A Comparative Study On The Treatment Process,Adverse Reactions And Prognosis Of Locally Advanced Cervical Cancer Treated By Neoadjuvant Chemotherapy Before Radical Hysterectomy,Directly Radical Hysterectomy And Concurrent Chemoradiotherapy

Objective: Locally advanced cervical cancer(LACC)accounts for more than half of the new cervical cancer cases in China,but its treatment methods are still controversial.We compared the differences of neoadjuvant chemotherapy(NACT)before radical hysterectomy(RH),directly radical hysterectomy and concurrent chemoradiotherapy(CCRT)in treatment process,adverse reactions and prognosis,according to a retrospective analysis,to discuss the value of neoadjuvant chemotherapy,aimed at providing data for large-scale clinical researches in the future.Method: The patients diagnosed with cervical cancer as FIGO stage IB2 and IIA2 in The Fourth Hospital of Hebei Medical University between February 2008 to February 2015 were retrospectively analyzed.The patients were divided into three groups according to the treatment methods:neoadjuvant chemotherapy before radical hysterectomy group,directly radical hysterectomy group and concurrent chemoradiotherapy group.The comparisons included: the curative effect before and after neoadjuvant chemotherapy;the operative time,the intraoperative bleeding,the blood transfusion rate,the intraoperative and postoperative complications,the postoperative pathology and the postoperative adjuvant treatment of neoadjuvant chemotherapy before radical hysterectomy group and directly radical hysterectomy group;the average total treatment months and times of three groups;adverse reactions of three groups;the 3-year disease free survival(DFS)rate,overall survival(OS)rate and recurrence-metastasis rate of three groups.Results:1.The total effective rate of neoadjuvant chemotherapy was 50 percent.The curative effect was related with chemotherapy regimens,and paclitaxel with carboplatin was better than with oxaliplatin or neidaplatin.Patients’ age,FIGO stagement,and pathological type didn’t make differences to the curative effect.2.There was no difference in operation time,blood transfusion rate,intrapostoperative complications between NACT+RH group and RH group.The amount of blood loss in NACT+RH group was less than that in RH group when with laparoscopy,and the difference was statistically significant.The positive rate of lymph node metastasis in NACT+RH group was higher than that in RH group,and the difference was statistically significant.There was no significant difference in deep cervical invasion,lymphovascular space invasion,parametrial involvement and positive surgical margin.There was no difference in the postoperative adjuvant therapy between NACT+RH group and RH group,but in the incomplete rate of postoperative adjuvant treatment,NACT+RH group was higher than that in RH group,and the difference was statistically significant.3.There was no significant difference in the average total treatment months among NACT+RH group,RH group and CCRT group,but the average total treatment times of NACT+RH group were higher than those of RH group and CCRT group,and the difference was statistically significant.4.There was no operative related adverse reactions in CCRT group.And there was no significant difference among NACT+RH group,RH group and CCRT group in non-operative side effects.5.There was no significant difference in 3-years OS,DFS and recurrencemetastasis rate among NACT+RH group,RH group and CCRT group.Conclusion:1.There was no difference in prognosis among NACT+RH group,RH group and CCRT group in the treatment of locally advanced cervical cancer,2.In the treatment process and adverse reactions,concurrent chemoradiotherapy had less treatment times,without operative related adversereaction,and was more easily accepted by patients.It is the first choice for the treatment of IB2 and IIA2 cervical cancer.3.Neoadjuvant chemotherapy could reduce the size of tumor,improved the rate of complete resection and decreased the amount of intraoperative bleeding.