A Clinicil Study On The Preoperative Neoadjuvant Chemoradiotherapy Using Nedaplatin Combined With Imrt Of Cervical Cancer In Stage ⅠB2-Ⅱb

Objective:To observe the objective response rate and security about the preoperative neoadjuvant chemoradiotherapy by using nedaplatin combined with IMRT of cervical cancer in stage IB2～IIB who cannot be treated with surgery firstly,and follow up the Disease-free survival and Overall survival about the patients.Methods:All 42 tissues were enrolled guangxi zhuang autonomous region people’s hospital from Janualy 2010 to July 2013,among which 11 in stage IB2,8 in stage IIA and 23 in stage IIB.Patients who was enrolled all accepted neoadjuvant chemotherapy with NDP 30mg/m2,weekly,5 weeks;combined with IMRT.When Concurrent chemoradiotherapy finished,got the radical hysterectomy + pelvic lymph node cleaning operation followed.If postoperative routine pathological examination showed the patients without any high risk recurrence factor,the patients were directly got into the observation.If there were any risk factors,the patients were continued to accept chemotherapy(nedaplatin+paclitaxel)4 cycles followed.Evaluate the objective response rate and safety of treatmen,the quality of life of the patients,and follow up the Disease-free survival and Overall survival about the patients.Results:In the process of CCRT,24 patients appeared in bone marrow suppression,including I degree 4 cases(9.52%),2 degrees 16 cases(38.10%),III degree of 5 cases(11.90%),no IV degree bone marrow suppression were observed.24patients appeared gastrointestinal reaction,including I degree 12 cases(28.57%),2 degrees 12 cases(28.57%).No III～IV degree gastrointestinal reaction were observed.No hepatic functional impairment、renal impairment、anaphylaxis and nervous lesion were founded.After CCRT finished 2-4 weeks,all patients accepted radical hysterectomy and pelvic lymph node cleaning operation.The curative effect evaluation of disease response rates and control rates were 100%.24 patients reached pathological complete response,and did not have any high risk recurrence factor(57.14%),got in the group of observation.3 patients reached pathological complete response,but had pelvic lymph node metastasis putely(7.14%).15 patients could not reach pathological complete response(35.71%).Patients who had high risk recurrence factors continued to accept 4 cycles chemotherapy with nedaplatin+ paclitaxel.Got into observation after chemotherapy finished.By April 2014,6 patients lost to follow-up.4 patients died.3 patients showed recurrence locally,and 1 patient showed metastasis in the 32 patients who still alive.It was less than 24 months from inconsequential time to this cut-off time about 15 patients.5 patients reached 3-years OS,12 patients reached 2-years OS but not reached 3-years OS yet.By April 2015 at last,17 patients lost follow-up totally.5 patients died.20 patients who still alive had survival-time longer than 20 months,median survival-time were 37.5 months.11 patients reached 3-years OS(55%),2 patients reached 2-years OS but not reached 3-years OS yet(10%).Compared to the time that 4 weeks after operation,quailty of life had increased in April 2014 and April 2015.Conclusion:Nedaplatin combined with IMRT was used in preoperative concurrent chemoradiotherapy of cervicaal cancer in stage IB2-IIB showed good recent curative,good patient-tolerance,and the quality of long-term survival as well.The benefits to DFS and OS of patients still had to be observed continue.