Assessment of different treatment modalities in stage IB2-IIA (Bulky) cervical cancer

ABSTRACTAssessment of Different Treatment Modalities in Stage IB2-IIA (Bulky) Cervical CancerObjective: Uncertainty of the treatment of stage IB2-IIA (Bulky) cervical cancer is still continuing. In this study, an analysis of stage IB2-IIA (Bulky) cervical cancer is made. The efficacy of Neoadjuvant chemotherapy after radical surgery and primary radical surgery is investigated.Material and Methods: Medical data of 50 patients who were diagnosed with stage IB2-IIA (Bulky) cervical cancer and treated between 2002-2009 were retrospectively assessed. In the radical surgery group, radical hysterectomy + bilateral pelvic + para-aortic lymphadenectomy was performed. In the neoadjuvant chemotherapy group, a combination of cisplatin/topotecan or paclitaxel/carboplatin was given to the patients and then radical surgery was performed. Both of the groups were evaluated individually. Prognostic factors were determined and survival were compared between the groups. P value was taken <0.05 for the statistical significance level among all results.Results: Radical surgery after neoadjuvant chemotherapy was performed in 21 patients. Primary radical surgery was performed in 29 patients. Median follow-up time was 36.0±14.0 months. Average of amour size before treatment was 50.2±7.6 mm. There was no difference in patients? ages, follow-up time, tumor size (before treatment) or dissected lymph nodes between the groups. The efficacy of surgical and pathological risk factors upon survival was noticed. In the primary radical surgery group, statistics revealed that all parameters negatively effect survival. In the radical surgery after neoadjuvant chemotherapy group, lymphovascular space invasion and tumor size (before and after treatment) were determined to be significant factors for each of disease-free survival and overall survival. On multivariate analysis, tumor size (before treatment) was found to be an independent prognostic factor for both of disease-free survival (p=0.006) and overall survival (0.010). Disease recurred in 14 patients (24.3%) and 13 of them died. In these patients disease-free survival and overall survival was 11.4 and 17.6 months, respectively.Conclusion: In this study, those who had undergone radical surgery, had a better rate of survival. However, there was not significant superiority between the treatment options. There is a need for further studies to compare the multimodal approaches in these stages of cervical cancerKeywords: Stage IB2-IIA (Bulky) cervical cancer, neoadjuvant chemotherapy, radical hysterectomy