全身新辅助化疗在巨块型宫颈癌Ⅰ_(B2)~Ⅱ_B期治疗中的价值  

The therapeutic value of preoperative neoadjuvent chemotherapy in patients with stage Ⅰ_(B2)~Ⅱ_b bulky cervical cancer

作　　者：赵淑萍[1] 王泽华[1] 刘素梅[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,湖北武汉430030 [2]青岛大学附属医院妇产科,山东青岛266003

出　　处：《中国癌症杂志》2006年第3期213-216,共4页China Oncology

摘　　要：背景与目的：宫颈癌是最常见的妇科恶性肿瘤，早期患者5年生存率达70％以上。宫颈癌早期患者经手术和（或）放射治疗可获得较好的疗效，但巨块型宫颈癌的疗效尚不理想，在这部分患者中新辅助化疗的使用日益受到重视。本研究探讨术前新辅助化疗对巨块型宫颈癌的近期疗效。方法：随机选择56例未接受过任何治疗、经病理确诊临床分期为的ⅠB2-ⅡB期巨块型宫颈癌患者作为研究对象，其中，ⅠB2期15例，Ⅱa期15例，Ⅱb期26例。采用PVB方案化疗2个疗程后手术，观察近期的疗效和毒副反应。结果：临床近期有效率达78．6％，手术切除率达100％。化疗期间未发现不能耐受的毒副反应。术前新辅助化疗可提高手术切除率和症状改善率，化疗后肿瘤直径较化疗前有不同程度的缩小，差异有显著性（P〈0．05）。所有手术患者均能顺利切除病灶并达到切缘距离病灶1cm以上。结论：术前新辅助化疗对巨块型宫颈癌治疗是安全有效的。可提高宫颈癌的近期疗效，成为治疗该病的一种新手段，有较大的临床应用价值。Background and Purpose： Cervical cancer is one of the most common malignant neoplasms among women. The 5-year survival for patients with early stage disease is over 70%. While it is generally accepted that either radical surgery or radiotherapy can achieve cure for the majority of patients with early-stage cervical cancer, there is no standard approach to the patients with bulky disease, whose prognosis remains very poor in spite of the therapeutic advances achieved in recent years. Neoadjuvant chemotherapy has been used as part of the muhidisciplinary treatment before either operation or radiation therapy. Although the approach still had many controversies, numerous studies have supported its effectiveness in bulky cervical cancer. The present study was conducted to explore whether neoadjuvant chemotherapy with the combination of vincristine, bleomycin and cisplatin could improve the operability and pathological response rate in Ⅰb2-Ⅱ b bulky cervical cancer patients. Methods： A total of fifty-six patients with bulky cervical cancer were histologically diagnosed and staged into Ⅰb2-Ⅱb according to the standards of International Federation of Gynecology and Obstetrics（ FIGO） and randomly selected, including 15 cases with Ⅰb2, 15 with Ⅱa, 26 with Ⅱb. They were treated by a regimen of PVB chemotherapy for 2 cycles and followed by operation. The immediate response and adverse effects were analyzed. Resuits： The overall response rate was 78.6%. The resectability rate for surgery after chemotherapy was 100%. No intolerable toxic and adverse effects were recorded during neoadjuvant chemotherapy. Preoperative neoadjuvant chemotherapy can apparently increase the possibility of resection by operation and enhance the remission rate . The primary tumor sizes were significantly decreased after chemotherapy before surgery （P 〈0. 05）. All patients underwent radical hysterectomy and more than 1cm margin could be reached between the edge of surgical specimens of the local primary tumor. Conclusions�

关 键 词：新辅助化疗 宫颈肿瘤 手术治疗 

分 类 号：R730.53[医药卫生—肿瘤] R737.33[医药卫生—临床医学]