子宫颈癌同步放化疗前瞻性随机对照研究  

PROSPECTIVE RANDOMIZIED CONTROLLED STUDY ON CONCURRENT CHEMORADIOTHERAPY FOR CERVICAL CANCER

作　　者：李魁秀[1] 牛书怀[1] 宋藏珠[1] 房朝辉[1] 樊晓妹[1] 刘红[1] 

机构地区：[1]河北医科大学第四医院妇瘤科,河北石家庄050011

出　　处：《河北医科大学学报》2013年第6期653-656,共4页Journal of Hebei Medical University

摘　　要：目的观察子宫颈癌同步放化疗的临床疗效。方法将2007年7月—2008年12月159例子宫颈癌患者随机分成同步放化疗组与单纯放疗组,其中154例完成治疗。75例子宫颈癌患者采用外照射(B点总剂量50.4～52Gy)同时顺铂(eisplatin,DDP)加5-氟尿嘧啶(5-fluorouracil,5-Fu)(FP)方案化疗(DDP 70mg/m^2,5-Fu2 400mg/m^2),并给予高剂量率腔内后装治疗(A点总剂量36～42Gy)。79例采用单纯放疗。2组均在放疗结束后1个月评价疗效。疗效较差者(部分缓解者)给予FP方案巩固化疗2～4个疗程。结果 154例子宫颈癌患者总生存率为69.5%,单纯放疗组为65.8%,同步放化疗组73.3%,2组相比差异无统计学意义(P>0.05)。经单因素及多因素分析,只有近期疗效是影响预后的独立因素(P<0.05)。同步放化疗组与单纯放疗组相比,Ⅲ～Ⅳ度白细胞下降者较多(P<0.05),但经及时治疗后均得以恢复。结论同步放化疗治疗中晚期宫颈癌没有提高生存率,不良反应较大,但可耐受,其确切疗效尚需全国范围内大宗病历前瞻性随机对照研究。Objective To evaluate the clinical effect of concurrent chemoradiotherapy for cervical cancer. Methods Radiotherapy alone （RT） or concurrent chemoradiotherapy （CCRT） were randomly administered to 159 patients with cervical cancer in the hospital between July 2007 to December 2008. A total of 154 out of 159 patients completed the planned treatment. Seventy-five patients with CCRT received pelvic radiotherapy （ point B 50.4 - 52Gy ） with two regimens of cisplatin-based chemotherapy concurrently and high-dose rate brachytherapy （point A 36 -42Gy ）, while 79 patients received radiotherapy alone. Cisplatin-based chemotherapy comprised cisplatin （70mg/m2） and 5-fluorouracil （2 400mg/m2）, repeated every four weeks for two cycles. All patients were evaluated clinical response after one month. Patients with partial response （PR） were administered consolidation chemotherapy with cisplatin-based chemotherapy （FP） for 2 -4 cycles. Results Overall survival rate of 154 cases was 69.5%. No significant difference in survival rates was found between CCRT（73.3% ） and RT（65.8% ） （P 〉 0. 05 ）. The Log-Rank test and Cox regression analysis indicated only clinical response in short term had significant effect on overall survival （ P 〈 0. 05 ）. More patients with grade 3 - 4 leukopenia in the group CCRT were found （ P 〈 0.05 ）, but toxicities were manageable with supportive therapy. Conclusion This study did not show the benefit to survival by adding concurrent FP chemotherapy to radical RT as given in this trial. Cisplatin-based CCRT was tolerated. Good clinical response revealed favorable correlation to survival. Further prospective randomized trials of comparing CCRT with RT should beundertaken to confirm wethaer CCRT will improve survival for a large number of patients in China.

关 键 词：宫颈肿瘤 放射疗法 药物疗法 治疗结果 

分 类 号：R737.33[医药卫生—肿瘤]