早期巨块型宫颈癌术前放化疗和新辅助化疗的临床对比研究  

Clinical Comparative study on Preoperative Chemoradiotherapy and Neoadjuvant Chemotherapy for the Treatment of Patients with Early Bulky Cervical Cancer

作　　者：陈亦乐[1] 夏蛮[1] 肖辉[1] 欧阳强[1] 

机构地区：[1]湖南省肿瘤医院,湖南长沙410006

出　　处：《医学临床研究》2007年第12期2059-2062,共4页Journal of Clinical Research

摘　　要：【目的】比较早期巨块型宫颈癌术前放化疗和新辅助化疗的疗效。【方法】1997年6月至2003年6月经本院治疗的早期巨块型宫颈癌166例,根据不同的术前治疗分为放化疗组和新辅助化疗组,放化疗组术前经动脉灌注或静脉化疗平均2疗程,同期给予^192Ir高剂量率腔内后装。化疗组用药方法及方案剂量相同。平均2疗程。2～3周后接受宫颈癌根治术。术前治疗结束2周评价临床效果。【结果】放化疗组完全缓解率、部分缓解率分别为38.9%、61.0%,化疗组分别为29.6%、70.4%（P均〉0.05）。术后病理宫颈肿瘤残留率,放化疗组41.1%,化疗组69.0%（P〈0.01）;宫旁浸润及盆腔淋巴结转移两组无统计学差异（P〉0.01）,病理完全缓解率放化疗组48.4%,化疗组26.8%（P〈0.01）。3年复发率,放化疗组低于化疗组（P〈0.05）,3年存活率两组差异无显著性（P〉0.05）。严重的副反应两组比较差异无显著性（P〉0.01）,放化疗组尿瘘率高于化疗组,但差异无显著性（P〉0.01）。【结论】新辅助化疗对早期巨块型宫颈癌能有效缩小肿块提高手术切除率,放化疗比单一的术前化疗更能降低宫颈肿瘤残存率,提高病理完全缓解率,但对预后不良高危因素的影响没有差异,对年轻患者可在新辅助化疗后选择手术,两种术前治疗对预后的影响有待长期随访及大样本研究。[Objective]To compare the preoperative therapeutic effects of chemoradiotherapy and neoadjuvant chemotherapy （NACT） for patients with early bulky cervical cancer. [Methods] One hundred and sixty six cases with early bulky cervical cancer treated in our hospital from June 1997 to June 2003 were collected and then divided into two groups. Chemoradiotherapy group was averagely treated with two cycles of arterial infusion or venous chemotherapy and meanwhile treated with 192Ir high-dose-rate intracavitary radiotherapy with a dose of 18 - 24Gy for point A within 3 to 4 times. NACT group was treated with the same chemotherapy regimen and dosage as chemoradiotherapy group＇. Both groups then underwent radical hysterectomy in 2 to 3 weeks after therapy. [Results]Clinical response rate in two groups was assessed in two weeks after pre-operation. The complete response rate in chemoradiotherapy group and NACT group were 38.9% and 29.6% respectively （ P 〉0.01）, while the partial response rate was 61.0% and 70.4% respectively （ P〉0.01）. There was a significant statistic difference in the rate of cervical tumor residue between two groups, the former 41.1% and the latter 69.0% （ P〈0.01）. No statistic difference was found in periuterine invasion and pelvic lymph node metastasis between two groups （ P 〉0. 01）. There was a significant statistic difference in pathological complete response rate, the former 48.4% and the latter 26.8%（ P 〈0.01）. The rate of a three-year recurrence in the former was 10.5% lower than the latter with 22.5% （ P〈0.05）, while there was no statistic difference in the rate of a three-year survival （ P 〉0.05）. There was no statistic difference in serious side effects （ P 〉0.01）. The rate of urethra fistula of the former was 4.2% higher than the latter with 1.4%, but no significant statistic difference was found （ P 〉0.01）. [Conclusion] NACT is effective to reduce the size of tumor and thus improve surgical resectability for patients with early bulky c

关 键 词：宫颈肿瘤/药物疗法 化学疗法 辅助 

分 类 号：R737.33[医药卫生—肿瘤]