Clinical effects of radical hysterectomy plus preoperative radiochemotherapy and radical radiotherapy with concurrent chemotherapy: a comparative study of patients with FIGO stage IIa- IIb cervical cancer

Objective To compare the clinical efficacy,prognosis and long- term toxicities of radical surgery plus preoperative chemoradiotherapy with radical radiotherapy plus concurrent chemotherapy in the treatment of stage IIa and IIb cervical carcinoma patients. Methods Retrospective analysis was performed on 207 patients with stage Ⅱ squamous cervical carcinoma in our Hospital from January 2001 to December 2008. 119 patients received radical surgery and preoperative chemoradiotherapy( RHT) and 88 Patients received radical radiotherapy and concurrent chemotherapy( RCT) with PF or TP chemotherapy regimen. 5- year overall survival rate,5- year progression free survival rate and incidence rate of early and late side- effect were analyzed. Results In the 207 patients,the 5- year overall survival rate( OS) was 73. 95% in group RHT and 54. 02% in group RCT; the 5- year disease- free survival rate( PFS) was 71. 43% in group RHT and 49. 43% in group RCT. 78 patients had recurrent cancer with either local recurrences( 51 patients,65%),distant metastases( 18 patients,23%) or both( 9 patients,12%). Univariate and multivariate analysis showed that overall survival time was correlated to squamous cell carcinoma antigen( SCC) levels before and 1 month after treatment and whether received surgery( RR = 0. 066,0. 045 and 2. 604,respectively,P 0. 05). Leg edema and urogenital fistula occurred more frequently in group RHT than in group RCT( all P 0. 05),while radiation enteritis and radiation urocystitis more frequently in group RCT than in group RHT( all P 0. 05). Conclusions By radical surgery with preoperative radiochemotherapy,stage IIa and IIb squamous cervical carcinoma patients obtained better prognosis. Patients who had SCC level ≥1. 5 mg / L before treatment,SCC level ≥1. 5 mg / L 1 month after treatment and without surgery had poor prognosis.