| objective: The explore the curative effect of metaphaseor advanced cervical cancer neoadjuvant chemotherapy.Methods: Choose between January2011-January2014in ourhospital90cases of Ib2-IIb cervical cancer patients who pathologicdiagnosis local tunor diameter greater than or equal4cm were analyzedretrospectively. All patients had complete clinical and pathologicaldata.Divided into observation group and surgery group,60cases ofsurgicaltreatment directly, as control group, according to the situation ofoperation and postoperative pathologic result to decide whether to requirefollow-up treatment and related treatments. The remaining30cases givessystemic vein chemotherapy in1-3period of treatment, the assessmentwill be made less than IIb lesions significantly shrink the radical surgery,as a group. On the results were retrospectively analyzed.The tumor size, improvement of utero-tissue infiltration and adverseeffects of NACT were reviewed.Analyze the related factors that influencethe short-term effect of neoadjuvant chemotherapy.Compare two groupsof the operation time, intraoperative blood loss and the incidence ofpostoperative complications.And we also compare two groups of theincidence of pelvic lymph node metastasis,cervical deep muscle infil- tration,invasion,utero-tissue infiltration,vascular space involvement andtumor positive rate of the vaginal incisal margin,and so on and so forth.Results:30patients with cervical cancer after1-3courses ofchemotherapy tumor diameter majority have different degrees ofshrink,including5cases of patients with invalid (PD+SD), including:3cases were squamous carcinoma, adenocarcinoma,8cases. The totaleffective rate was83.3%, NACT short-term curative effect is certain.Different tumor category squamous carcinoma total effective rate92.3%,adenocarcinoma of total effective rate25%, p <0.05, thedifference was statistically significant. There were3complete responsecases,22partial response cases and，and stable disease(SD)in5patient.Surgery revealed positive nodes in36.67％primary surgery grouppatients and in17.86％neoadjuvant chemotherapy grouppatients(p<0.05).Similar resultsoccurred with vascular spaceinvolvement：46.67％in the primary surgery group compared to25％inthe neoadjuvant chemotherapy group(p<0.05).However，the rates of deepstromal invasion was found in43.08％of the patients in the primarysurgery group，while47.91％Showed in the neoadjvant chemotherapygroup(P>0.05).signif-icant difference were not observed in tumor positiverate of theincisal margin and parametrial involvement.Vaginal cut edgetransfer rate of chemotherapy group3.5%, suigery group scores of5.5%.As far as factors related to surgery quality are concerned，the neoadjuvant chemotherapy group is superior to the primary surgerygroup，including the blood loss during operation.(P<0.05). Chemotherapygroup operation time and simple operation time has no obvious differencebetween surgical group(P>0.05). Survival rate comparison, observationgroup3years overall survival was85.0%, control group was83.5%,p>0.05, there was no statistically significant difference.3yeardisease-free survival rate ofpreoperative chemotherapy group was79.6%,control group was50%, p<0.05, the difference was statisticallysignificant. The side reaction of chemotherapy in42cases,8cases withnoresponse, the main reaction characterized by nausea, vomiting, slightbone marrow suppression and hair loss. But all are mild reaction, givesymptomatic treatment after all can normal complete chemotherapytreatment, chemotherapy after2weeks review of routine blood, noobvious abnormal was found in all blood biochemistry, liver and kidneyfunction.Conclusion:Neoadjuvant chemotherapy of Ib2-stage IIb cervicalcancer curative effect significantly, improve the resection rate, reduce theintraoperative blood loss, lower vascular infiltration, lymph nodemetastasis and improve disease-free survival rate.and adverse reactionmild, safe and effective.Neoadjuvant chemotherapy in squamouscellcarcinomas of the treatment effect is better than that ofadenocarcinoma. |
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