精确放疗同步化疗治疗局部晚期宫颈鳞癌疗效分析  

Clinical Analysis of Concurrent Chemo-Radiotherapy for Locally Advanced Cervical Squamous Cell Carcinoma

作　　者：顾科[1] 胡群超[1] 陈杰[1] 冀胜军[1] 刘政操[1] 李颖[1] 吴锦昌[1] 

机构地区：[1]南京医科大学附属苏州医院、苏州市立医院东区放疗科,江苏苏州215001

出　　处：《中国血液流变学杂志》2016年第1期60-64,共5页Chinese Journal of Hemorheology

基　　金：江苏省重点研发计划一社会发展项目（BE2015645）;江苏省卫生厅科研资助项目（Z201413）;苏州市卫生局科技项目（LCZX201309）;苏州市科技局项目（SYSD2014116）;苏州市肿瘤临床医学中心项目（Szzx201506）

摘　　要：目的：回顾性分析局部晚期宫颈鳞癌进行精确放疗同步化疗的临床疗效及不良反应。方法收集2012年4月—2015年5月进行精确放疗的局部晚期宫颈鳞癌47例，其中22例给予同步单药顺铂化疗（RT＋P组），17例行同步紫杉醇或紫杉醇脂质体联合顺铂化疗（RT＋TP组），8例仅接受单纯放疗（RT组）。回顾性分析比较三种治疗方法的近期疗效，1年、2年及3年生存率以及放射性阴道炎、放射性直肠炎、放射性膀胱炎、胃肠道反应、骨髓抑制等不良反应。结果 RT＋P组、RT＋TP组的近期有效率分别为90.9%、82.4%，均明显高于RT组的75.0%，差异有统计学意义（P=0.011）。RT＋P组、RT＋TP组的3年生存率分别为90.9%、87.4%，均明显高于RT组的72.9%，差异有统计学意义（P＜0.05）。同步放化疗（CCRT）组之间的近期治疗有效率及生存率差异无统计学意义（P＞0.05）。RT组仅出现Ⅰ-Ⅱ级骨髓抑制，而CCRT组有35.3%～45.5%达到Ⅲ级骨髓抑制，与RT组相比差异有统计学意义（P=0.019），CCRT组之间骨髓抑制程度差异无统计学意义（P＞0.05）。所有病例未出现Ⅲ级及以上放射性胃肠道反应，其中RT组反应程度仅为Ⅰ级，RT＋P组及RT＋TP组的胃肠道反应高于RT组，但是差异无统计学意义（P＞0.05）。该研究中未出现Ⅲ级及以上放射性阴道炎、直肠炎和膀胱炎病例，RT组、RT＋P组及RT＋TP组三者之间差异无统计学意义（P＞0.05）。结论局部晚期宫颈鳞癌患者CCRT具有良好的耐受性，两种C C RT方案在疗效及副反应上无明显差异，具有较好的近期疗效及生存获益，明显优于单纯放疗。精确放疗同步紫杉醇/紫杉醇脂质体联合顺铂化疗治疗局部晚期宫颈鳞癌，值得临床推广应用。Objective To retrospectively analyze clinical efifcacy and adverse reaction of concurrent precise radiotherapy and cisplatin combined with paclitaxel or paclitaxel liposome chemotherapy for locally advanced cervical squamous cell carcinoma.Methods From April 2012 to May 2015, the clinical data of 47 patients with locally advanced cervical squamous carcinoma were collected. 22 patients received radiotherapy concurrent cisplatin chemotherapy （RT＋P group） and 17 cases underwent radiotherapy synchronous paclitaxel or paclitaxel liposome combined with cisplatin chemotherapy （RT＋TP group）. 8 cases received radiotherapy only （RT group）. The effects and adverse reactions of three treatment methods were retrospectively analyzed involving 1 year, 2 years and 3 years overall survival rates and irradiation-induced adverse reactions including virginities, proctitis,cystitis, gastrointestinal tract reaction and bone marrow suppression.Results The overall response rates of RT＋P group and RT＋TP group were 90.9% and 82.4% respectively, which were significantly higher than that of RT group （75.0%）. The difference was statistically signiifcant （P=0.011）. The 3 years overall survival rates of RT＋P group and RT＋TP group were 90.9% and 87.4% respectively, which were significantly higher than that of RT group （72.9%）. The difference was statistically signiifcant （P〈0.05）. There was no signiifcant difference of the short-term efifcacy and overall survival rates between concurrent chemo-radiotherapy （CCRT） groups （P〉 0.05）. Up to 5.3%~45.5% cases of RT＋P and RT＋TP groups presented gradeⅢ bone marrow suppression. In RT group, there occurred merely gradeⅠ andⅡ bone marrow suppression which superior to the toxicities in CCRT groups （P=0.019）. There was no significant difference in bone marrow inhibition between CCRT groups （P〉0.05）. No case presents gradeⅢ or worse gastrointestinal tract reaction, vaginitis, proctitis or cystitis. Only gradeⅠ gastrointestinal tract

关 键 词：局部晚期宫颈癌 精确放疗 顺铂 紫杉醇 紫杉醇脂质体 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]