Korean J Obstet Gynecol.  2012 Dec;55(12):913-919. 10.5468/KJOG.2012.55.12.913.

Prognosis of stage IIB cervical cancer among treatment regimens: Radical hysterectomy vs. neoadjuvant chemotherapy followed by radical hysterectomy vs. concurrent chemoradiotherapy

Affiliations
  • 1Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 2Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. hellojungmi@hanmail.net
  • 3Paik Institute for Clinical Research, Inje University, Busan, Korea.

Abstract


OBJECTIVE
We aimed to compare the prognosis of patients with stage IIB cervical cancer treated with radical hysterectomy alone, with neoadjuvant chemotherapy followed by radical hysterectomy, and with concurrent chemoradiation therapy (CCRT).
METHODS
From January 2000 to December 2006, 104 patients with cervical cancer IIB were diagnosed and managed with radical hysterectomy alone, neoadjuvant chemotherapy followed by radical hysterectomy, and CCRT. The outcomes of patients in terms of the 5-year disease-free survival, overall survival, and recurrence rates were compared.
RESULTS
Of 86 eligible patients, 20 were treated with radical hysterectomy alone, 43 with neoadjuvant chemotherapy, and 23 with CCRT. Neoadjuvant chemotherapy with radical hysterectomy was performed in young (P<0.001) and radical hysterectomy alone was performed in the patients with a large tumor size (P<0.001). Among the 3 groups, distant metastasis was the lowest in the neoadjuvant chemotherapy group (p=0.014). Between the neoadjuvant chemotherapy group and radical hysterectomy alone group, radical hysterectomy alone group showed a larger tumor size (>4 cm) (p=0.0459) and more extensive lympho-vascular involvement (p=0.0158) in pathologic finding.
CONCLUSION
No significant differences in the 5-year disease-free and overall survival rates were observed among the 3 groups. However, the neoadjuvant chemotherapy group showed lower distant metastasis, smaller tumor size, and less extensive lympho-vascular involvement than the other 2 groups. Accordingly, unnecessary adjuvant therapy could be avoided. These results imply that neoadjuvant chemotherapy could improve the prognosis of patients with cervical cancer IIB.

Keyword

Cervical cancer; Neoadjuvant chemotherapy; Radical hysterectomy; Concurrent chemoradiation therapy; Survival

MeSH Terms

Chemoradiotherapy
Disease-Free Survival
Humans
Hysterectomy
Neoplasm Metastasis
Prognosis
Recurrence
Survival Rate
Uterine Cervical Neoplasms

Figure

  • Fig. 1 (A) Disease-free survival rate by treatment group. (B) Overall survival rate by treatment group. NAC, neoadjuvant chemotherapy; RAH, radical hysterectomy; CCRT, concurrent chemoradiotherapy.


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