局部晚期宫颈癌辅助治疗的临床意义  

Clinical significance of preoperative adjuvant therapy about locally advanced cervical cancer

作　　者：蓝建发[1] 潘华[2] 李瑞萍[3] 张海滨[3] 孙鹏飞[4] 高峻[3] 

机构地区：[1]厦门大学附属第一医院妇产科,福建厦门361003 [2]厦门大学附属第一医院检验科,福建厦门361003 [3]兰州大学第二医院妇科,甘肃兰州730030 [4]兰州大学第二医院放射科,甘肃兰州730030

出　　处：《兰州大学学报（医学版）》2015年第5期33-38,共6页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的比较局部晚期宫颈癌术前两种不同辅助治疗方案的治疗效果。方法 67例局部晚期宫颈癌分为两组,新辅助化疗联合放疗组33例,单纯新辅助化疗组34例。两组化疗方案均为顺铂+紫杉醇,新辅助化疗联合放疗组在两次化疗期间加腔内近距离放疗。两组患者辅助治疗后选择合适时间手术,对比辅助治疗前后MRI信号变化、毒副反应及近期疗效,评估两组手术后病理学检查结果及远期疗效。结果两组局部晚期宫颈癌辅助治疗前后MRI的表观扩散系数(ADC)值及组间ADC值差异均有统计学意义(P<0.001)。两组不同辅助治疗的近期疗效及远期疗效差异有统计学意义(P<0.05)。两组患者术后切缘阳性率、宫颈肌层深部浸润率、淋巴结转移率及病理完全缓解率差异均有计学意义(P<0.05)。两组患者血液和胃肠道毒副反应差异无统计学意义(P>0.05)。结论新辅助化疗联合放疗的疗效优于单纯接受新辅助化疗,可提高局部晚期宫颈癌患者的生存率。Objective To compare the therapeutic effect of two different preoperative adjuvant treatment regimens on locally advanced cervical cancer. Methods 67 patients with locally advanced cervical cancer were divided into two groups, including 33 cases of neoadjuvant chemotherapy combined with radiotherapy and 34 cases of neoadjuvant chemotherapy alone. The chemotherapy regimens are cisplatin plus paclitaxel. Intracavitary brachytherapy was performed during the two chemotherapy. The patients accepted the operation at appropriate time after the adjuvant treatment. MRI（magnetic resonance imaging） signal changes, toxic and side effects, short- term effects, pathology differences and long- term efficacy were compared between the two groups. Results Apparent diffusion coefficients（ADC） of MRI was found to be significant differences in patients with locally advanced cervical cancer between before and after therapy, and between two groups（P〈 0.001）. There were significant differences in the short-term and long-term efficacy between the two groups（P〈0.05）. The positive rate of resected specimens margin, the depth of cervical muscle invasion, rate of lymph node metastasis and the complete remission rate of pathological change showed statistically significant differences between two groups（P〈0.05）. Blood toxicity and gastrointestinal side effects had no statistical significance（P〉0.05） between the two groups. Conclusion The therapeutic effect of neoadjuvant chemotherapy combined with radiotherapy was better than that of the neoadjuvant chemotherapy alone, could improve the survival of patients with locally advanced cervical cancer.

关 键 词：宫颈癌 新辅助化疗 放疗 核磁共振成像 磁共振扩散加权成像 

分 类 号：R737.33[医药卫生—肿瘤]