Tumour size is an important prognostic factor in patients with stage IB cervical cancer. The patient with stage IB2 (bulky) cervical cancer represents a therapeutic challenge. Neither radical hysterectomy nor primary radiation therapy are sufficiently effective and are associated with significant treatment-related complications including ovarian failure and psychosexual deficits. A number of phase III studies have explored alternative management approaches in this patient population. It appears that extrafascial hysterectomy following radiation therapy does not improve overall survival relative to radiation therapy alone. Consistent with results seen in locally advanced cervical carcinoma, chemoradiation therapy is superior to radiation therapy alone as primary treatment for stage IB2 cervical cancer and as adjuvant therapy for surgically treated patients with high-risk factors for recurrence. Neoadjuvant chemotherapy has resulted in high clinical response rates and operability rates. There are two phase III trials suggesting an improvement in survival with neoadjuvant chemotherapy followed by radical hysterectomy versus either surgery (and selected postoperative radiation) or radiation therapy alone. These emerging treatments should be scrutinized in prospective controlled trials.

中文翻译：

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IB2期（大）宫颈癌的治疗。

肿瘤大小是IB期宫颈癌患者的重要预后因素。IB2期（大）宫颈癌患者代表了治疗挑战。彻底的子宫切除术和主要的放射治疗都没有足够的效果，并且与包括卵巢功能衰竭和性心理缺陷在内的与治疗相关的重大并发症相关。许多III期研究已经探索了该患者人群的替代治疗方法。相对于单独的放射治疗，似乎放射治疗后的筋膜外子宫切除术并不能提高整体生存率。与在局部晚期宫颈癌中观察到的结果一致，化学放射治疗优于单独的放射治疗，作为IB2期宫颈癌的主要治疗方法，以及对复发风险高的手术治疗患者的辅助治疗。新辅助化疗已导致较高的临床反应率和可操作性率。有两项III期临床试验表明，与单独进行手术（和选择的术后放射治疗）或单独进行放射治疗相比，新辅助化疗联合根治性子宫切除术可以提高生存率。这些新出现的治疗方法应在前瞻性对照试验中进行仔细研究。有两项III期临床试验表明，与单独进行手术（和选择的术后放射治疗）或单独进行放射治疗相比，新辅助化疗联合根治性子宫切除术可以提高生存率。这些新出现的治疗方法应在前瞻性对照试验中进行仔细研究。有两项III期临床试验表明，与单独进行手术（和选择的术后放射治疗）或单独进行放射治疗相比，新辅助化疗联合根治性子宫切除术可以提高生存率。这些新出现的治疗方法应在前瞻性对照试验中进行仔细研究。