|Title:||Radical Hysterectomy Alone or Combined with Neoadjuvant Chemotherapy in the Treatment of Early Stage Bulky Cervical Carcinoma||Authors:||CHEN, CHI-AN
|Keywords:||cervical carcinoma;neoadjuvant chemotherapy;survival;SQUAMOUS-CELL CARCINOMA;GYNECOLOGIC-ONCOLOGY-GROUP;RANDOMIZED TRIAL||Issue Date:||2002||Journal Volume:||v.101||Journal Issue:||n.3||Start page/Pages:||195-202||Source:||JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION||Abstract:||
Background and Purpose: Early-stage bulky cervical carcinoma treated with conventional surgery or radiotherapy has a higher rate of recurrence compared to smaller tumors at the same stage. Whether neoadjuvant chemotherapy prior to radical hysterectomy can improve survival in early- stage bulky cervical carcinoma remains unclear. This study was designed to answer this question.Methods: Fifty-eight women with early-stage bulky cervical cancer were included in this retrospective study. Thirty-one had received neoadjuvant chemotherapy before radical hysterectomy, and the other 27 patients underwent surgery alone. The chemotherapeutic regimen was a combination of cisplatin, vincristine, and bleomycin with a 10-day interval for two to three courses. Results: The age, parity, and tumor diameter before treatment in the two groups were similar. The mean tumor diameter was significantly decreased after neoadjuvant chemotherapy (4.6 + /- 0.8 vs 3.4 +/- 1.5 cm, P = 0.003). Patients without neoadjuvant chemotherapy had a significantly higher incidence of parametrial invasion (14/ 27 vs 7/31, P = 0.022). More involved lymph nodes were found during surgery in patients without neoadjuvant chemotherapy (23.1 +/- 10.5 vs 17. 4 +/- 7.1, P = 0.024), but the incidence of lymph node metastasis was not different between the two groups (18/31 vs 17/27, P = 0.71). The response rate of primary tumor to chemotherapy was 48.4% (15/31). No significant differences in clinical and pathologic parameters were found between responders and non-responders. Deep stromal invasion (greater than or equal to 3/4 thickness of cervical stoma) was the only independent prognostic factor for disease-free survival (DFS) and overall survival (OS ) in the 58 patients and in the 31 patients who received neoadjuvant chemotherapy. Neither neoadjuvant chemotherapy nor the response to it was an independent prognostic factor for DFS or OS.Conclusions: Neoadjuvant chemotherapy could reduce the incidence of local invasion for bulky early- stage cervical carcinoma but did not improve the DFS of OS in our patients . Without further randomized study of the effects of neoadjuvant chemotherapy, this treatment should be chosen carefully.
|Appears in Collections:||醫學系|
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