Therapeutic Value Of Neoadjuvant Chemotherapy For Cervical Cancer And A Meta-Analysis

Cervical cancer is one of the most common gynecological manlignancy in women worldwide,the incidence of disease is the first place in some developing countries.Although surgery and radiation are the conventional treatment methods for cervical cancer,the effect of the treatment did not improve in the past 40 years,the overall 5-year survival is about 50%. This study is to probe the prognosis factors of cervical cancer,to evaluate the value of neoadjuvant chemotherapy for cervical cancer and a "hotspot" of treatment with evidence based medicine's method.The data come from the Department of gynecology oncology of Guangxi Tumor Hospital.Prognosis fanctors of cervical cancerOBJECTIVE:To evaluate the prognosis factors of cervical cancer.METHODS:We collect the data of 1057 patients who were hospitalized in the Department of gynecology oncology of Guangxi Tumor Hospital from Jan.1985 to Dec.2005.Analyzing the prognosis factors of cervical cancer,such as age,the type of pathology,histology grade,FIGO stage,with or without local or distant recurrence,survival analyses were performed using the life-table method.The log-rank test was used for univariate analyses and the Cox proportional hazards regression model was used for multivariate analyses.RESULTS:In univariate analysis the prognostic factors were the FIGO stage,local or distant recurrence,multivariate analysis showed that FIGO stage,local or distant recurrence were the most important prognostic factors.Of FIGO stageⅢb squamous carcinoma patients,the prognoses of those who were younger than and exactly 40 are darkened comparing with those who were older than 40. CONCLUSIONS:FIGO stage,with or without local or distant recurrence are the prognosis factors of cervical cancer.Of stageⅢb squamous carcinoma patients who were younger than and exactly 40 had poor prognoses. Therapeutic value of neoadjuvant chemotherapy for cervical cancerOBJECTIVE:To evaluate the therapeutic value of neoadjuvant chemotherapy for cervical cancer.METHODS:We collected the data of patients who were hospitalized in the Department of gynecology oncology of Guangxi Tumor Hospital from Jan.1986 to Dec.2005. Totally 24 patients were treated with neoadjuvant chemotherapy followed by surgery,30 patients were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy were performed when necessary,116 patients were treated with neoadjuvant chemotherapy followed by radiotherapy.Another 29 patients were treated surgery alone,42 patients were treated with surgery and radiotherapy were performed when necessary,89 patients were treated with radiotherapy alone as the control groups of the above-mentioned groups respectively.We tried to find out the superiority of neoadjuvant chemotherapy followed by surgery compared with conventional radiotherapy in the patients of FIGO stageⅡb:17 patients in the study group and 16 patients in the control group.Ninety-two stageⅢb patients who were treated with neoadjuvant chemotherapy followed by radiotherapy were selected out to compare with 62 patients with the same stage who were treated with radiotherapy alone.Toxicities of neoadjuvant chemotherapy were evaluaded simultaneously.RESULTS: The survival rate of neoadjuvant chemotherapy followed by surgery versus surgery alone are 79.2%VS51.7%,P=0.685,neoadjuvant chemotherapy followed by surgery and radiotherapy were performed when necessary versus surgery alone and radiotherapy were performed when necessary are 83.3%VS73.8%,P=0.369;neoadjuvant chemotherapy followed by radiotherapy versus radiotherapy alone are 41.4%VS30.3%,P=0.772.The survival rate of neoadjuvant chemotherapy followed by surgery of FIGO stageⅡb versus radiotherapy alone are 76.5% VS50.0%,P=0.334,while there are 57.6%VS72.6%,P=0.058 in neoadjuvant chemotherapy followed by radiotherapy group versue radiotherapy alone group in stageⅢb patients. CONCLUSION:Neoadiuvant chemotherapy didn't show benefit for prognosis. Therapeutic value of intra-arterial infusion neoadjuvant chemotherapy for cervical cancerOBJECTIVE:To evaluate the therapeutic value of intra-arterial infusion neoadjuvant chemotherapy for cervical cancer.METHODS:We collected the data of patients who were hospitalized in the Department of gynecology oncology of Guangxi Tumor Hospital from Jan.1997 to Dec.2005.Thirty-two patients performed neoadjuvant chemotherpy by intra-arterial infusion were selected as a study group while 34 patients performed neoadjuvant chemotherapy by intravenous drip as the control group to see whether there was difference between these two ways.Survival rate was calculate and tested using the chi-square test. Toxicities of neoadjuvant chemotherapy were evaluaded simultaneously.RESULTS:The survival rate of neoadjuvant chemotherpy performed by intra-arterial infusion versus intravenous drip is 47.1%VS62.5%,P=0.103.CONCLUSION:Neoadjuvant chemotherapy performed by intra-arterial infusion didn't show superiority.Toxicities were tolerant in both groups.Neoadjuvant chemotherapy followed by surgery versus surgery alone for stageⅠb cervical cancer:a Meta-analysisOBJECTIVE:To assess the efficiency of neoadjuvant chemotherapy followed by surgery in patients with stageⅠb cervical cancer,and to analyze factors influencing the efficiency. METHODS:A systematic review of neoadjuvant chemotherapy followed by surgery was performed by searching databases including PUBMED,EMBASE,CBM and COCHRANE LIBRARY.Literature references were checked at the same time,no language restriction when searching.Trials were collected and evaluated according to the inclusion and exclusion criteria.RESULTS:Three trials(all RCTs)involving 599 patients were included.Pooled 5-year survival rate OR=1.47,95%CI(1.04,2.10),P=0.031＜0.05,demonstrated a statistically significance.Recurrence or metastasis rate's RR=0.51,95%CI(0.33,0.80),P=0.003. Pathological risk factors were not decreased significantly when compared to the control group,including parametrial infiltration,RR=0.45,95%CI(0.15,1.34),P=0.15;vascular space involvement RR=0.32,95%CI(0.07,1.52),P=0.153;lymph node metastasis RR=0.43,95% CI(0.17,1.05),P=0.064.CONCLUSION:Neoadjuvant chemotherapy eliminate recurrence and metastasis,improve the 5-year survival rate,but can't decrease occurrences of pathological risk factors such as parametrial infiltration,vascular space involvement,lymph node metastasis.