[Effect of preoperative chemotherapy on bulky cervical cancer by internal iliac arterial infusion]

To evaluate the effect of preoperative chemotherapy on bulky cervical cancer by internal iliac arterial infusion.

One hundred and eighty-six patients with bulky cervical cancer were randomly divided into two groups: chemotherapy + radiotherapy group (C + R group, n = 105) and radiotherapy group (R group, n = 81). Patients in C + R group underwent internal iliac arterial infusion chemotherapy by using Seldinger technique internal iliac arterial or epigastric arterial catheterization. Combined regimens were prescribed including cisplatin as the major drug. Meanwhile 192Ir high-dose-rate intracavitary radiotherapy was performed, with A point dose at 12 - 24 Gy/2-4 times (C + R group). Patients in R group were only given radiotherapy. Both groups of patients received radical hysterectomy two weeks after radiotherapy.

The tumor regression rate of C + R group was 97.1%, significantly higher than 79.0% in R group (P < 0.01). The effective rate for clinical Ib stage cancer in C + R group was 100.0%, significantly higher than 78.3% in R group (P < 0.01), but for clinical IIa, IIb stage cancers, the effective rate between two groups had no obvious difference (P > 0.05). Postoperative pathologic examinations showed the percentage of cervical tumor residue, parauterine invasion, pelvic lymph node metastasis in C + R group was lower than those of R group (P < 0.01). The 2-year recurrent rate in R group (23.5%) was higher than that of C + R group (6.7%, P < 0.01), but 2-year survival rate between two groups had no obvious difference.

Internal iliac arterial infusion chemotherapy can effectively reduce tumor volume, decrease lymph node and subclinical metastasis rates and postoperative recurrence rate; it can also improve radical resectability of patients with stage IIb cervical cancer. But the effect on long-term survival rate needs to be further evaluated through long-term follow-up of patients.