Neoadjuvant Chemotherapy Followed By Surgery Versus Concurrent Chemotherapy In Patients With Locally Advanced Cervical Cancer: A Clinical Controlled Trial

Objective To compare the short-term efficacy,adverse effects,economic benefits and quality of life of neoadjuvant chemotherapy followed by surgery versus concurrent chemoradiotherapy in patients with locally advanced cervical cancer.Methods We selected sixty patients with locally advanced cervical cancer who were treated in the First People’s Hospital of Yichang and the Cancer Hospital of Yichang between January 2016 and January 2017.They were randomly divided into neoadjuvant chemothapy plus surgery group(n=30)and concurrent chemoradiotherapy group(n=30),statistical analysis two groups of patients with the short-term effects,adverse reactions,economic benefits,quality of life and recurrence rate.The quality of life was measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionaire(EORTC QLQ-C30)and the Cervix Cancer Module(EORTC QLQCX24).Results 1.There was no significant difference in short-term effects between the two groups(100%vs90%,P>0.05).2.The results of QLQ-C30 questionnaire survey showed that there were no significant difference in the evaluation of body function,role function and cognitive function between the two groups(P > 0.05).Comparison of concurrent chemoradiotherapy group,the evaluation of emotional function and social function in the neoadjuvant chemotherapy group were higher,the incidence of nausea and vomiting,shortness of breath,insomnia,diarrhea were lower,the incidence of constipation was higher,the economic difficulty score was lower,the difference were statistically significant(P<0.05).QLQ-CX24 survey results showed that the incidence of stool,frequent urination,vaginal discharge,vaginal tightening,vaginal dryness,sexual intercourse pain in the neoadjuvant chemotherapy plus surgery group were lower than in the concurrent chemoradiotherapy group,the difference were statistically significant(P < 0.05).3.There was significant difference about bone marrow inhibition rate between the two groups(83.3%vs100%,P<0.05).The rate of gastrointestinal reaction,neurotoxicity,liver and kidney injury of neoadjuvant chemotherapy plus surgery group were lower than in the concurrent chemoradiotherapy group,the difference were statistically significant(P <0.05).There was no significant difference between the two groups of alopecia(P>0.05).The concurrent chemoradiotherapy group showed different degrees of chronic radiation cystitis and enterocolitis.4.The average hospitalization expenses and hospitalization time of neoadjuvant chemotherapy plus surgery group were all lower than the concurrent chemoradiotherapy group(P < 0.05).5.Two groups had no recurrence after 1 years of follow-up.Conclusion Compared with concurrent chemoradiotherapy,neoadjuvant chemotherapy followed by surgery for locally advanced cervical cancer has similar short-term effects,higher quality of life,light adverse reactions,more economical benefits.The long-term effect was uncertain and need to be followed up further.We could choose individualized treatment based on the patient’s economic situation,the requirements for the quality of life and survival time in clinically.