title: Radical hysterectomy alone or combined with neoadjuvant chemotherapy in the treatment of early stage bulky cervical carcinoma.
abstract: OBJECTIVE
  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 (> or = 3/4 thickness of cervical stroma) 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 or OS in our patients. Without further randomized study of the effects of neoadjuvant chemotherapy, this treatment should be chosen carefully.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chi-An
authors.initials: CA
authors.lastname: Chen
authors.forename: Wen-Fang
authors.initials: WF
authors.lastname: Cheng
authors.forename: Lin-Hung
authors.initials: LH
authors.lastname: Wei
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Su
authors.forename: Chang-Yao
authors.initials: CY
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*