NAIC联合手术与NAIC和术前放疗联合手术两种方案治疗Ib～IIIb期宫颈癌的临床研究  

Study of neoadjuvant intra-arterial infusion chemotherapy followed by surgery versus NAIC with preoperative radiotherapy followed by surgery in patients with stageⅠb~Ⅲb cervical cancer

作　　者：陈明晖[1] 巫岳鹏[1] 何科[1] 

机构地区：[1]中山大学附属第一医院妇产科,510089

出　　处：《中国妇幼保健》2006年第5期613-616,共4页Maternal and Child Health Care of China

摘　　要：目的:探讨动脉灌注新辅助化疗(NeoadjuvantIntra-arterialInfusionChemotherapy,NAIC)联合手术或NAIC和术前放疗联合手术治疗Ib～IIIb期宫颈癌的效果。方法:对象为1997年1月～2002年12月期间连续的59例宫颈活检病理确诊为子宫颈癌FIGO分期为Ib～IIIb期,入该院前没接受过治疗的住院病人。其中22例在接受NAIC后进行手术,被归入NAIC联合手术治疗组;另外37例先后接受NAIC和术前放疗后进行手术,被归入NAIC和术前放疗联合手术治疗组。NAIC的方案为:卡铂200～400mg/m2、氟尿嘧啶1.0～1.5g或博莱霉素30～45mg;次数1～2次,间隔时间4周。术前放疗采用后装腔内放疗,剂量为6～10Gy/次,每周1次,次数2～6次。NAIC或放疗后2周进行广泛全宫切除术及盆腔淋巴结清扫术。结果:NAIC联合手术治疗组5年生存率87.9%,其中IIb～III期宫颈癌患者4年生存率为77.1%。NAIC和术前放疗联合手术治疗组5年生存率81.8%,其中IIb～III期宫颈癌患者4年生存率76.1%。NAIC联合手术治疗组中IIb～III期宫颈癌患者的4年生存率与NAIC和术前放疗联合手术治疗组相比差异无统计学意义(P=0.976)。NAIC联合手术治疗组与NAIC和术前放疗联合手术治疗组3～4度白细胞减少、中性粒细胞减少、贫血、血小板减少的发生率差异无统计学意义(P值分别为0.821、0.677、1.000、1.000)。结论:NAIC联合手术与NAIC和术前放疗联合手术两种方案治疗Ib～IIIb期宫颈癌是有效的。两种方案对IIb～III期宫颈癌患者4年生存率的影响相近。两种方案引起的毒副反应患者均可耐受。Objective： To study the effect of neoadjuvant intra - arterial infusion chemotherapy （ NAIC ） followed by surgery with or without preoperative radiotherapy in patients with stage Ⅰb～Ⅲb cervical cancer. Methods： From Jan. 1997 to Dec. 2002, 59 untreated patients with stage Ⅰb～Ⅲb cervical cancer confirmed by pathological examination were continuously enrolled in this study. 22 patients who received NAIC followed by surgery without preoperative radiotherapy were grouped into NAIC - surgery group and 37 patients who received NAIC followed by surgery with preoperative radiotherapy were grouped to NAIC - preoperative radiotherapy - surgery group. NAIC was administered for 1 - 2 course every 4 weeks using a combination of carboplatin 200 - 400 mg/ml. 2, 5 - fluorouracil 1. 0 - 1. 5 g or bleomycin 30 - 45 mg. Preoperative pelvic radiotherapy by a remote after loading system was used for 2 - 6 course （6 - 10 Gy/times, one times each week） . Two weeks after NAIC or preoperative radiotherapy extensive hysterectomy and pelvic lymphadenectomy was performed. Results： 5 - year - survival rate of NAIC - surgery group was 87.9% ; 4 - year - survival rate for patients in stage Ⅰb～Ⅲb of this group was 77.1% .5 - year - survival rate of NAIC - preoperative radiotherapy - surgery group was 81. 8% ; 4 - year - survival rate of patients in stage Ⅰb～Ⅲb of this group was 76. 1%. The difference of 4 - year - survival rate of patients in stage Ⅰb～Ⅲb between NAIC - surgery group （ 77.1% ） and NAIC - preoperative radiotherapy - surgery group （76. 1% ） was not significant （ P = 0. 976） . The difference of grade 3 - 4 toxicity including leucopenia, granulocytopenia, anemia and thrombocytopenia between NAIC - surgery group and NAIC - preoperative radiotherapy - surgery group was not significant. Conclusion： Both NAIC followed by surgery and NAIC with preoperative radiotherapy followed by surgery were effective for cervical cancer and their toxicity were tolerable.

关 键 词：宫颈癌 动脉灌注化疗 新辅助化疗 手术 放疗 

分 类 号：R737.33[医药卫生—肿瘤]