Clinical Observation Of Neoadjuvant Intra-arterial Chemotherapy In Treatment Of Cervical Cancer And The Effect On Cell Proliferation And Apoptosis

Objective1. Based on 76 patients of stage Ib-IIb cervical cancer who were randomly divided into two groups as preoperative intra-arterial infusion chemoembolization and directly surgical operation,to observe and analyze its clinical therapeutic effect.2. To detect tumor cell proliferation index (Ki-67 labeling index,LI) and apoptotic index (AI) from samples of before-chemotherapy, after-chemotherapy and operation directly, and analyze the effect of neoadjuvant intra-arterial infusion chemoembolization on tumor cell proliferation and apoptosis.3. To further investigate mechanism and indications of neoadjuvant intra-arterial chemotherapy, according to evidence-based medicine。Method1. Samples76 patients of cervical epidermoid carcinoma Stage Ib-IIb who were diagnosed in Guangzhou First Municipal People's Hospital from Jan 2006 to Dec 2008,were randomly divided into two groups. Group A of 46 cases had undergone neoadjuvant intra-arterial infusion chemoembolization first,then selected radiotherapy or surgery according to the outcome of chemoembolization.Meanwhile group B of 30 cases had undergone surgical operation directly , then they were decided to accept supplementary chemotherapy or radiotherapy according to pathological report. Intra-arterial infusion chemoembolization was performed by ultraselective uterine artery infusion and embolization + internal iliac artery infusion under DSA,where chemotherapy regimen was:Carboplatin 300mg/m² + Bleomycin 30mg (total).2. Clinical observationThe focus of cervical cancer in the largest diameter and vertical transverse diameter were measured before and after chemotherapy, the effective rate of intra-arterial infusion chemoembolization (total effective rate = complete remission rate + partial remission rate)were calculated. The haemorrhage volume during operation of 2 groups were recorded, then their difference were compared ; Statistics of pelvic lymph node metastasis rate, parametrium infiltration rate and vaginal infiltration rate were collected according to pathological reports.3. Experiment methodWith mouse anti-human monoclonal antibody, envision immunohisto- chemistry were used to detect proliferation antigen(Ki-67) of cervical cancer specimens for 3 groups,such as before chemoembolization(group A₁) ,after chemoembolization(group A₂) and direct surgery(group B). Apoptosis cell of these 3 groups were detected by DNA fragment-end labeling method. Proliferation index(Ki-67 labeling index,LI) and apoptotic index(AI) were compared.4. Statistics analysisSoftware SPSS17.0 was used for statistical analysis on all data,measurement data in groups using T test,Comparison of rate using X2 test, proliferation index and apoptotic index using one-way analysis of variance. P<0.05 has statistical significance。Results1. Total effective rate for intra-arterial infusion chemoembolization in group A was 86.96%. After chemoembolization four cases underwent radiotherapy ,when 42 cases underwent surgical operation.2. The haemorrhage volume during operation in grouop A was 364.4±111.5ml, which in group B was 524.3±153.6ml. The two groups showed statistically significant difference(P <0.05),that surgical bleeding of group A was less than group B.3. Comparing group A and group B by lymph node metastasis rate, parametrium infiltration rate and vaginal infiltration rate,no statistical significance was found(P> 0.05).4.LI (%) for sample of pre-chemotherapy group, after- chemotherapy group and direct surgery group were 87.22±7.55,66.67±7.79,80.12±8.97. Group A₁ and group A₂, group A₂ and group B were significantly different (P <0.05),but group A₁ and group B has no significant difference(P> 0.05). Above all ,Ki-67 index of group A₂ was much lower than of group A₁ and B.5.AI(%) for sample of pre-chemoembolization group, after- chemoembolization group and direct surgery group were 0.67±0.21,3.56±1.29, 0.85±0.27. Group A₁and group A₂, group A₂ and group B were significantly different(P <0.01), but comparing group A₁and group B, we found no significant difference.In brief apoptotic index of group A₂ increased obviously than the other two groups.Conclusions1. Neoadjuvant intra-arterial infusion chemoembolization on uterine cervical cancer of Ib-IIb, can significantly reduce the size of lesions, increase opportunity for complete surgical resection of lesions,reduce the possible need of radiatherapy and chemotherapy follow-up ,then improve the quality of life for patients.2. compared with cases of direct surgical operation , The haemorrhage volume during operation after neoadjuvant intra-arterial infusion chemoembolization reduced significantly,which is conducive to recovery for patients.3. After neoadjuvant intra-arterial infusion chemoembolization, the tumor cell proliferation decreased obviously and apoptosis increased significantly, suggesting that intra-arterial infusion chemoembolization inhibit tumor cell proliferation and promote the role of apoptosis.