The Effect of Neoadjuvant Chemotherapy Combined With Brachytherapy Before Radical Hysterectomy on Stage IB2 and IIA Cervical Cancer: A Retrospective Analysis

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).

Clinical Effect of Laparoscopic Radical Surgery Combined with Neoadjuvant Chemotherapy in Treating Cervical Cancer and Its Influence on Postoperative Complications and Adverse Reaction Rates

“…The main treatment for patients with cervical cancer is surgery, and laparoscopic radical surgery is commonly adopted in the clinic to remove the tumor tissue by minimally invasive techniques, thereby achieving the therapeutic effect. However, the surgical risk is greater and the success rate is smaller if cervical cancer reaches middle and advanced stages, so downstaging the tumor by narrowing the tumor tissue with the aid of certain adjuvant therapies is required [ 19 – 21 ]. Neoadjuvant chemotherapy refers to the chemotherapy for downstaging before the cervical cancer surgery, and it was reported that the combination treatment of neoadjuvant chemotherapy and laparoscopic radical surgery can remarkably improve the curative effect and lower the risk of postoperative complications [ 22 – 24 ].…”

Comparison of pathological outcomes of neoadjuvant chemotherapy before surgery versus radical hysterectomy alone in stage IB3 and IIA2 cervical cancer

“…However, NAC may interfere with the evaluation of postoperative adjuvant chemotherapy or CCRT by masking the pathologic findings [10][11][12][13]. An alternative to this treatment approach is radical hysterectomy (RH), which can improve patients' survival outcomes and maintain primitive postoperative pathological state [14]. Intermediate-risk factors, including large tumor diameter >4 cm, lymphovascular space invasion (LVSI) and deep stromal infiltration, and highrisk factors, such as lymph node metastasis (LNM), positive parametria and positive surgical margin, have a significant impact on the recurrence of LACC [15].…”