J Gynecol Oncol.  2009 Mar;20(1):22-27. 10.3802/jgo.2009.20.1.22.

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

• Cho YH
• Kim DY
• Kim JH
• Kim YM
• Kim YT
• Nam JH

• KMID: 2055644
• DOI: http://doi.org/10.3802/jgo.2009.20.1.22

Abstract

OBJECTIVE
To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer.
METHODS
From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone.
RESULTS
There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival.
CONCLUSION
As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.

Keyword

Locally advanced cervical cancer; Neoadjuvant chemotherapy; Radical hysterectomy

MeSH Terms

Humans
Hysterectomy
Lymph Nodes
Neoplasm Metastasis
Paclitaxel
Platinum
Prognosis
Quality of Life
Radiotherapy, Adjuvant
Recurrence
Risk Factors
Uterine Cervical Neoplasms
Paclitaxel
Platinum

Figure

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  Fig. 1 (A) Disease-free survival and (B) overall survival rates in the neoadjuvant chemotherapy and primary surgery groups. NAC: neoadjuvant chemotherapy, PS: primary surgery.

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  Fig. 2 (A) Disease-free survival and (B) overall survival rates in responder, nonresponder and primary surgery groups. PS: primary surgery.

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