title: A prospective randomized controlled study on multiple neoadjuvant treatments for patients with stage IB2 to IIA cervical cancer.
abstract: OBJECTIVE
  Patients with stage IB2 to IIA cervical cancer have a poor survival regardless of what primary treatment is performed. We conducted a study to demonstrate whether neoadjuvant treatment could offer survival benefits to those patients.
  
  
  METHODS
  Between January 2006 and December 2009, 123 patients with stage IB2 to IIA cervical cancer were enrolled and randomly assigned to receive 1 of the following 4 treatments: radical surgery alone (arm RS), brachytherapy with a total dose of 15Gy to point A followed by radical surgery (arm BT), intravenous chemotherapy with cisplatin 50 mg/m plus 5-fluorouracil 750 mg/m at a 2-week interval for 2 courses followed by radical surgery (arm IVCT), or intra-arterial chemotherapy with the same regimen as the IVCT arm followed by radical surgery (arm IACT). Two weeks after neoadjuvant treatment, all patients underwent evaluation for response and operability. Those who were not amenable to surgery received concurrent chemoradiotherapy.
  
  
  RESULTS
  With a mean follow-up of 34.8 months, 120 patients were evaluable. Baseline characteristics were similarly distributed in the 4 arms. Clinical overall response rates were 61.3%, 42.9%, and 79.3% in the BT, IVCT, and IACT groups, respectively. Two patients achieved pathological complete response. Three-year progression-free survival rates were 70.7%, 66.3%, 81.5%, and 79.7% in the RS, BT, IVCT, and IACT arms, respectively (P = 0.354). Three-year overall survival was 73.3%, 68.3%, 82.9% and 80.4%, respectively (P = 0.431). Multivariate analysis showed that only lymph node status correlated with progression-free survival.
  
  
  CONCLUSIONS
  Neoadjuvant treatment had no significant impact on the outcomes of patients with stage IB2 to IIA cervical cancer.
authors.affiliation: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wen
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wu
authors.forename: Ziting
authors.initials: Z
authors.lastname: Li
authors.forename: Huaying
authors.initials: H
authors.lastname: Wang
authors.forename: Rongyu
authors.initials: R
authors.lastname: Zang
authors.forename: Min
authors.initials: M
authors.lastname: Sun
authors.forename: Xiao
authors.initials: X
authors.lastname: Huang
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Shumo
authors.initials: S
authors.lastname: Cai
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*