Comparative Clinical Research Of The Short-term Efficacy And Security Of Preoperative Brachytherapy Combinded Concurrent Chemotherapy And Neoadjuvant Chemotherapy For Patients With FIGO Stage â… B2 And â…¡A2 Cervical Cancer

Objective:To comparative research and evaluate short-term efficacy and security of preoperative brachytherapy combinded concurrent chemotherapy and neoadjuvant chemotherapy for patients with FIGO stage ⅠB2 and ⅡA2 cervical cancer.Methods:According to some conditions, total of 88 patients with FIGO stage IB2 and ⅡA2 cervical cancer, including IB2 37 cases and IIA2 51cases, were enrolled retrospectively treated in the department of Gynaecology of Drum Tower Hospital affiliated to Medical College of Nanjing University from June 2010 to Jan 2016. According to the different preoperative regimens, they were categorized into three groups, including directly radical surgical group (Group A,28 cases), neoadjuvant chemotherapy group (Group B,45 cases), and brachytherapy combinded concurrent chemotherapy group(brachy-chemotherapy group) (Group C,15 cases). Open or laparoscopic radical hysterectomy and pelvic lymph node dissection (or para-aortic lymph node dissection) was performed following the later two regimens. Young cervical squamous-cell carcinoma patients (age<45 years) underwent ovarian transposition. Some patients need supplementary adjuvant chemoradiotherapy according postoperative pathologic risk factors when necessary. To compare three groups of average intra-operative blood loss, average surgical time, average postoperative hospital stay, clinical pathological remission rate including tumor regression rate, vascular and neural invasion rate, deep muscle invasion rate and node-positive rate, incidence of complications and 3-year overall survival. To evaluate the relationship between tumor subtype, size, grade and efficacy of the two adjuvant treatments and to analysis its survival prognostic risk factors. Results:Postoperative hospital stay was significantly longer in group B than group A. Intra-operative blood loss was significantly more in group B than in group C. These difference were statistically significant (P<0.05). In terms of intra-operative blood loss there were no significant difference between in group A and B, C. Vascular invasion rate, deep muscle invasion rate, lymph node positive rate and intermediate- or high-risk rate were all less in group C than in group A and B. All these difference were statistically significant (All P<0.05), and no statistically significant difference were noted in latter A and B groups (P>0.05). The preoperative therapeutic effective rate of 85.7% in group C was much better than 36.4% in group B with a statistically significant difference (P<0.05). Three postoperative complication rates were 37.7%,24.4% and 13.3% respectively. The occurrence rate of surgery-related complications and nerve invasion rate have no statistically significant difference among three groups (P>0.05). Median survival time and 3-year survival in group A, B and C were 41.4 months (95%CI:34.1 months-38.6 months) and (64.3±9.7)%,33.8 months (95%CI: 28.9 months -38.7 months)and (44.2%±11.3)%,41.4 months(95%CI:36.7 months-46.1 months) and (68.2±20.7)% respectively, where there were no statistically significant difference among three groups (P>0.05). There were also no significant difference in 3-year overall survival among three groups of 56 cases of intermediate-or high-risk,35 cases of abdominal surgery and 53 cases of laparoscopic surgery (All P> 0.05). When tumor subtype of adenocarcinoma, too large diameter (> 5cm), grade G3, there was no significant difference in efficacy between in the two adjuvant treatment groups (P> 0.05). Multivariate COX proportional hazards regression analysis showed that lymph node metastasis was an independent risk factor of decreasing survival time (P<0.05). Conclusions:Brachytherapy combinded concurrent chemotherapy and neoadjuvant chemotherapy as preoperative adjuvant regimens all could improve pathological remission rate. Preoperative brachytherapy combinded concurrent chemotherapy is superior to neoadjuvant chemotherapy in terms of efficacy. Preoperative brachytherapy combinded concurrent chemotherapy is an effective and safe regimen for patients with stage ⅠB2 and ⅡA2 cervical cancer.