Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients

Abstract

Objective This study aimed to evaluate the clinical outcomes for patients with stage IB2/IIA2 cervical squamous cell carcinoma treated with neoadjuvant chemotherapy combined with radical surgery. Methods A total of 68 patients with cervical squamous cell carcinoma were randomly divided into the experimental group (n = 35) and the control group (n = 33). The patients in the experimental group received paclitaxel plus cisplatin neoadjuvant chemotherapy for two cycles, then underwent radical hysterectomy and bilateral adnexectomy at 2 weeks post-chemotherapy. The control group only underwent radical hysterectomy and bilateral adnexectomy after the diagnosis of cervical squamous cell carcinoma. The toxic and side effects of chemotherapy in the experimental group were observed. Also, the operation method, operation time, blood loss, grade of wound healing, complications, and postoperative pathology were noted in the two groups. Primary foci and pelvic lymph node recurrence and distant metastasis were observed, and 3-year and 5-year survival rates were calculated. Results Only one patient in the experiment had grade III bone marrow suppression; no other grade III and IV chemotherapy toxic reactions were observed. The operation was successfully completed in all patients. The operation time, intraoperative blood loss, placement of the ureteral catheter, bladder injury, ureteric injury, postoperative urinary tub, pelvic drainage tube indwelling time, anal exhaust time, postoperative complications, and metastatic ratio of lymph nodes were not significantly different between the two groups (P > 0.05). The number of dissected lymph nodes, deep myometrial invasion, and vascular tumor emboli showed a significant difference in the experimental group compared with the control group (P < 0.05). The 3-year disease-free survival (82.9% vs 81.9%), 5-year disease-free survival (71.4% vs 60.6%), 3-year overall survival (91.4% vs 87.8%), and 5-year overall survival (82.9% vs 75.6%) were not statistically significantly different between the experimental group and the control group (P > 0.05). Conclusions Neoadjuvant chemotherapy in IB2/IIA2 stage cervical squamous cell carcinoma showed low toxic side effects. Radical surgery after chemotherapy is safe and feasible. It plays a coordinating role in reducing the tumor infiltration depth of the deep muscle layer and the incidence of vascular tumor emboli, reducing the use of postoperative adjuvant therapy, and improving the quality of life of patients, but does not improve the 3-year/5-year survival rate.

Evaluation of Implementation Effect of Cervical Cancer Comprehensive Treatment Patients With Whole-Course High-Quality Care Combined With Network Continuation Care

“…In the implementation of comprehensive treatment for cervical cancer patients, the clinical approach mostly adopts staged treatment. That is, cervical cancer patients with stage Ia1–IIa2 are treated with comprehensive treatment measures mainly with surgery and supplemented with radiotherapy; patients with stage ≥IIb are treated with simultaneous radiotherapy and chemotherapy with radiotherapy as the core ( 7 , 11 ). However, it has been observed that after cervical cancer surgery, the sense of experience such as pain or incompleteness caused by surgical resection can lead to a range of negative emotions such as low self-esteem, loss, and depression ( 12 , 13 ); Damage to adjacent organs, fatigue or bone marrow suppression caused by radiotherapy can cause further damage to the patient's health status and quality of life ( 14 , 15 ); Moreover, the damage to the digestive tract caused by chemotherapy can lead to decreased appetite, nausea and vomiting, and even rejection of food, and the patient's nutrient intake is insufficient, and the body's immunity can be further reduced ( 16 , 17 ).…”

“…A comprehensive treatment plan based on surgery and radiotherapy, supplemented by chemotherapy, is usually adopted clinically after considering the patient's age, physical condition, fertility needs, and cancer stage. However, there is a high risk of complications such as pain, radiation cystitis, radiation proctitis, bone marrow suppression, skin damage, hair loss, and gastrointestinal symptoms after surgery or during radiotherapy or chemotherapy, which affects patients' physical and mental status and treatment compliance ( 6 , 7 ). However, the lack of scientific medical guidance and standardized nursing management after patients leave the hospital makes them more prone to a series of near and long-term complications and sequelae.…”

Controversies in minimally invasive surgery for invasive cervical cancer

“…В ряде публикаций авторы сообщают, что внутриартериальное введение лекарственных препаратов способствует более высокой частоте клинического ответа, чем при внутривенной химиотерапии, что, в свою очередь, приводит к более благоприятному прогнозу выживаемости [13]. В то же время существуют исследования, указывающие, что проведение НАХТ не влияет на безрецидивную и общую выживаемость по сравнению с пациентками, не получавшими химиотерапию на первом этапе, но в то же время способствует уменьшению параметральной инфильтрации, глубине стромальной инвазии, снижению частоты использования послеоперационной лучевой терапии [14]. Многоцентровое исследование, включавшее больных РШМ IB/ IIA стадии, показывает, что НАХТ была связана с относительным снижением кровопотери, увеличением времени операции и повышением вероятности применения лапароскопической хирургии.…”

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

“…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].…”