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Comparison of Clinical Efficacy of Three Different Neoadjuvant Approaches (Chemotherapy Combined Vaginal Intracavitary Irradiation, Neoadjuvant Chemotherapy Alone or Radiotherapy) Combined with Surgery for Patients with Stage Ib2 and IIa2 Cervical Cancer

  • Fu, Jian-Hong (Department of Obstetrics and Gynecology, Radiotherapy, The Fifth Affiliated Hospital of Zhengzhou University) ;
  • Gao, Zhan (Department of Obstetrics and Gynecology, Radiotherapy, The Fifth Affiliated Hospital of Zhengzhou University) ;
  • Ren, Chen-Chen (Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University) ;
  • Shi, Yong-Gang (Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University)
  • 발행 : 2013.04.30

초록

A total of 285 patients with stage Ib2 and IIa2 cervical cancer were categorized into three groups, and received preoperative neoadjuvant chemotherapy combined with vaginal intracavitary irradiation, neoadjuvant chemotherapy alone or radiotherapy, respectively. The effective rate of 70.6 % in group 1 was much higher than 41.4% in group 2 (P=0.000) and 46.9 % in group 3 (P=0.000); The percentage of patients receiving postoperative adjuvant therapy was 44.1% in group 1, much lower than 67.8% in group 2 (P=0.001) and 64.6% in group 3 (P=0.004); The percentage of patients with no postoperative risk factor in group 1 was 52.0%, much higher than 32.2% in group 2 (P=0.006) and 35.4% in group 3 (P=0.019); The occurrence rate of surgery-related complications in groups 1, 2 and 3 were 29.4%, 28.7%, and 33.3%, respectively, with no statistical differences among the groups (P=0.981). Regarding preoperative neoadjuvant complications, none were obvious in group 3, while occurrence rates of myelosuppression in groups 1 and 2 were 89.1% and 86.6%, of nausea and vomitting were 78.4% and 78.2%, but without significant differences (all P>0.05). Among 166 patients who received postoperative adjuvant therapy in the three groups, the occurrence rates were: 65.4%, 64.3% and 61.1% respectively for myelosuppression; 42.3%, 38.1%, and 38.9% for nausea and vomiting; 9.6%, 9.5% and 9.7% for urocystitis; and 63.5%, 69.0% and 65.3% enteritis and rectitis. There were no statistically significant differences among them (all P>0.05). The five-year disease-free survival rates (DFS) in groups 1, 2, 3 were 78.3%, 75.1%, 80.9%, respectively; the five-year overall survival rates (OS) were 81.4%, 78.2%, and 81.1%, respectively. The five-year OS of 166 patients receiving postoperative in the three groups were 72.4%, 69.5%, and 71.8%, respectively, with no significant variation (all P>0.05). Although there were no differences among three groups in DFS and OS, preoperative neoadjuvant chemotherapy combined with intracavitary radiotherapy may increase the effective rate and the percentage of patients with no postoperative risk factors and decrease the percentage of patients receiving postoperative adjuvant therapy, thereby decreasing complications indirectly and increasing quality of life.

