Background:Patients with LACC have worse prognosis than early stage patients. FIGO guidelines recommend 3 options for the treatment of LACC: concurrent chemoradiation; NACT+RS
+/- postoperative radiotherapy; or RS followed by adjuvant radiation or chemoradiation. For some patients with LACC, intravenous NACT has not been successful because the response rate decreases as tumor size increase. To increase the efficacy of NACT, pelvic intraarterial administration and embolization has been proposed as it offers increased drug concentration at the tumor level, decreased drug delivery to systemic tissue and reduction of tumor vascular supply.
Aim:The aim of this study was to compare the efficacy of a double modality treatment of NACT to intravenous NACT in LACC.
Methods:From January 1st 2008 to June 30th 2013,158 women with cervical cancer stage IB2–IIB2 were included in the study. A regimen of double modality NACT using a combination of paclitaxel 135-175mg/ m2 given intravenously and 100 mg/m2 of cisplatin via the bilateral internal iliac artery plus uterine trans-arterial embolization was administered to 80 patients; an intravenously given NACT was administered to 78 patients.
Results:The response rate was 87.5% in double modality NACT group and 73.1% in the intravenous NACT group(p=0.022).As to surgical complications,the incidence of blood loss >400ml was significantly lower in the double modality group(16%vs43.8%, p= 0.003). The incidence of deep stromal invasion,lymph node metastasis and vascular space involvement was significantly lower in the double modality group(44,24,and 8%vs75,50,and 29.2%).The 3-year survival rate was higher for patients of double modality NACT group than that of the intravenous groups( 87% vs 67%).
Conclusions:Double modality treatment with intra-arterial infusion as a means of NACT is useful in the treatment of LACC. Compared to intravenous NACT, this mode of NACT is more effective in reducing tumor volume, diminishing pathologic risk factors and improving the prognosis of responding patients.