title: Outcome of patients with bulky IB (≥ 6 cm) cervical squamous cell carcinoma with and without cisplatin-based neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To study the surgical morbidity and outcomes of patients with markedly bulky cervical squamous cell carcinoma (≥ 6 cm Cx-SCC) who underwent radical hysterectomy (RH) with and without neoadjuvant chemotherapy (NACT).
  
  
  METHODS
  This retrospective study enrolled patients with International Federation of Gynecology and Obstetrics (FIGO) IB markedly bulky Cx-SCC who were treated with either three courses of weekly single agent cisplatin NACT (50 mg/m2) and subsequent radical hysterectomy (NACT-RH) or direct radical hysterectomy (RH) between 1996 and 2001. A total of 60 patients fulfilled the criteria, including 35 and 25 patients with NsACT-RH and RH, respectively.
  
  
  RESULTS
  There was no statistically significant difference in basic characteristics between the two groups, except the smaller pathological tumor size, less blood loss, and lower immediate complication rate in the NACT-RH group. Median survival was 143.8 months in the NACT-RH group and 129.8 months in the RH group, respectively, without a statistically significant difference. Multivariate analysis showed that large pathological tumor size [hazard ratio (HR) 10.66, 95% confidence interval (CI) 2.93-38.80], the presence of para-aortic lymph node metastases and an immediate complication (HR 8.33 and 4.55, 95% CI 1.66-41.75 and 1.35-15.27, respectively) contributed to a worse outcome.
  
  
  CONCLUSIONS
  Weekly single agent cisplatin NACT indeed reduced the pathological tumor size and immediate complication rate during the RH, supporting the feasibility of subsequent RH in the management of patients with bulky Cx-SCC.
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Nursing, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. Electronic address: phwang@vghtpe.gov.tw.
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yen-Hou
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Hui
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Hsun
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shu-Yun
authors.initials: SY
authors.lastname: Huang
authors.affiliation: Department of Pathology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chiung-Ru
authors.initials: CR
authors.lastname: Lai
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chi-Mou
authors.initials: CM
authors.lastname: Juang
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Huann-Cheng
authors.initials: HC
authors.lastname: Horng
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kuo-Chang
authors.initials: KC
authors.lastname: Wen
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Foundation of Gynecologic Cancer, Taipei, Taiwan.
authors.forename: Heung-Tat
authors.initials: HT
authors.lastname: Ng
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chiou-Chung
authors.initials: CC
authors.lastname: Yuan
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kuan-Chong
authors.initials: KC
authors.lastname: Chao
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. Electronic address: msyen@vghtpe.gov.tw.
authors.forename: Ming-Shyen
authors.initials: MS
authors.lastname: Yen
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: bulky cervical squamous cell carcinoma; cervical cancer; neoadjuvant chemotherapy; radical hysterectomy