Effects of sonodynamic component of neoadjuvant chemotherapy on treatment outcomes of cervical cancer patients

Aim. The present study aims to investigate the efficacy of a modified combination neoadjuvant polychemotherapy (NACT) with a sonodynamic component in patients diagnosed with stage IIA2 locally advanced cervical cancer.
Materials and methods. The study encompassed data from 82 patients diagnosed with locally advanced cervical cancer, classified as stage IIA2 (T2a2N0M0). All patients underwent NACT courses according to the cisplatin and bleomycetin regimen. Patients in the control group (n = 32) underwent intravenous NACT, while patients in the main group (n = 50) underwent intravenous NACT in conjunction with contact sonodynamic chemotherapy comprising 5-fluorouracil. The number of NACT courses ranged from two to three, contingent upon the immediate treatment outcomes. Following the attainment of complete or partial regression of the tumor, an extended nerve-sparing extirpation of the uterus, including the appendages, was performed. In instances where the initial treatment did not yield the desired outcome, that is, stabilization of the process, the subsequent treatment plan involved the administration of chemoradiation therapy.
Results. The study revealed that patients in the experimental group demonstrated a substantially higher degree of resectability following two cycles of NACT with a sonodynamic component when compared to the control group. The observed values were 94 and 56.2 %, respectively (p <0.05). A greater proportion of patients in the control group required the third course of NACT, with 43.75 % of patients requiring this intervention, compared to 6 % of patients in the main group (p <0.05). The prevalence of drug-induced pathomorphosis grades III–IV in the main group was documented in 64.3 % of cases, while in the control group drug-induced pathomorphosis grades I–II were predominant (60 %). The overall 5-year survival rate of patients in the primary cohort was notably higher than that of the control group. The study revealed that 82.1 % of the subjects in the first group exhibited a positive response, in contrast to 63.6 % of the subjects in the second group (p <0.05). The five-year relapse-free survival rate in the primary cohort was 78.8 ± 9.5 %, while in the control group, it was 58.8 ± 6.2 % (p <0.05). Conclusion. The application of accelerated regression of cancer tumors under the influence of combined NACT has been demonstrated to result in a reduction in the number of NACT courses and an increase in the number of optimal radical surgeries. The efficacy of the method was substantiated by the findings of morphological and immunohistochemical studies, as evidenced by the indicators of 5-year overall and relapsefree survival for this patient population.

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