A Research On Recent Curative Effect Of Neoadjuvant Chemotherapy On Cervical Cancer In Stage ⅠB₂-ⅡB

[Objective]To research the recent curative effect of neoadjuvant chemotherapy on cervicalcancer in stage ⅠB₂-ⅡB, its influence on both clinical radical hysterectomy andpostoperative pathology of adverse factors; comparing the recent curative effectbetween intravenous chemotherapy and transarterial chemoembolization on cervical cancerin stage ⅠB₂-ⅡB in order to provide reference opinions for clinical cervical cancertreatment decision.[Method]1. A retrospective study was carried on125cervical cancer patients who wereconfirmed by cervical biopsy pathology and in stage ⅠB₂-ⅡB according to the2009international maternity league （FIGO） for clinical stage in Anhui provincial hospitalfrom Jan2006to Dec2010.2. Patients were allocated to several groups in the way they cured,40patients weregiven an operation only （the direct operation group）;57patients were given a radicalsurgery after neoadjuvant chemotherapy （the operation group after neoadjuvantchemotherapy）:30patients from the intravenous chemotherapy group,27patients fromthe transarterial chemoembolization group.28patients who were invalid afterneoadjuvant chemotherapy were given radiotherapy and did not have operations. Inother words,85patients in the neoadjuvant chemotherapy group [44patients in theintravenous chemotherapy （IVCT） group,41patients in the transarterialchemoembolization （TACE） group].3. Patients in the neoadjuvant chemotherapy group were given1or2courses ofcombination chemotherapy which was with a VBP scheme and radical surgery followedby chemotherapy if condition was permitted, radiotherapy was given if condition was not permitted.4. Compared the general clinical data, the operation situation （such as surgery time,blood loss, the occurrence rate of operation complications） and pathologic risk factors（such as lymph node metastasis, parametrial involvement, deep muscle infiltration,vaginal cut edge positive and vascular tumor emboli） occurrence rates between thedirect operation group and the group after neoadjuvant chemotherapy.5. The general clinical datas, the effective rates of chemotherapy, changes of tumordiameters before and after neoadjuvant chemotherapy, the operation situation andpathologic risk factors occurrence rates were also compared between the IVCT groupand the TACE group. The relationship between clinical characteristics andchemotherapy effect were analyzed in order to find which factors affect the curativeeffect of chemotherapy.[Result]1. The comparation of the average surgery time between the operation group afterneoadjuvant chemotherapy and the direct operation group [（210.19±49.87）min VS （255.72±47.83）min] was statistical significance （P<0.05）;while there were no statistical significances in the average blood loss andthe surgical complications occurrence rate.2. The occurrence rate of postoperative pathologic risk factors was obviouslylower in the operation group after neoadjuvant chemotherapy than that ofin the direct operation group （54.3%VS90%）; the comparation of the ratesof lymph node metastasis was （7.0%VS22.5%）, the rate of parametrialinvolvement was （10.5%VS27.5%）; significant differences were found in therates of lymph node metastasis and parametrial involvement in the twogroups（P<0.05）;While there were no significant differences in deep muscleinfiltration, vascular carcinoma bolt transferring and vaginal cutting edgepositive rate in the two groups.3. The effective rate of chemotherapy, surgery time, blood loss and surgical complications rate were no significant differences between IVCT group andTACE group. The rates of parametrial involvement and deep muscle layerinfiltration in TACE group were lower than that of in IVCT group（3.7%VS30%,7.4%VS33.3%）, The comparisons of postoperative pathologichigh-risk factors such as vascular carcinoma bolt transfer, lymph nodemetastasis and vaginal cutting edge positive rate were no statisticalsignificance.4. The comparation of the tumor diameters before and after chemotherapy was[（4.953±0.739）cm VS （2.304±0.841）cm，（5.264±0.918）cm VS（2.036±0.716）cm],There were significant differences on the tumordiameters before and after chemotherapy in two groups （P<0.05）. Thecurative effect of chemotherapy showed no differences in different clinicalstages and different pathological types （P>0.05）; the curative effect ofchemotherapy showed some differences in different tumor diameters（P<0.05）, small tumor is better than big tumor in curative effect..[Conclusion]1. The neoadjuvant chemotherapy of cervical cancer can make tumor shrinkage,parametrial involvement improvement and lymph node metastasis reductionwhich are beneficial for operation.2. Comparing with direct operation, the neoadjuvant chemotherapy can shortensurgical time, decrease postoperative pathologic risk factors incidence, do notincrease the blood loss in the operation and the surgical complicationsoccurrence rates.3. The recent effect is similar between two kinds of neoadjuvant chemotherapy inpatients with cervical cancer in stage ⅠB₂-ⅡB. Transarterial chemoembolizationis better than intravenous chemotherapy in improving parametrial involvementand deep muscle layer infiltration.4. The curative effect of neoadjuvant chemotherapy in patients with cervical cancer stage ⅠB₂-ⅡB have nothing to do with clinical stages and pathologicaltypes, it has something relevant to tumor diameters. The curative effect ofsmall tumor is better than that of big tumor.