Efficacy and prognosis of multiple neoadjuvant therapy and concurrent chemoradiotherapy in locally advanced cervical cancer

Abstract

Objective To investigate the short-term efficacy and prognosis of neoadjuvant chemotherapy (arterial interventional chemotherapy and intravenous chemotherapy) combined with surgery and concurrent chemoradiotherapy in patients with locally advanced cervical cancer. Methods A total of 187 patients with stage IB3-IIB cervical cancer hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2013 to May 2019 were included in this study. According to the inclusion criteria, these patients were pathologically confirmed to be cervical squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma and completed the treatment according to the established protocol. According to the treatment methods, they were divided into three groups: neoadjuvant arterial interventional chemotherapy + surgery + chemotherapy group (IA-NAC + RS) which included 40 patients, neoadjuvant intravenous chemotherapy + surgery + chemotherapy group (IV-NAC + RS) which included 63 patients and concurrent chemoradiotherapy group (CCRT) which included 84 patients. The prognosis of the three groups and the chemotherapy efficacy, intraoperative blood loss, operation time and postoperative pathological risk factors of different neoadjuvant therapy groups were compared. Results ①There were no significant differences in the 3-year overall survival (OS) rate, 3-year progression free survival (PFS) rate, 5-year OS rate, and 5-year PFS rate among the three groups (p > 0.05). ②The chemotherapy response rates of IA-NAC + RS group (37.5%) and IV-NAC + RS group (25.4%) were comparable (p > 0.05). ③The intraoperative blood loss in the IA-NAC + RS group (average 92.13 ± 84.09ml) was lower than that in the IV-NAC + RS group (average 127.2 ± 82.36ml), and the difference between the two groups was statistically significant (p < 0.05). ④The operation time of the IA-NAC + RS group (average 231.43 ± 63.10min) and the IV-NAC + RS group (average 219.82 ± 49.11min)were comparable (p > 0.05). ⑤There were no significant differences between the IA-NAC + RS group and IV-NAC + RS group in postoperative pathological lymph node metastasis, parametrial invasion and involvement of lymphovascular space (p > 0.05). Conclusions Neoadjuvant chemotherapy combined with surgery had the same long-term survival benefit as concurrent chemoradiotherapy; neoadjuvant arterial chemotherapy could achieve better short-term efficacy than neoadjuvant intravenous chemotherapy without increasing the risk of postoperative pathological risk factors.