A Meta-analysis Of Cervical Cancer With Intravenous Chemotherapy And Interventional Chemotherapy

Background The incidence of cervical cancer is ranked second among the women’s normal malignant tumours in the world, which ranks first in developing countries for women and is next to cancer of breast. In the past, operation and radiotherapy are the major treatments to the tumor. Before II A, early cervical cancer can be cured by surgery; for ⅡB, radiotherapy should be chosen as the main treatment for Advanced Cervical Cancer. However, recently there is a growing tendency for the incidence of cervical cancer. Trend of incidence age of patients with cervical cancer gradually gets younger. Radiotherapy has dad effect on ovary Function. The vagina gets narrow because of fibrosis which affect future life and which has been paid more and more attention. Neo-juvant chemothempy, NACT can increase surgical resection rates for early cervical cancer, and decrease unnecessary radiotherapy, and lift the level and quality of life of patients. There is still no cure for the new adjuvant chemotherapy for the treatment of cervical cancer. There are two ways to chemotherapy, intravenous injection and injection by the artery.Objective We make a comparison of the effect and side-effect of neoadjuvant chemotherapy treatment Ⅰ b-Ⅱ b cervical cancer to further discuss its value.Data and Methods In this study, systematic evaluation was used to collect all domestic and foreign information on two ways to neoadjuvant chemotherapy treatment Ⅰ b-Ⅱ b cervical cancer of the short-term curative effect and toxicity compared to cervical cancer neoadjuvant chemotherapy to further explore the therapeutic value, Medline database, Cochrane library, EMBASE, China Academic Journal, Wanfang database, manual searches of Shandong University Library, limited only in English and Chinese. Make the original research, evaluate the quality, extract the information and check, remove non-research purposes and standards of the research literature, and make a Meta-analysis by the end of the study. According to the new way adjuvant chemotherapy is divided into intra-arterial infusion chemotherapy group and the intravenous systemic chemotherapy group. RavMan4.2provided by Cochrane was used for Meta Analysis. The treatment efficiency, operation rate, pathological parametrial invasion, lymph node metastasis,2-year recurrence rate,3-year survival rate, toxicity in the gastrointestinal tract and bone marrow suppression were observed. By calculating the RR value of the various studies and the combined RR value, draw conclusions and guide the direction of future research.Result There are ten studies with908cases of patients which meet the inclusion criteria and which are all randomized controlled clinical trials(RCT) and clinical controlled trial (CCT). Extract information shows the results of statistical analysis. Cervical cancer is divided into pre-arterial and intravenous chemotherapy groups. First, Treatment efficiency of the combined RR=1.18,95%CI=[0.85,1.63], p=0.33, the diamond has an invalid line, and the kind of difference has no statistically significance. Second,2-year recurrence rate, the combined RR=1.15,95%CI=[0.68,1.93], p=0.61, the diamond has an invalid line, and the kind of difference has no statistically significance. Third,3-year survival rate, the combined RR=1.41,95%CI=[0.76,2.51], p=0.24, the diamond has an invalid line, and the kind of difference has no statistically significance. Fourth, Pathological parametrial infiltration rate, the combined RR=0.25,95%CI=[0.13,0.47], p=0.0001, an invalid line is in the left side of the diamond, and the kind of difference has no statistically significance. Fifthly, pathological lymph node metastasis rate, the combined RR=0.56,95%CI=[0.36,0.88], p=0.01, invalid line in the left side of the diamond, and the kind of difference has no statistically significance. Sixth, Response rate of gastrointestinal complications, combined RR=0.56,95%CI=[0.40,0.,79, p= 0.0009, an invalid line is in the left side of the diamond, and the kind of difference has no statistically significance. Seventh, the rate of complications of bone marrow suppression, the combined RR=0.37,95%CI=[0.25,0.56], p=0.00001, an invalid line is in the left side of the diamond, and the kind of difference has no statistically significance.Conclusion The two new methods of adjuvant chemotherapy for preoperative treatment of patients with cervical cancer of stage Ⅰ b～Ⅱ b, comparing the efficacy and adverse reactions in the intervention group of short-term effect and no significant difference between intravenous group which is quite effective and intervention group. The incidence of parametrial invasion was lower than that of vein. The kind of difference has no statistical significance. Lymph node metastasis rate in the intervention group is equal to intravenous group. The kind of difference has no statistical significance. Complication rate of arterial chemotherapy was significantly lower than that of intravenous chemotherapy group. The kind of difference has no statistical significance.2-year recurrence rate is equal to3-year survival rate. The kind of difference has no statistical significance. Cervical arterial administration of neoadjuvant chemotherapy has little toxicity and chemotherapy drugs directly enter into the cancer tissue, but this requires a high level of technology, cost a fortune, and has complications of pelvic pain after chemotherapy, but intravenous administration is convenient, inexpensive, but has severe toxicity. However, in the collected CCT and RCT, there is the possibility of the occurrence of bias. Further conclusions can be drawn by multiple high-quality, large randomized controlled clinical trial to confirm.