COMPARATIVE STUDY OF CHEMORADIATION AND NEOADJUV ANT CHEMOTHERAPY BEFORE RADICAL HYSTERECTOMY IN STAGE m - 1m BULKY CERVICAL CANCER AND WITH TUMOR DIAMETER GREATER THAN 4 CM

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor size greater than 4 cm (bulky) in diameter have worse outcome.' The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NArC) programs followed by radical hysterectomy in stage Ib - lIb bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage Ib - IIb bulky cervical cancer were treated with preoperative extemal beam radiotherapy to 45Gy plus weekly cisplatin 50 mg/m2 or preoperative neoadjuvant chemotherapy by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7-10 days, for three courses, Surgery was perfonned 4-6 weeks after completion of the preoperative treatment. There was no significant difference between age, stage, tumor size and histopathological type in the two groups (p>0.05).Toxicity associated with the two treatment methods was usually mild. In the chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long term hydronephrosis that needed ureteral stenting. Before surgery, complete and pmiial clinical response had no significant difference between the two groups (p>0,05). After surgery, lymph node and parametrial involvement had no significant difference between the two groups (p>0.05). In the NAIC group more patients had significant residual tumor (p=0,0 12) but residual tumor size had no significant difference between the two groups (p>0. 05). Pathological complete response was significantly higher in the chemoradiation group (p= 0. 004), According to the results of this study it seems that NArC and chemoradiation have similar effects on survival prognostic factors