Application And Curative Effect Of Neoadjuvant Chemotherapy In The Treatment Of Stageâ… B2-â…¡B Cervical Cancer

Cervical cancer is one of common gynecological malignant tumor [1], its morbidity and mortality in patients after breast cancer, is now gradually younger. At present the main treatment is early operation, advanced radio therapy, but the operation and radiotherapy have certain limitations, only act on the lesion or around, still unable control to some other aspect, such as pelvic lymph node metastasis, distant metastasis, vascular invasion and other risk factors, resulting in the after treatment cervical cancer recurrence rate is still high, the 5 year survival rate has no obvious improvement is still hovering at about 64.9% [2, 14]. So suggest new treatment options is particularly important. Cervical cancer(especially squamous cell carcinoma) have been considered to be resistance to chemotherapy of malignant tumor, chemotherapy is only a kind of palliative therapy method to recurrence after operation in patients or not tolerated to radiotherapy. In twentieth century 80 years ago, although many scholars have conducted the thorough research to it, but the results are not as willing, but since 1982 the NACT(Neoadjuvant Chemotherapy)views proposed by Frei and later platinum based chemotherapy in malignant tumor is widely used, NACT played a very good effect in the treatment of part cervical cancer, from then on NACT for the treatment of cervical cancer has been widely recognized by scholars at home and abroad, this thesis is intended to discuss NACT’s application in the treatment of stageⅠB –ⅡB cervical cancer and this the effect of treatment.Objective: To explore the application and curative effect of neoadjuvant chemotherapy in the treatment of stageⅠB2-ⅡB cervical cancer.Methods: Retrospectively collected 94 cases patients of stageⅠB2-ⅡB cervical cancer,whose by traditional treatment way were treated with 2012.05-2014.05 of Dalian Medical University School Affiliated Hospital, according to whether had neoadjuvant chemotherapy were divided into the experimental group(the neoadjuvant chemotherapy treatment) and control group(directly operation treatment), the patients of experimental group are 48 cases,among them have 18 cases stageⅠB2, 20 cases stage ⅡA, 10 cases stage ⅡB; the patients of control group are 46 cases, among them have 20 cases stage Ⅰ B2, 26 cases stage Ⅱ A; recording the size of the tumor,, exclude contraindication to chemotherapy after 2 cycles of TP(paclitaxel plus cisplatin chemotherapy), to 2 weeks after the complete end of chemotherapy, according to UICC(Union for International Cancer Control) criteria to evaluate the curative effect of chemotherapy, to the patients whose effective to neoadjuvant chemotherapy received operation therapy(extensive hysterectomy and pelvic lymph node dissection) in the day of 21-28 after the end of treatment, the control group of 46 cases patients were directly treated with operation. Given the direct spread and lymph node metastasis are main metastasis way for cervical cancer, ovarian metastasis occurs rarely, the age <50 years old, according to the patients or their families willing can be considered to retain one or both ovaries and also for suspension surgery of ovary(ovarian transposition to the iliac fossa); for age >50 years old, but at the same time for bilateral adnexectomy. After the end of surgery on perioperative patients in the two group cases(intraoperative bleeding volume, operation time, recovery time of bladder function, hospitalization time), curative effect of surgery(postoperative pathological results) and postoperative recurrence rate and tumor free survival time were compared, according to the evaluate results to determiantion the curative effect of NACT and its application value in the treatment of stage ⅠB2-ⅡB cervical cancer.Results: 1.In the patients of experimental group after 2 cycles of neoadjuvant chemotherapy,the tumor size is reduced in different degree;1)18case stage Ⅰ B2, including 3cases of complete remission(mass eye disappeared), 11 cases of partial remission(reduce mass > 50%), 4 patients stable disease(reduce mass <50%), 0 cases of the disease progression, its probability is respectively 16.67%, 61.11%, 22.22%, 0, 77.78% efficiency;2) 20 cases stage Ⅱ A patients, including 1 cases of complete remission, 13 cases of partial remission, 5 cases of stable disease, 1 cases of disease progression(mass increases,the probability of>25%), ite probability is5%, 65%, 25%,5%, 70% efficiency;3) 10 cases stage ⅡB patients, in which 0 cases of complete remission, 6 cases of partial remission, 3 cases of stable disease, 1 cases of disease progression,its probability is respectively0, 60%, 30%, 10%, 60% efficiency;4) 48 cases stageⅠB2-ⅡB patients, 4 cases of complete remission, 30 cases of partial remission, 12 cases of stable disease, 2 cases of the disease progression, its probability is respectively 8.33%, 62.50%, 25%, 4.17%, 70.83% efficiency;2.In the experimental group of 38 cases of squamous carcinoma,among them 4 cases of complete remission, 26 cases of partial remission, 8 cases of stable disease, 0 cases of the disease progression, its probability is respectively 10.53%,68.42%, 21.05%, 0, 78.95%efficiency; in the experimental group of 10 cases adenocarcinoma, among them 0 cases of complete remission, 4 cases of partial remission, 4 cases of stable disease, 2 cases of the disease progression, its probability is respectively0, 40.00%, 40.00%,20.00%,40.00%efficiency;3.In the experimental group of 44 patients were follow-up surgery, including 6 cases of partial remission in patients with stage Ⅱ B, NACT significantly improved their parametrial infiltration degree(the original thickening parametrial tissue becomes soft, nodular sensation disappered), makes it obtain the chance of operation but also improve its surgical resection thoroughly, the remaining 4patients direct radiation;4.Two groups of patients with intraoperative bleeding volume and the time of operation, recovery time of bladder function, hospitalization time and so on were no significant difference in the perioperation period(P>0.05);5.In lymph node metastasis was significantly lower than the control group, the positive rates were 22.73% and 43.48%, there was statistical significant difference between the two groups(P<0.05);and they in postoperative vascular lymphatic invasion, the rate of vaginal residual tumor margin, and postoperative recurrence rate or tumor free survival time, no statistical significance(P>0.05).Conclusion: 1.Neoadjuvant Chemotherapy reduces the stage Ⅰ B2- Ⅱ B cervical cancer tumor volume in different extent;2. Neoadjuvant Chemotherapy for adenocarcinoma curative effect is lower than squamous cell carcinoma;3.Neoadjuvant Chemotherapy in part of stage ⅡB patients improved their the parametrial infiltration degree(thickening parametrial tissue becomes soft, nodular sensation disappeared), which can make the operation, also improve the operation resection and thoroughness;4. Neoadjuvant Chemotherapy reduces incidence of the pelvic lymph nodes metastasis in patients with cervical cancer of stageⅠB2-ⅡB;5.Neoadjuvant Chemotherapy in improving perioperation period no significant effect in patients with cervical cancer of stage ⅠB2-ⅡB;6. Neoadjuvant Chemotherapy in improving their postoperative vascular lymphatic invasion, the rate of vaginal residual tumor margin, and so on no significant effect in patients with cervical cancer of stage ⅠB2-ⅡB;7.Neoadjuvant chemotherapy in determine the postoperative recurrence rate,tumor-free survival time and other aspects still need more large samples to confirm.