The Application Of Preoperative Concurrent Chemoradiotherapy On Bulky Cervical Cancer

Objective:To evaluate the security and feasibility of preoperative concurrent chemoradiotherapy on bulky cervical cancer in stageⅠb2～Ⅱb, and it is curative effect and prognosis for the radical hysterectomy.Methods: 259 cervical cancer patients in stageⅠb2～Ⅱb during November 1995 to December 2008 from the Cancer Hospital of the Medical College of Shantou University, of which their maximum diameter of local lesions was > 4cm, were enrolled: group A, 64 cases with preoperative concurrent chemoradiotherapy; group B, 73 cases treated with preoperative radiotherapy only; group C, 122 cases treated by surgical removed of the tumor. All patients of the three groups were treated for radical hysterectomy which refers to extensive hysterectomy and pelvic lymph node dissection, while for pre-menopausal patients remain both ovaries or one ovary and shift, and performed bilateral internal iliac artery infusion chemotherapy (DDP 60mg) before lymph node dissection. Following treatment, tumor volume reduction, adverse effects were compared between the preoperative concurrent chemoradiotherapy group and the preoperative radiotherapy alone group; operation time, hemorrhage volume during operation, complications, pathological features, and effects on survival were compared between different groups.Results:(1)The tumor volume of the preoperative concurrent chemoradiotherapy group (53.60cm3±35.19cm3) after chemoradiotherapy (10.81cm3±10.38cm3) was significantly smaller, compared to the preoperative radiotherapy alone group (10.81cm3±10.38cm3) after radiotherapy (15.51cm3±17.15cm3)(P<0.05).(2)No difference in myelosuppression or gastrointestinal reactions was found between preoperative concurrent chemoradiotherapy treatment vs preoperative radiotherapy alone(P>0.05).(3)Operation time of the preoperative concurrent chemoradiotherapy group (218.5min±33.8min) was shorter than the preoperative radiotherapy alone group (242.7min±48.3min) and the surgery only group (240.4min±50.6min) with a significant difference(P<0.05).(4)Hemorrhage volume during operation of the preoperative concurrent chemoradiotherapy group (476.3ml±211.2ml) was less than the preoperative radiotherapy alone group (639.9ml±415.4ml) and the surgery only group (592.5ml±318.8ml) with a significant difference(P<0.05).(5)The difference of complications between the three groups was insignificant(P>0.05).(6)Pathology analysis after surgery show that cervix infiltration of the preoperative concurrent chemoradiotherapy group (55 cases, 85.9%) was less than either the preoperative radiotherapy alone group (70 cases, 95.9%) or the surgery only group (122 cases,100%)(P<0.05). Vascular thrombosis of the preoperative concurrent chemoradiotherapy group (0 cases, 0%) was less than either the radiotherapy alone group (6 cases,8.2%) or the surgery only group (10 cases,8.2%) (P<0.05). Deep muscular layer infiltration, parametrium infiltration, vaginal stump infiltration, and lymphnode metastasis rates were similar, with no significant differences between the three groups(P>0.05). (7) The recurrence rate and 1-year, 3-years, 5-year survival difference of the three groups were also similar,without a significant difference(P>0.05).Conclusions: The patients with bulky cervical cancer in stageⅠb2～Ⅱb treated with preoperative concurrent chemoradiotherapy were safe and feasible. The patients with bulky cervical cancer in stageⅠb2～Ⅱb treated with preoperative concurrent chemoradiotherapy can reduced the tumor volume, can diminish the operation time,the hemorrhage volume during operation, the cervix infiltration and the vascular thrombosis. At the same time, the preoperative concurrent chemoradiotherapy does not increase toxicity and postoperative complications which has some clinical value.However,the recurrence rate and 5-year survival rate had not significant improvement and it is worth for further study.