Abstract
ObjectiveThis study aims to retrospectively evaluate and compare the clinical efficacy in patients with stage IB2 and IIA cervical cancer, who treated with neoadjuvant chemotherapy combined with brachytherapy or not before radical hysterectomy.MethodsThe data of patients who have diagnosed with stage IB2 and IIA cervical cancer between January 2010 and December 2013 were retrieved through the Hospital Information System (HIS) of Gansu Provincial Maternal and Child Health Hospital. Patients were divided into two groups: neoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy group (NACT+BT Group) and direct radical hysterectomy group (RH Group). The rate of adjuvant radiotherapy, progression-free survival (PFS), and overall survival (OS) were compared between the two groups.ResultsA total of 183 patients were included in this study with 82 in the NACT+BT group and 101 in the RH group. The median follow up duration was 44.9 months for the NACT+BT group and 38.1 months for the RH group. The 5-year PFS for NACT+BT Group was 93.8%, which was significantly higher compared to the RH group (77.2%, P= 0.0202). The rate of postoperative adjuvant pelvic radiotherapy was significantly lower in the NACT+BT group compared to the RH group (30.49% vs 79.21%; P <0.05). COX multivariate analysis showed that NACT+BT increased PFS by 29% compared with RH treatment, and Positive margin decreased PFS and OS by by 4.7 and 6.87 times, respectively.ConclusionNeoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy (NACT+BT) can extend PFS, reduce postoperative pathological risk, and postoperative adjuvant pelvic radiotherapy compared to the direct radical hysterectomy (RH).
Highlights
Cervical cancer is the second most common cancer and the third leading cause of cancer-related deaths among women in less developed countries
According to the cervical cancer Federation of Gynecology and Obstetrics (FIGO) guidelines, In the present study, we explored whether neoadjuvant chemotherapy combined with brachytherapy can 1) reduce the rate of supplementary pelvic radiotherapy and chemotherapy and 2) improve the survival in patients with stage IB2 and IIA cervical cancer [5]
In the Neoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy group (NACT+BT group), patients must complete both NACT+BT and radical hysterectomy
Summary
Cervical cancer is the second most common cancer and the third leading cause of cancer-related deaths among women in less developed countries. There are 5.27 million new cases and 2.65 million deathseach year [1], and nearly 90% of cervical cancer deaths are recorded in developing countries due to the inadequate public health service system and limited coverage of cervical cancer screening [2]. The National Comprehensive Cancer Network (NCCN) guidelines recommend chemoradiation for LACC, therapeutic methods vary greatly in different parts of the world. In North America, chemoradiation is the most popular method, whereas in Europe, Asia, and Latin America, neoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy is the main therapeutic approach. According to the cervical cancer FIGO guidelines, In the present study, we explored whether neoadjuvant chemotherapy combined with brachytherapy can 1) reduce the rate of supplementary pelvic radiotherapy and chemotherapy and 2) improve the survival in patients with stage IB2 and IIA cervical cancer [5]
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