title: Outcome of stage IB2-IIB patients with bulky uterine cervical cancer who underwent neoadjuvant chemotherapy followed by radical hysterectomy.
abstract: BACKGROUND
  We performed a retrospective study to clarify the outcome of stage IB2-IIB patients with bulky cervical cancer who underwent neoadjuvant chemotherapy (NAC) followed by radical hysterectomy and adjuvant treatment.
  
  
  METHODS
  Sixty-five patients with bulky stage IB2-IIB cervical cancer, treated at Tottori University Hospital between 2001 and 2011, were examined retrospectively. The indication for adjuvant treatment was limited to the following pathological high-risk factors: pelvic lymph node (PLN) involvement, parametrial infiltration (PI), and a compromised surgical margin.
  
  
  RESULTS
  Fifty-one patients had squamous cell carcinoma (SCC) and 14 non-SCC. Three patients were ineligible for radical hysterectomy after NAC, and underwent concurrent chemoradiotherapy. In 62 patients who underwent radical hysterectomy, 13 had only PLN involvement and 6 only PI, and 10 had both PLN involvement and PI. In 33 patients who had no adjuvant treatment, 6 recurred, and only one underwent salvage chemotherapy. In 29 patients who underwent adjuvant treatment, 15 recurred and 11 died. Multivariate Cox proportional analysis revealed that PLN involvement was an independent prognostic factor.
  
  
  CONCLUSIONS
  Even if the indication for adjuvant treatment is limited to only high-risk patients, about 70 % of stage IB2-IIB patients with bulky cervical cancer could be cured by NAC followed by radical hysterectomy. Additionally, about 40 % of those patients could be cured without adjuvant treatment. In contrast, the strategy for patients with PLN involvement, who account for about 35 % of stage IB2-IIB bulky cervical cancer after NAC, should be carefully reconsidered based on quality of life and cost-effectiveness.
authors.affiliation: Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Uegaki
authors.forename: Muneaki
authors.initials: M
authors.lastname: Shimada
authors.forename: Seiya
authors.initials: S
authors.lastname: Sato
authors.forename: Imari
authors.initials: I
authors.lastname: Deura
authors.forename: Jun
authors.initials: J
authors.lastname: Naniwa
authors.forename: Shinya
authors.initials: S
authors.lastname: Sato
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Oishi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Itamochi
authors.forename: Tasuku
authors.initials: T
authors.lastname: Harada
authors.forename: Junzo
authors.initials: J
authors.lastname: Kigawa
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*