宫颈腺癌同步放化疗疗效及残余病灶挽救性治疗分析  

Clinical efficacy of concurrent chemoradiotherapy for cervical adenocarcinoma and salvage treatment of residual lesions

作　　者：马佳彬[1] 胡克[1] 张福泉[1] Ma Jiabin;Hu Ke;Zhang Fuquan(Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院放疗科,100730

出　　处：《中华放射肿瘤学杂志》2020年第9期762-766,共5页Chinese Journal of Radiation Oncology

基　　金：国家"十三五"项目(2016YFC0105207);国家自然科学基金项目(U19A2064)。

摘　　要：目的评估宫颈腺癌根治性同步放化疗后疗效,分析同步放化疗后仍有残留病灶患者的治疗及预后。方法回顾性分析2005-2016年间收治的109例局部进展期宫颈腺癌患者的临床资料。外照射临床靶体积处方剂量50.4 Gy分28次,内照射A点剂量30~36 Gy分5~7次。同步顺铂或紫杉醇周疗。放化疗后进行临床疗效评价。对部分缓解(PR)者进行挽救性治疗(手术和/或紫杉醇联合卡铂或顺铂化疗和/或放疗)。Kaplan-Meier法生存分析。结果中位随访时间48个月,3、5年总生存率分别为74.1%、58.5%。放化疗后72例(66.1%)患者达完全缓解,31例(28.4%)患者达PR。PR患者挽救性治疗后3年总生存、无进展生存率分别为53%、41%。放化疗后仅4例(3.7%)和2例(1.8%)患者出现>3级泌尿系和胃肠道不良反应。结论对于同步放化疗后仍有临床残余病灶的宫颈腺癌患者应积极采取挽救性治疗,以期更多的生存获益。Objective To evaluate the clinical efficacy of concurrent chemoradiotherapy for cervical adenocarcinoma,and to analyze the treatment and evaluate the prognosis of patients with residual lesions after definitive radiotherapy.Methods Clinical data of 109 patients with locally advanced cervical adenocarcinoma treated from January 2005 to February 2016 were analyzed retrospectively.The prescription dose of external irradiation was 50.4 Gy,28 fractions,and the point A dose of brachytherapy was 30-36 Gy,5-7 fractions.Cisplatin or paclitaxel was used as concurrent chemotherapy regimen.Clinical efficacy was evaluated after concurrent chemoradiotherapy.Patients with clinical partial remission(PR)after treatment might receive salvage surgery and/or chemotherapy and/or radiotherapy.The survival analysis was performed with Kaplan Meier method.Results The median follow-up period was 48 months,and the 3-year and 5-year overall survival rates were 74.1%and 58.5%,respectively.After concurrent chemoradiotherapy,72 patients(66.1%)achieved clinical complete remission,and 31 patients(28.4%)obtained PR.After receiving salvage treatment,the 3-year overall survival rate and progression-free survival rate of PR patients were 53.1%and 40.5%,respectively.Only 4 patients(3.7%)and 2 patients(1.8%)had grade 3 or greater urinary and gastrointestinal toxicity after definitive treatment.Conclusion For patients with cervical adenocarcinoma who have clinical residual lesions after primary treatment,salvage treatment should be actively taken in order to improve survival outcomes.

关 键 词：宫颈腺癌/同步放化疗法 残余病灶/挽救性治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]