Neoadjuvant chemotherapy in locally advanced cervical carcinoma: which is better, intravenous or intra-arterial?

Abstract

Ting Gui,* Keng Shen,* Yang Xiang, Lingya Pan, Jinghe Lang, Ming Wu, Huifang Huang, Dongyan Cao, Jiaxin YangDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China *These authors contributed equally to the work Purpose: The aim of our study is to investigate the differences in therapeutic effects and clinical significance between intravenous systematic chemotherapy and intra-arterial interventional chemotherapy in stage Ib2-IIb cervical carcinomas. Methods: A retrospective analysis was performed on 93 cases of intravenous and 118 cases of intra-arterial neoadjuvant chemotherapy for stage Ib2-IIb cervical carcinomas treated in Peking Union Medical College Hospital from the year 2001 to 2010. Results: After neoadjuvant chemotherapy, the overall response rate was 84.9% versus (vs) 88.2% and the operability rate was 77.4% vs 81.4%, for intravenous vs intra-arterial (P>0.05). There were no significant differences in toxicities, surgical duration, perioperative blood loss, and operative complications between these two groups. Postoperative pathological examination revealed a significantly lower parametrial infiltration in the intra-arterial group (12.5% vs 38.1%, P<0.05), while the positive vaginal margin, lymph node metastasis, and intravascular tumor embolus showed no significant differences. The intravenous group and the intra-arterial group had similar recurrence rate (16.0% vs 12.3%), distant metastasis rate (9.1% vs 8.5%), and 5 year survival rate (79.5% vs 84.9%), without significant differences. Conclusion: Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil are safe and effective for patients with locally advanced cervical carcinomas. The intravenous and the intra-arterial approaches present with similar chemotherapy efficacy and clinical outcome. Since it is more simple and economical, the intravenous systematic approach shows greater value in clinical application. Keywords: cervical carcinoma, neoadjuvant chemotherapy, parametrial infiltration, intravenous systemic chemotherapy, intra-arterial interventional chemotherapy