machine which was used of intracavitary afterloading radiotherapy with 192 iridium in high dosage.The dosage of A point was 5- 7Gy every time once a week and the total dosage was 35-42Gy.And it was not need to radiate the whole pelvis out-of-body at the day when the intracavitary afterloading radiotherapy was carried out.Observeed the recent curative effect and side reaction of the patients with advanced cervical carcinoma with intra-arterial neoadjuvant chemotherapy before radiotherapy, and compared with 21 patients of cervical carcinoma in the same stage (IIIa—IVa) with a radical cure radiotherapy to appraise the recent curative effect and side reaction of the patients with advanced cervical carcinoma with intra-arterial neoadjuvant chemotherapy before radiotherapy.Results:1 .In 24 patients within cervical carcinoma stage II b, there were 16 patients who had the symptom as colp- sanguinis profluvium in various degree or cervix contacting bleed when given a gynecologic examination. One week after the 1st course of intra-arterial neoadjuvant chemotherapy, the vagina bleed of 11 cases stop, the vagina bleed of 5 cases reduced obviously. One week after the 2st course of intra-arterial neoadjuvant chemotherapy, all cases hadn't obvious symptom of vagina bleed. Other symptoms as colp- apocenosis, the fall distended feeling of cavitas pelvis, ache of lumbosacral area and inferior belly all have improved in various degree after 1-3 courses of intra-arterial neoadjuvant chemotherapy. There were 18 cases improved obviously, 4 cases improved partially, the total alleviating rate of symptom was 100%. When all courses of intra-arterial neoadjuvant chemotherapy were finished, the cervix tumor of 2 cases achieved complete remission, 17 cases achieved partial remission, 5 cases achieved stable desease and no case was progress disease, the total effective rate was 79.17%. After neoadjuvant chemotherapy, 24 cases in the treat group all achieved the chance for laparoscopic radical hysterectomy and pelvic lymphadenetomy with abdominoscope. The operating time ,median blood loss , number of scavenged lymphnode ,the bladder rehabilitation time for radical hysterectomy and pelvic lymphadenectomy in patients with stage II b were similar to those patients with stages I b and II a disease. Serious complication didn't presented during the operation and after the operation. The patho-result after operation of the 24 cases displaied that no neoplastic cell was found on vagina cutting edge, the juncture of cervix and body of uterus, every ligament cutting edge and pair sides of uterine tubes and ovaries. Lymph gland shifted in the pelvis appeared in 2 cases (8.33%).2. After 1-3 courses of preradiotherapy neoadjuvant chemotherapy , the symptom caused by tumour such as colp- apocenosis,colp- sanguinis profluvium,the distended feeling of inferior belly,ache of lumbosacral area were all improved in various degree, 18 cases improved obviously, 4 cases improved partially, the total alleviating rate of symptom was 100%. Regarding cervix tumor, complete remission patients were 9 cases, partial remission patients were 10 cases, stable desease patients were 3 cases and no case was progress disease, the total effective rate was 86.36%. All cases had not presented the serious bad reaction related to the intraarterial chemotherapy. After chemotherapy, all cases had gastrointestinal reaction in various degree and some patients depilate more obviously. 2 cases appearred one degree of bone marrow depression, 17 cases appearred two degree of bone marrow depression, 4 cases appearred three degree of bone marrow depression, there was no case to appears four degree of bone marrow depression. The majority patients shown as the decrease of leucocyte , red blood corpuscles and blood platelet didn' t drop obviously. Minority patients shown as the decrease of all the cells in three system.Conclusion :1. Neoadjuvant chemotherapy ultraselectional through uterus artery combinede with radical hysterectomy and(or) radiotherapy is a kind of effective comprehensive therapy for patients with metaphase or advanced cervical carcinoma.It can improve the partial therapeutical effect of cervix. It can diminish the volume of tumour and the range of tumour infiltrated into pelvis .Therefore, the patients with cervical carcinoma stage IIb that choosed radiotherapy before have the chance to cut the focus of infection complete now, and does not increase postoperative complications and the difficult degree of laparoscopic radical hysterectomy and pelvic lymphadenetomy .According to the patho-result after operation, neoadjuvant chemotherapy can improve the infaust factors that influenced the prognosis. For patients with advanced cervical carcinoma , neoadjuvant chemotherapy is given before radiotherapy can diminish the volume of tumour, prevent the tumor recurrence or transfer . Furthermore, the chemotherapy medicines based on DDP can be used as sensitizer to improve the tumour cell ' s sensitiveness for radiotherapy, thus improve the result of the treatment. Though toxicity reacts have increaseed to some extent, but the patient's can tolerate generally, does not influence the radiotherapy course proceed smoothly.2. The chemotherapy scheme of DDP+ pirarubicin+5 - Fu has better clinical effect and smaller poisonous side effect, the price is cheap, and has better results for squamous cell carcinoma. Because the number of adenocarcinoma is small in this research, the clinical effect of this scheme for adenocarcinoma still awaits the further observation.3. Intra-arterial neoadjuvant chemotherapy add thorough operation in good time or radical radiotherapy can have better recent curative effect for patients with metaphase or advanced cervical carcinoma.But,it's influence for long-term curative effect and survival rate still need a large number of clinical cases and a long time following up to verify.