키워드

참고문헌

  1. Beskow C, Agren-Cronqvist AK, Granath F, et al (2002). Pathologic complete remission after preoperative intracavitary radiotherapy of cervical cancer stage Ib and IIa is a strong prognostic factor for long-term survival: analysis of the Radiumhemmet data 1989-1991. Int J Gynecol Cancer, 12, 158-70. https://doi.org/10.1046/j.1525-1438.2002.01089.x
  2. Cai HB, Chen HZ, Yin HH (2006). Randomized study of preoperative chemotherapy versus primary surgery for stage Ib cervical cancer. J Obstet Gynaecol Res, 32, 315-23. https://doi.org/10.1111/j.1447-0756.2006.00404.x
  3. Chen SW, Liang JA, Shiau AC, et al (2010). Lack of the doserate effect of 192Ir source activity on pelvic control and late complications after high-dose-rate brachytherapy for cervical cancer. J Radiat Res, 51, 173-9. https://doi.org/10.1269/jrr.09089
  4. Demirci S, Ozsaran Z, Ozsaran A, et al (2012). Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy. Eur J Gynaecol Oncol, 33, 62-7.
  5. Eddy GL, Bundy BN, Creasman WT, et al (2007). Treatment of ("bulky") stage Ib cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of the gynecologic oncology group. Gynecol Oncol, 106, 362-9. https://doi.org/10.1016/j.ygyno.2007.04.007
  6. Hosaka M, Watari H, Kato T, et al (2012). Clinical efficacy of paclitaxel/cisplatin as an adjuvant chemotherapy for patients with cervical cancer who underwent radical hysterectomy and systematic lymphadenectomy. J Surg Oncol, 105, 612-6. https://doi.org/10.1002/jso.22136
  7. Huguet F, Cojocariu OM, Levy P, et al (2008). Preoperative concurrent radiation therapy and chemotherapy for bulky stage Ib2, IIa, and IIb carcinoma of the uterine cervix with proximal parametrial invasion. Int J Radiat Oncol Biol Phys, 72, 1508-15. https://doi.org/10.1016/j.ijrobp.2008.03.054
  8. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  9. Ki KD, Song DH, Tong SY, et al (2009).Neoadjuvant chemotherapy in bulky stage Ib-IIa cervical cancer: results of a quick course with vincristine, bleomycin, and cisplatin. Int J Gynecol Cancer, 19, 50-3. https://doi.org/10.1111/IGJ.0b013e318197f8be
  10. Kim HS, Kim MK, Kim HJ, et al (2012). Phase II study of consolidation chemotherapy after adjuvant or primary concurrent chemoradiation using paclitaxel and carboplatin to treat high-risk early-stage or locally advanced cervical cancer. Cancer Res Treat, 44, 97-103. https://doi.org/10.4143/crt.2012.44.2.97
  11. Li FS, Wu YM, Kong WM, et al (2008). Comparison of the effects of preoperative vaginal intracavitary irradiation plus surgery and surgery alone for stage Ib2 and IIa cervical cancer. Chin J Clin Oncol, 35, 797-80. Chinese
  12. Modarress M, Maghami FQ, Golnavaz M, et al (2005). Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage Ib-IIb bulky cervical cancer and with tumor diameter greater than 4 cm. Int J Gynecol Cancer, 15, 483-8. https://doi.org/10.1111/j.1525-1438.2005.15312.x
  13. Nagai Y, Toita T, Wakayama A, et al (2012). Concurrent chemoradiotherapy with paclitaxel and cisplatin for adenocarcinoma of the cervix. Anticancer Res, 32, 1475-9.
  14. Namkoong SE, Park JS, Kim JW, et al (1995).Comparative study of the patients with locally advanced stages I and II cervical cancer treated by radical surgery with and without preoperative adjuvant chemotherapy. Gynecol Oncol, 59, 136-42. https://doi.org/10.1006/gyno.1995.1280
  15. Rotman M, Sedlis A, Piedmonte MR, et al (2006). A phase III randomized trial of postoperative pelvic irradiation in Stage Ib cervical carcinoma with poor prognostic features: followup of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys, 65, 169-76. https://doi.org/10.1016/j.ijrobp.2005.10.019
  16. Ryu HS, Kang SB, Kim KT, et al (2007). Efficacy of different types of treatment in FIGO stage Ib2 cervical cancer in Korea: results of a multicenter retrospective Korean study (KGOG-1005). Int J Gynecol Cancer, 17, 132-6. https://doi.org/10.1111/j.1525-1438.2007.00803.x
  17. Sardi JE, Giaroli A, Sananes C, et al (1997). Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol, 67, 61-9. https://doi.org/10.1006/gyno.1997.4812
  18. Sardi J, Sananes C, Giaroli A, et al (1993).Results of a prospective randomized trial with neoadjuvant chemotherapy in stage Ib, bulky, squamous carcinoma of the cervix. Gynecol Oncol, 49, 156-65. https://doi.org/10.1006/gyno.1993.1100
  19. Sedlis A, Bundy BN, Rotman MZ, et al (1999). A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol, 73, 177-83. https://doi.org/10.1006/gyno.1999.5387
  20. Sehouli J, Runnebaum IB, Fotopoulou C, et al (2012). A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (SRC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study. Ann Oncol, 23, 2259-64. https://doi.org/10.1093/annonc/mdr628
  21. Singh KC, Agarwal A, Agarwal S, et al (2004). 'Quick course' neoadjuvant chemotherapy with cisplatin, bleomycin and vincristine in advanced cervical cancer. Gynecol Obstet Invest, 58, 109-13. https://doi.org/10.1159/000078863
  22. Stehman FB, Ali S, Keys HM, et al (2007). Radiation therapy with or without weekly cisplatin for bulky stage Ib cervical carcinoma: follow-up of a Gynecologic Oncology Group trial. Am J Obstet Gynecol, 197, 503.e1-6.
  23. Suzuki O, Yoshioka Y, Isohashi F, et al (2008). Effect of highdose-rate 192Ir source activity on late rectal bleeding after intracavitary radiation therapy for uterine cervix cancer. Int J Radiat Oncol Biol Phys, 71, 1329-34. https://doi.org/10.1016/j.ijrobp.2007.11.074
  24. Tsuchida Y, Therasse P (2001). Response evaluation criteria in solid tumors (RECIST): new guidelines. Med Pediatr Oncol, 37, 1-3. https://doi.org/10.1002/mpo.1154
  25. Wang Y, Zhong R, Wu LY, et al (2010). The prognostic factors for patients with stage Ib cervical squamouscell carcinoma treated by radical hysterectomy and radiotherapy. Chin J Radiat Oncol, 19, 241-5.
  26. Yao HW, Wu LY, Li XG, et al (2009). Efficacy of preoperative intracavitary brachtherapy and surgery in patients with stage Ib2 and IIa bulky cervical cancer. Chin J Radiat Oncol, 18, 214-6. Chinese.
  27. Zhao YB, Wang JH, Chen XX, et al (2012). Values of three different preoperative regimens in comprehensive treatment for young patients with stage Ib2 cervical cancer. Asian Pac J Cancer Prev, 13, 1487-9. https://doi.org/10.7314/APJCP.2012.13.4.1487

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