title: Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB-IIB bulky cervical cancer and with tumor diameter greater than 4 cm.
abstract: Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor greater than 4 cm (bulky) in diameter have worse outcome. The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NAIC) programs followed by radical hysterectomy in stage IB-IIB bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage IB-IIB bulky cervical cancer were treated with preoperative external-beam radiotherapy to 45 Gy plus weekly cisplatin 50 mg/m2 or preoperative NAIC by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7-10 days, for three courses. Surgery was performed 4-6 weeks after the completion of the preoperative treatment. There were no significant difference between age, stage, tumor size, and histopathologic type in two groups (P > 0.05). Toxicity associated with two treatment methods was usually mild. In chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long-term hydronephrosis that needed urethral stenting. Before surgery, complete and partial clinical response had no significant difference between two groups (P > 0.05). After surgery, lymph node and parametrial involvement had no significant difference between two groups (P > 0.05). In NAIC group, more patients had significantly residual tumor (P = 0.012), but residual tumor size had no significant difference between two groups (P > 0.05). Pathologic complete response was significantly higher in chemoradiation group (P = 0.004). According to the result of this study, it seems that NAIC and chemoradiation had similar effects in survival prognostic factors.
authors.affiliation: Department of Gynecology & Obstetrics, Tehran University of Medical Science, Tehran, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Modarress
authors.forename: F Q
authors.initials: FQ
authors.lastname: Maghami
authors.forename: M
authors.initials: M
authors.lastname: Golnavaz
authors.forename: N
authors.initials: N
authors.lastname: Behtash
authors.forename: A
authors.initials: A
authors.lastname: Mousavi
authors.forename: G R
authors.initials: GR
authors.lastname: Khalili
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D002945:Cisplatin