Objective To evaluate the clinical efficacy and prognosis of neoadjuvant chemoradiotherapy combined with radical resection in patients with stage ⅡA1 cervical cancer.

Methods The clinical data of 120 patients aged 41–63 (49.2±4.6) years old with stage ⅡA1 cervical cancer and who were diagnosed at the 900th Hospital of Joint Logistics Support Force of PLA from June 2012 to December 2014 were analyzed retrospectively. The patients were divided into the study group and the control group (60 cases in each group) in accordance with different treatment methods. The patients in the study group underwent neoadjuvant chemoradiotherapy combined with radical resection and those in the control group underwent radical resection. The changes in the clinical stages of the patients in the study group after undergoing neoadjuvant chemoradiotherapy were observed. The differences in perioperative complications, postoperative high-risk factors, interstitial invasion, and vascular tumor thrombus between the two groups were compared. The acute and chronic radiation injuries of the two groups were evaluated and compared by using the later radiation injury scoring standard. The differences in the 5-year progression-free survival (PFS) rate and overall survival (OS) rate between the two groups were compared. χ² test was used to compare the count data of the groups, and the Kaplan-Meier method and Log-rank test were used for survival analysis.

Results In the study group, the decline rate of the clinical stage was 95.0% (57/60) and the pathological complete remission rate was 15.0% (9/60) after neoadjuvant chemoradiotherapy. No significant differences in perioperative bleeding, incidences of perioperative complications, and postoperative recovery time were observed between the two groups (χ²=0.430, 0.137, 0.100; all P>0.05). The comparison of postoperative high-risk factors revealed that the incidences of lymph node (+), stump (+), and parauterine infiltration in the study group were 3.3% (2/60), 1.7% (1/60), and 0 (0/60), respectively, and were lower than those (8.3% (5/60), 3.3% (2/60), and 6.7% (4/60)) in the control group (χ²=5.335, P<0.05). Among the patients with postoperative interstitial infiltration in the study group, the pathological complete remission rate and the proportion of shallow interstitial infiltration in 1/3 were 15.0% (9/60) and 31.7% (19/60), respectively, and were higher than those (0 (0/60) and 20.0% (12/60)) in the control group. The proportions of the middle 1/3 and deep 1/3 in the study group were 41.7% (25/60) and 11.7% (7/60), respectively, and were lower than those (50.0% (30/60) and 30.0% (18/60)) in the control group (χ²=15.875, P<0.01). The incidence of postoperative vascular tumor thrombus in the study group was 26.7% (16/60) and was significantly lower than that (56.7% (34/60)) in the control group (χ²=11.109, P<0.01). The incidences of grade 1–2 acute and chronic radiation enteritis, acute and chronic radiation cystitis, and acute hematological toxicity in the study group were lower than those in the control group (χ²=3.927–6.508, all P<0.05). The 5-year PFS rate and OS rate in the study group were 66.7% and 80.0% respectively, and were higher than those (65.0% and 78.3%) in the control group. However, no significant difference was observed between groups (χ²=1.27, 1.96; both P>0.05).

Conclusion In patients with stage Ⅱ A1 cervical cancer, neoadjuvant chemoradiotherapy combined with radical resection can effectively reduce postoperative high-risk factors and radiation injuries but did not affect the incidence of perioperative complications and prognosis.