两种同步放化疗方案治疗Ⅰb2～Ⅳa期子宫颈鳞癌的临床分析  

Comparison of two different chemotherapy regimens for concurrent chemoradiotherapy in stage I b2 to Ⅳ a squamous cell carcinoma of the uterine cervix

作　　者：李小凡[1] 李永恒[1] 高雨农[2] 李彩莉 岳海振[1] 徐刚[1] 李东明[1] 苏星[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所妇科,北京100142 [3]山东省泰安市肥城矿业中心医院肿瘤科

出　　处：《中华妇产科杂志》2013年第10期763-767,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的比较分析Ⅰb2～Ⅳa期宫颈鳞癌患者同步放化疗中两种含铂化疗方案的疗效和安全性。方法回顾性分析2007年11月至2011年11月北京大学肿瘤医院收治的接受同步放化疗的宫颈鳞癌患者共146例的临床病理资料，根据同步放化疗中化疗方案的不同分为两组：铂类单药每周方案化疗（单药化疗组）59例，氟尿嘧啶＋铂类联合3周方案化疗（联合方案组）87例。治疗结束3个月后进行评效，比较两组患者的近期疗效、生存率和毒性反应发生情况。结果单药化疗组和联合方案组患者的有效率分别为97％（57／59）、93％（81／87），两组比较，差异无统计学意义（P=0．249）。单药化疗组、联合方案组患者的5年总生存率分别为61．2％和69．5％，5年无进展生存率分别为43．3％和24．4％，5年局部复发率分别为11．8％和9．8％，5年远处转移率分别为29．4％和38．7％，分别比较，差异均无统计学意义（P〉0．05）。毒性反应发生情况：联合方案组的消化道毒性反应（恶心、呕吐）发生率明显高于单药化疗组[分别为78％（68／87）、51％（30／59），P〈0．01]，且其贫血较单药化疗组更常见[贫血发生率分别为53％（46／87）、25％（15／59），P=0．019]；但急性和晚期放射性直肠炎、膀胱炎及其他常见毒性反应的发生率比较，差异无统计学意义（P〉0．05）。结论两种同步放化疗方案的疗效相当，铂类单药每周方案的毒性反应发生率明显低于含铂的3周联合方案。Objective To compare the clinical efficacy and safety of two chemotherapy regimens for concurrent ehemoradiotherapy in patients with stage I b2 to IV a squamous cell carcinoma of the uterine cervix. Methods Between November 2007 and November 2011, 146 patients with stage I b2 to IV a squamous cell carcinoma of the uterine cervix who received concurrent ehemoradiotherapy in Peking University Cancer Hospital were analyzed. All cases were divided into two groups according to the different chemotherapy regimens during radiation therapy, the group receiving radiotherapy concomitant with weekly cisplatin or nedaplatin alone （ platinum alone group, n = 59 ） , the group receiving radiotherapy concomitant with cisplatin plus fluorouracil or nedaplatin plus tegafur every 3 weeks （ combined group, n = 87 ）. There were no statistical difference in the clinical and pathological characteristics between the two groups. Results Patients were evaluated by pelvic examination and pelvic MRI after chemoradiotherapy for 3 months according to WHO criteria. The response rate were respectively 97% （57/59） and 93% （81/87） in platinum alone group and combined group, in which there was no significant difference （ P = 0. 249 ）. The five-year overall survival and the five-year progression-free survival of platinum alone group and combined group were respectively 61.2% versus 69.5% （ P 〉 0.05） and 43.3% versus 24.4% （ P 〉 0.05 ）. There were also no statistically significant differences between platinum alone group and combined group in the five- year local recurrence rate and five-year distant metastasis （ 11.8% versus 9. 8% , 29. 4% versus 38.7% ; all P 〉 0. 05 ）. Acute gastrointestinal toxicities （nausea and vomiting） in combined group were exactly higher than that in the other group [78% （68/87） versus 51% （30/59）, P 〈0.01]. Moreover, anaemia was slightly more common in combined group [ 53% （ 46/87 ） versus 25% （ 15/59 ）, P = 0. 019 ]. However, the occurrence rate of the acute or

关 键 词：宫颈肿瘤癌 鳞状细胞 放射疗法 调强适形 药物疗法 肿瘤治疗方案 

分 类 号：R737.33[医药卫生—肿瘤]