Comparative analysis of neoadjuvant therapies in stage Ⅰ b2 and Ⅱ a2 cervical carcinoma
10.3760/cma.j.issn.0529-567x.2012.06.011
- VernacularTitle:Ⅰb2期和Ⅱa2期子宫颈癌新辅助治疗方式的比较分析
- Author:
Jinlong HU
;
Lingying WU
;
Ning LI
;
Xiaoguang LI
;
Manhi HUANG
;
Rong ZHANG
- Publication Type:Journal Article
- Keywords:
Uterine cervical neoplasms;
Neoplasm staging;
Chemotherapy,adjuvant;
Brachytherapy
- From:
Chinese Journal of Obstetrics and Gynecology
2012;47(6):452-457
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the clinical efficacy of neoadjuvant chemotherapy plus vaginal intracavitary irradiation,neoadjuvant chemotherapy alone and vaginal intracavitary irradiation alone followed by radical hysterectomy in patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma.Methods Between January 2000 and December 2009,224 patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma ( tumor diameter ＞ 4 cm) received neoadjuvant therapy combined surgery in Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences were respectively analyzed,and they were divided into 3 groups according to the preoperative neoadjuvant therapy,the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group (chemotherapy combined irradiation group,n =86 ),the neoadjuvant chemotherapy alone group ( chemotherapy group,n =48 ),the vaginal intracavitary irradiation alone group ( irradiation group,n =90).The efficacy,postoperative risk factors,postoperative adjuvant therapy and survival were compared among the 3 groups.Results Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the response rate (RR) were respectively 62％ (53/86),42％(20/48) and 37％ ( 33/90 ),and there was significant difference ( P =0.003 ).The comparison of deep stromal invasion,lymph node metastases,lympho-vascular space involvement(LVSI) and other risk factors among the 3 groups,which showed that there were no statistically significant differences ( P ＞ 0.05 ).In chemotherapy combined irradiation group,the percentage of stromal invasion ≥ 1/2 was lower than that in chemotherapy group [ 53％ ( 46/86 ) vs.73％ ( 35/48 ),P =0.027 ],and the percentage of lymph node metastases was significantly lower than irradiation group [ 17％ ( 15/86)vs.29％ (26/90),P =0.046],and the risk factors-free rate was significantly higher than chemotherapy group [ 44％ (38/86)vs.25％ ( 12/48 ),P =0.028 ].Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the percentage of postoperative radiation therapy were respectively 47％ (40/86),67％ (32/48)and 62％ (56/90),and the differences were statistically significant (P =0.035).The five-year disease free survival (DFS) was 79％,75％ and 78％,respectively.The five-year overall survival (OS) was respectively 81％,78％ and 81％ among 3 groups,and there were no statistically significant differences (P ＞ 0.05).Among 224 patients,the five-year DFS of the patients with 0,1 and ≥ 2 risk factors after surgery were 90％,75％ and 57％,and OS were 95％,82％ and 65％,and there were no statistically significant differences( P ＜ 0.01,respectively).Of patients without postoperative risk factors,the five-year OS in those without receiving postoperative radiation therapy was 96％,while 89％ in received postoperative radiation therapy patients,there were no statistically significant differences ( P =0.263 ).Conclusion There are no differences of DFS and OS among the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group,the neoadjuvant chemotherapy alone group and the vaginal intracavitary irradiation alone group patients with stage Ⅰ b2 and Ⅱ a2.Patients without risk factors after neoadjuvant therapies have better prognosis.
