Comparison Of Paclitaxel Or Irinotecan Combine Carboplatin In Neoadjuvant Intraarterial Chemotherapy Of Lacc

Objective: To compare the recent curative effect and side reaction between patients treated with paclitaxel and carboplatin and those who treated with irinotecan hydrochloride and carboplatin. The purpose of this study was determine the current effect of neoadjuvant intraarterial chemotherapy (NAIC) of patients with locally advanced cervical cancer.Methods: From May 2008 to April 2010, 85 previously untreated patients with stageⅠb2–Ⅱb cervical cancer were enrolled in the study in the Sichuan Cancer Hospital,which containⅠb2 forty-one,Ⅱa2 thirty-one andⅡb thirteen,with 72 squamous cell carcinoma and 13 adenocarcinoma.The chemotherapy approach was transarterial chemoembolization, with gelatin sponge as embolization .There were 43 cases in paclitaxel and carboplatin group(paclitaxel 135-175 mg/m~2,carboplatin AUC=6). And there were 42 cases in irinotecan hydrochloride and carboplatin group ( irinotecan hydrochloride 130mg/m~2, carboplatin AUC=6 ) .None of the 85 cases have any contraindication . The curative effect was assessed by the same gynaecologists team after chemotherapy finished fourteen and twenty days.Then, the effective cases were given an operation of radical hysterectomy with pelvic lymphadenectomy, and bilateral ovaries were reserved and transported position in young women.Pathologic findings were evaluated with histologic examinations of surgical specimens.The patients with high risk of recurrence received adjuvant chemo-radiation,while non-NAC responders accepted concomitant chemo-radiotherapy. Factors suh as the alleviation of clinical symptom ,the effectivity and side effect of chemotherapy ,time duarations of the operations, hemorrhage volume during operation,and the pathology result (including parametrical infiltration, lymph node metastasis, uterus muscular layer invasion ) were compared between the two groups .Results: The total alleviating rate of clinical symptom of the two groups were both 100%.When all courses of neoadjuvant intraarterial chemotherapy were finished,the cervix tumor of 12 cases achieved complete remission,28 cases achieved partial remission,3 cases achieved stable disease and no achieved progress disease in paclitaxel and carboplatin group,and the total effective rate was 93.0%.While in irinotecan hydrochloride and carboplatin group,the cervix tumor of 11 cases achieved complete remission,27 cases achieved partial remission,4 cases achieved stable disease and no achieved progress disease, the total effective rate was 90.5%. The rate of surgery in paclitaxel and carboplatin group is higher than that of irinotecan hydrochloride and carboplatin group, but no obvious difference in statistics (P>0.05).The total effective rate of the two groups was 91.8%(78/85). The bone marrow depression ofⅢ～Ⅳin the paclitaxel and carboplatin group is 30.2%(13/43)and 4.8%(2/42) in the other group. The bone marrow depression in the paclitaxel and carboplatin group is higher than in irinotecan hydrochloride and carboplatin group (P<0.05).The incidence rate of diarrhea in the paclitaxel and carboplatin group is 23.3%(10/43)and 85.7%(36/42) in the other group,with obvious difference in statistics(P<0.05). The other chemotherapy side effects such as nausea and vomiting, fatigue and alopecia in both groups can remit through symptomatic treatment. There were not significant differences in average operative time, operative hemorrhage and pathology and histology outcomes (parametrium invasion,lymph node metastasis, uterus muscular layer invasion) in statistics(P>0.05).Conclusions: Neoadjuvant intraarterial chemotherapy for LACC could reduce the tumor volume evidently, increase the rate of surgery and QOL(quality of life). NACT in paclitaxel and carboplatin group and irinotecan hydrochloride and carboplatin group are both efficient in stageⅠb2–Ⅱb cervical cancer. The paclitaxel and carboplatin group has a higher bone marrow depression rate than irinotecan hydrochloride and carboplatin group. Diarrhoea is the most common side reaction of irinotecan hydrochloride and carboplatin.To get better therapeutic effect,we need to choose the proper chemotherapy regimens according to every patient's specific circumstances and following the individualized principle .