Background and purpose: A variety of measures are taken preoperatively to reduce the tumor size of stage Ⅰb2 bulky cervical cancer before surgery. Which one is safer and more effective

currently

there is no consensus. This article compared the effect in 3 different treatment methods (neoadjuvant chemotherapy

neoadjuvant chemoradiotherapy and operation) on patients with stage Ⅰb2 bulky cervical cancer

and provided evidence for clinical decision. Methods: Retrospective analysis the clinical date of 133 Ⅰb2 bulky cervical cancer patients

who received preoperative neoadjuvant chemotherapy

neoadjuvant chemoradiotherapy and direct operation from Apr. 2006 to Oct. 2010 in our hospital. Results: The effective rates of neoadjuvant chemotherapy

neoadjuvant chemoradiotherapy group were 91.8% and 92.5%

respectively

there was no statistical difference(P0.05). The tumor size got smaller after treatment compared with the size before treatment (P0.05); The pathological efficiency rates were 95.56% and 97.30%

respectively

the difference was not statistically significant (P0.05). The bleeding volume of neoadjuvant chemo radio therapy group was significantly higher than those in the other 2 groups (158.9±50.7 vs 116.8±45.5

123.1±30.2; P0.05)

the infection of immediate surgery group was more severe than the other 2 groups (P0.05). The pairwise comparison of average operation time in neoadjuvant chemotherapy group

neoadjuvant chemoradiotherapy group

and the immediate surgery group

pairwise comparisons of neoadjuvant chemotherapy group and the immediate surgery group in bleeding

comparion of neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group on postoperative infection

and the comparison of the 3 groups on pelvic organ injury and lymphocele

had no statistical difference(P0.05); Pathological examination showed that vascular invasion in surgery group had statistical differences than other 2 groups (P0.05)

there was no patient with positive margin in the 3 groups

and the lymph node metastasis rates also had no statistical difference (P0.05); Besides

there were no statistical difference on vascular invasion between the 3 groups (P0.05); And on 3-year overall survival

disease-free survival there was no statistical difference between the 3 groups (P0.05). Conclusion: Neoadjuvant chemotherapy can effectively reduce tumor size for patients with stage Ⅰb2 bulky cervical cancer before operation

it is better than direct surgery or preoperative chemoradiotherapy in improving the resection rate

and reducing postoperative pathological positive rate

and infection. Neoadjuvant chemotherapy can improve the pathological complete remission rate. The combination of radiation and chemotherapy might produce synergistic effect on huge cervical tumor

but it can’t improve the survival rate. Therefore

neoadjuvant chemotherapy is the best choice for the stage Ⅰb2 cervical cancer patients. Therefore

a long-term followup or large sample randomized controlled trials is necessary to assess the prognosis of preoperative neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.