Retrospective Analysis Of Neoadjuvant Chemotherapy For Locally Advanced Cervical Cancer

Research objectiveTo explore the factors affecting the short-term efficacy of neoadjuvant chemotherapy(neoadjuvant chemotherapy,NACT)in patients with locally advanced cervical cancer(ⅡB-ⅢB)and the side effects of chemotherapy,and to compare the prognosis of patients with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy(concurrent chemoradiotherapy,CCRT)and direct concurrent chemoradiotherapy,provide new ideas for the comprehensive treatment of patients with locally advanced cervical cancer.Research methods1.Study design:the case data of diagnosed cervical cancer patients were reviewed.According to the 2014 edition of the Federation Internationa of Gynecology and Obstetrics(Federation Internationa of Gynecology and Obstetrics,FIGO),the influencing factors of short-term efficacy and chemotherapy-related side effects of NACT were analyzed,and the prognosis of patients treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy(NACT+CCRT)and direct concurrent chemoradiotherapy(CCRT)were compared.2.Study subjects:patients with stage ⅡB-ⅢB cervical cancer who were treated with NACT+CCRT and CCRT in the First People’s Hospital of Huaihua City from January 2014 to December 2017 were selected.3.Treatment:NACT was treated with platinum-containing dual-drug regimen,which was sensitive to cervical cancer.The chemotherapy cycle was 21 days,the course of treatment was 2-3 cycles,and concurrent chemoradiotherapy were given at the end of 3 weeks.Followed external-beam radiation therapy(external-beam radiation therapy,EBRT)+concurrent chemotherapy+brachytherapy(brachytherapy,BT)recommended by the National Comprehensive Cancer Network(National Comprehensive Cancer Network,NCCN)guidelines.4.The influencing factors of short-term response to neoadjuvant chemotherapy:according to the International Response Evaluation Criteria in Solid Tumors(Response Evaluation Criteria in Solid Tumors,RECIST 1.1),we divided the response to neoadjuvant chemotherapy into four categories:complete remission(complete response,CR),partial response(partial response,PR),stable disease(stable disease,SD)and progressive disease(progressive disease,PD).The response(effective)group to neoadjuvant chemotherapy refers to patients with CR and PR.The non-response(ineffective)group refers to patients with SD and PD,with a response rate of(CR+PR)/all patients who received neoadjuvant chemotherapy.The effects of FIGO stage,age of onset,diameter of cancer focus(d),naked eye type,pathological type,differentiation degree and chemotherapy cycle on the short-term response of NACT were analyzed.5.Adverse reactions related to neoadjuvant chemotherapy:according to the World Health Organization(World Health Organization,WHO)criteria for the classification of toxic reactions to chemotherapeutic drugs.The purpose of this study was to analyze myelosuppression,gastrointestinal reaction,hepatorenal function toxicity and neurotoxicity.The toxicity and side effects were divided into 0 grade,I grade,Ⅱ grade,Ⅲ grade and Ⅳ grade,and the severe toxic reaction was Ⅲ-Ⅳgrade.6.The basic characteristics of patients with different treatment methods in the two groups:the differences of FIGO stage,age of onset,diameter of cancer focus(d),naked eye type,pathological type and degree of differentiation between the two groups were analyzed.7.The prognosis of two different treatments:the Progression free survival(Progression free surviva,PFS)and overall survival(overall survival,OS)of 1-year,2-year and 3-year were compared between the two groups.Results1.A total of 112 patients were included in NACT,66 cases of NACT responders,with a response rate of 58.9%(66/112).There were 3 cases of complete response,63 cases of partial response,35 cases of stable disease,and 11 cases of progressive disease.2.The influencing factors of short-term response to neoadjuvant chemotherapy:FIGO stage,tumor diameter,pathological type and chemotherapy cycle were significantly correlated with NACT response rate(P<0.05).The later the stage and the larger the tumor diameter,the lower the response rate of chemotherapy.The response rate of non-squamous cell carcinoma and 2 cycles of chemotherapy was lower than that of squamous cell carcinoma and 3 cycles of chemotherapy.There was no significant correlation between the age of onset,the type of naked eye,the degree of differentiation and the rate of NACT response(P≥ 0.05).Further analysis showed that tumor diameter≥5.5cm was an independent factor affecting NACT reaction(P<0.05).3.Side effects related to neoadjuvant chemotherapy:the common side effects after NACT were hemoglobin decrease,nausea and vomiting,leukopenia,neutropenia,peripheral neurotoxicity and thrombocytopenia.The severe side effects(Ⅲ-Ⅳ grade)after NACT were leukopenia,neutropenia,nausea and vomiting,hemoglobin decrease and thrombocytopenia.There were no patients with severe liver insufficiency,renal insufficiency and neurotoxicity.4.The basic characteristics of patients with different treatment methods in the two groups:the stage of patients in the neoadjuvant chemotherapy followed by concurrent chemoradiotherapy group was later than that in the direct concurrent chemoradiotherapy group,and the diameter of the cancer focus was larger than that in the concurrent chemoradiotherapy group(P<0.05).There was no significant difference in onset age,naked eye type,pathological type and degree of differentiation among patients with different treatment methods(P≥0.05).5.The prognosis of two different treatments:under the different baseline conditions mentioned above,the result showed that the 1-year PFS of in NACT+CCRT group and CCRT group was 85.7%and 70.2%respectively,and the 1-year PFS in NACT+CCRT group was higher than that in CCRT group.However,there was no significant difference in 1-year OS,2-year and 3-year PFS and OS between the two groups(P≥0.05).Research conclusions1.The short-term response rate of neoadjuvant chemotherapy(NACT)in patients with stage Ⅱ B-Ⅲ B cervical cancer was 58.9%,and the side effects were tolerable.2.The later the stage and the larger the tumor diameter,the lower the response rate of chemotherapy.The response rate of non-squamous cell carcinoma and 2 cycles of chemotherapy was lower than that of squamous cell carcinoma and 3 cycles of chemotherapy,the short-term response of neoadjuvant chemotherapy in patients with tumor diameter≥5.5cm was worse,but the age of onset,the type of naked eye and the degree of differentiation did not affect the short-term response of neoadjuvant chemotherapy.3.Compared with direct concurrent chemoradiotherapy(CCRT),patients with stage ⅡB-ⅢB cervical cancer with later staging and larger tumor diameter,neoadjuvant chemotherapy followed by concurrent chemoradiotherapy is more likely to be used first,under this baseline condition,this can increase the PFS of the patients within 1 year,but not the OS within 3 years.The role of neoadjuvant chemotherapy needs to be further standardized to complete the baseline indicators.