The Recent Therapeutic Effect Of Neoadjuvant Intraarterial Chemotherapy In Cervical Carcinoma

Cervical cancer is a global public health problem, representing the second most common neoplasia among women worldwide, the incidence of cancer of the cervix is lower than breast cancer. In the recent years the incidence of the cervical cancer has increasing tendency. The effect of radical hysterectomy is positive for the cervical cancer with stage Ib2-II,but the five years survival rate is not higher for the bulky tumor,much more hemorrhage or obvious parametrial invasion ,it is because of the tumor not controlled,recurrence and metastasis, finding a new therapy is very important. Cromer firstly utilized intraarterial infusion chemotherapy in the clinical, gradually developed later and proposed neoadjuvant intraarterial chemotherapy(NAIC), the effect of NAIC is better for the cancer of the cervix, so we explore the recent therapeutic effect of NAIC in cervical cancer.Objective:To explore the recent therapeutic effect of neoadjuvant intraarterial chemotherapy in patients with stage Ib2~II cervical cancer.Methods:A retrospective study was carried out on 44 patients with stageⅠb～Ⅱcervical carcinoma with surgical operation admitted in the first affiliated hospital of Dalian Medical University from Jan. 2003 to Dec.2006. These patients were divided into two groups: preoperative chemotherapy group(13cases) and operative group as comparison (31cases). Of all the patients in preoperative chemotherapy group , 2 cases in stage Ib2, 3 cases in stage IIa, 8 cases in stage IIb, 13 cases in preoperative chemotherapy group were treated with chemotherapy by internal iliac arterial infusion and embolism in 10~16 days before surgery treatment. Using a regimen of cisplatin,5-fluorouracil,mitomycin and camptothecin,31 patients in comparison group , 10 cases in stage Ib1, 21cases in stage IIa. The effect and safety of neoadjuvant intraarterial chemotherapy in the treatment of early and middle cervical cancer were evaluated by average operative time ,operative blood ,post-operative complications and pelvic lymph node metastasis.Results: The overall clinical response rate of the neoadjuvant intraarterial chemotherapy for the 13 patients in preoperative group was 76.92%,the tumor volume and the ulcer were differently smaller, the blood decreased, 8 cases in stage IIb with parametrial invasion had a significant reduction, reduced clinical stage, and underwent radical surgery; average operative time , post-operative complications between the two groups had no obvious difference (p>0.05), but average operative blood in two group was 400+25ml,600+30ml ,preoperative chemotherapy group was lower than operative group, average operative blood between the two groups had obvious difference (p=0.02,p<0.05); pelvic lymph node metastasis in group A was 15.38%, pelvic lymph node metastasis in preoperative chemotherapy group was 48.39%, pelvic lymph node metastasis in preoperative chemotherapy group was lower than those of comparison group , pelvic lymph node metastasis between the two groups had obvious difference (p=0.04,p<0.05).Conclusions: neoadjuvant intraarterial chemotherapy is safe and efficient in early and middle bulky and locally advanced cervical cancer before surgery. It can reduce the tumor volume,ulcer blood , reduce parametrial invasion and clinical stage, raise the radical surgery, reduce average operative blood loss and operative time , decrease pelvic lymph node metastasis, neoadjuvant intraarterial chemotherapy is worth popularizing in clinical treatment.