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Woo, Byun, Jeong, Kim, Kim, Seo, Sung, Lee, and Kim: Prognosis of stage IIB cervical cancer among treatment regimens: Radical hysterectomy vs. neoadjuvant chemotherapy followed by radical hysterectomy vs. concurrent chemoradiotherapy
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(12): 913-919.

Published online: 18 December 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.12.913

Prognosis of stage IIB cervical cancer among treatment regimens: Radical hysterectomy vs. neoadjuvant chemotherapy followed by radical hysterectomy vs. concurrent chemoradiotherapy

Young Ju Woo, MD1, Jung Mi Byun, MD2, Dae Hoon Jeong, MD2, 3, Young Nam Kim, MD2, 3, Su Seon Kim, MD2, Young Jin Seo, MD2, Moon Su Sung, MD2, Kyoung Bok Lee, MD2, Ki Tae Kim, MD2, 3

1Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

2Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

3Paik Institute for Clinical Research, Inje University, Busan, Korea.

Corresponding author: Ki Tae Kim, MD. Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: +82-51-890-6374 Fax: +82-51-897-6380, hellojungmi@hanmail.net

Received 27 June 2012       Revised 5 September 2012       Accepted 9 October 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

We aimed to compare the prognosis of patients with stage IIB cervical cancer treated with radical hysterectomy alone, with neoadjuvant chemotherapy followed by radical hysterectomy, and with concurrent chemoradiation therapy (CCRT).

Methods

From January 2000 to December 2006, 104 patients with cervical cancer IIB were diagnosed and managed with radical hysterectomy alone, neoadjuvant chemotherapy followed by radical hysterectomy, and CCRT. The outcomes of patients in terms of the 5-year disease-free survival, overall survival, and recurrence rates were compared.

Results

Of 86 eligible patients, 20 were treated with radical hysterectomy alone, 43 with neoadjuvant chemotherapy, and 23 with CCRT. Neoadjuvant chemotherapy with radical hysterectomy was performed in young (P<0.001) and radical hysterectomy alone was performed in the patients with a large tumor size (P<0.001). Among the 3 groups, distant metastasis was the lowest in the neoadjuvant chemotherapy group (p=0.014). Between the neoadjuvant chemotherapy group and radical hysterectomy alone group, radical hysterectomy alone group showed a larger tumor size (>4 cm) (p=0.0459) and more extensive lympho-vascular involvement (p=0.0158) in pathologic finding.

Conclusion

No significant differences in the 5-year disease-free and overall survival rates were observed among the 3 groups. However, the neoadjuvant chemotherapy group showed lower distant metastasis, smaller tumor size, and less extensive lympho-vascular involvement than the other 2 groups. Accordingly, unnecessary adjuvant therapy could be avoided. These results imply that neoadjuvant chemotherapy could improve the prognosis of patients with cervical cancer IIB.

Keywords: Cervical cancer, Neoadjuvant chemotherapy, Radical hysterectomy, Concurrent chemoradiation therapy, Survival

Figures and Tables

Fig. 1
(A) Disease-free survival rate by treatment group. (B) Overall survival rate by treatment group. NAC, neoadjuvant chemotherapy; RAH, radical hysterectomy; CCRT, concurrent chemoradiotherapy.
kjog-55-913-g001
Table 1
Patient characteristics
kjog-55-913-i001

Values are presented as mean ± standard deviation or number (%).

NAC, neoadjuvant chemotherapy; RAH, radical abdominal hysterectomy; CCRT, concurrent chemoradiotherapy; BMI, body mass index.

Table 2
Comparison of surgico-pathologic outcomes
kjog-55-913-i002

Values are presented as mean ± standard deviation or number (%).

NAC, neoadjuvant chemotherapy; RAH, radical abdominal hysterectomy; LVSI, lymphovascular space invasion.

Table 3
Comparison of clinical courses
kjog-55-913-i003

Values are presented as number (%).

NAC, neoadjuvant chemotherapy; RAH, radical abdominal hysterectomy; CCRT, concurrent chemoradiotherapy; 5YSR, 5-year survival rate; DFS, disease-free survival.

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