| ObjectiveCervical cancer is one of the most common gynecologic tumors. It is second only to breast cancer as the most common female malignancy in both incidence and mortality worldwide. Local bulky cervical cancer is a special type of cervical cancer. It is difficult to deal with patients with early-stage bulky cervical cancer, because of the high recurrence rate and worse prognosis, compared to those with smaller tumors at the same stage. According to the NCCN principles of treatment for cervical cancer, patients with stage ⅡA1cervical cancer can accept radical operation directly. However, it is difficult to perform an operation in patients with local bulky cervical mass at stage ⅡA1, especially when the pelvic examination result is not so good. For patients at stage ⅡA2, the FIGO principles recommend neoadjuvant chemotherapy followed by radical operation, but it is not sure whether the effect is good. For patients with local bulky cervical mass at stage IIA, if we can make an induction of tumor shrinkage before a surgery, the surgery will be performed more successful especially when the surgery is performed through laparoscopy. Neoadjuvant chemotherapy (NACT) is a new treatment method. However, the use of NACT is still controversial in the treatment of cervical cancer. Some studies have shown great advantages of NACT in the shrinkage of local mass in cervical cancer. This study intends to explore the curative effect of NACT in stage IIA cervical cancer patients with local mass greater than3centimeter.MethodsA retrospective analysis of78cases between September2008to December2014, all cases enrolled were stage IIA cervical cancer patients with local mass greater than3centimeter. All the patients were divided into two groups:the study group (47cases) and the control group (31cases). Patients enrolled the study group were treated with neoadjuvant chemotherapy for one to three cycles followed by radical hysterectomy(type Ⅲ surgery) and pelvic lymphadenectomy2-3weeks after the chemotherapy. The neoadjuvant chemotherapy was consisted of1) cisplatin, vincristine and bleomylin(BVP);2) paclitaxel and carboplatin(TC);3) paclitaxel and nedaplatin(TN). Another31patients as control group were treated with radical surgery(type Ⅲ) and pelvic lymphadenectomy alone. The operation time, bleeding volume, pelvic lymph node metastasis, depth of myocervical invasion, vaginal resection margin and vascular invasion were compared between the two groups. Besides, the size change of local mass and the remission rate were observed after chemotherapy. Moreover, the different remission rates were compared in different chemotherapy regimen.Results1. The mean operation time was shorter in the study group than that in the control group, and the mean bleeding volume was lower in the study group than that in the control group, however, there was no significant difference (p>0.05). However, the comparision had significant difference in patients who accepted laparoscopy.2. The margin positive rate in the study group was lower than that in the control group (p<0.05), the vascular invasion rate in the study group was lower than that in the control group (p<0.05), and the deep myometrial invasion rate was also lower in the study group than that in the control group (p<0.05). The ratio of pelvic lymph node metastasis was lower in the study group than that in the control group, but there was no significant difference (p>0.05). However, the comparision had significant difference between post-chemotherapy patients who had remission and patients who accepted surgery directly.3. The local cervical mass was shrunk significantly after the neoadjuvant chemotherapy (p<0.01). The overall clinical remission rate was78.72%. Among patients at stage IIA1, the overall remission rate was75.00%; among patients at stage IIA2, the overall remission rate was90.91%. There were no progressive ones during the neoadjuvant chemotherapy.4. The remission rate was different in patients treated with different chemotherapy regimen. The overall remission rate was86.36%in patients treated with TC chemotherapy regimen,81.82%in patients treated with TN chemotherapy regimen, and64.29%in patients treated with BVP chemotherapy regimen. However, there was no significant difference (p>0.05).ConclusionNeoadjuvant chemotherapy can shrink the tumor size in cervical cancer patients at stage IIA with local mass greater than3centimeter. The shrinkage of the tumor size will bring advantages to laparoscopy surgery performing, such as reduce operation time and bleeding volume. Meanwhile, the neoadjuvant chemotherapy can lower the margin positive rate, vascular invasion rate and deep myometrial invasion rate, and can also lower the pelvic lymph node metastasis rate in patients who had remission. The remission rate is different in patients treated with different chemotherapy regimen. The result hint that chemotherapy based on platinum seems to have better effect. |
PDF Full Text Request