【摘要】 目的观察比较同步放化疗与新辅助化疗术前用药对局部晚期宫颈癌患者的治疗效果。方法选取90例局部晚期宫颈癌患者并采用信封法随机分为同步放化疗组及新辅助化疗组各45例。同步放化疗组中给予鳞癌患者顺铂(DDP)及博来霉素静脉滴注,每周1次,每28天重复1次;非磷癌患者给予DDP、氟尿嘧啶(5-Fu)及丝裂毒素(MMC)静脉滴注,共化疗4个疗程。在化疗后第2天开始配合外照射加腔内近距离放疗2~4次,放疗结束1周行手术治疗。新辅助化疗组患者采用与同步放化疗组患者相同的化疗方案,在化疗结束后10~14天行手术治疗。采用实体瘤疗效评价标准对两组患者进行近期疗效评价,观察比较两组患者治疗期间毒性反应及手术情况,随访两组患者5年,观察比较两组患者远期生存率。结果同步放化疗组近期总有效率为93.33%,新辅助化疗组近期总有效率为88.89%,两组患者近期疗效无显著差异(P>0.05)。两组患者1年生存率无显著差异(P>0.05),但同步放化疗组3年生存率及5年生存率均明显高于新辅助化疗组,两组差异显著(x~2值分别为4.94和4.41,均P<0.05)。同步放化疗组根治性手术率及手术切缘阴性率均明显高于新辅助化疗组(x~2值分别为4.44和4.41,均P<0.05)。两组患者血液毒性及胃肠反应无显著差异(均P>0.05),但同步放化疗组放射性直肠炎及放射性膀胱炎发生率均明显高于新辅助化疗组(x~2值分别为5.29和4.19,均P<0.05)。结论对局部晚期宫颈癌患者采用同步放化疗术前用药远期疗效优于新辅助化疗,但不良反应发生率高,临床上应根据患者实际情况选择综合治疗方案。更多还原

【Abstract】 Objective To observe and compare the therapeutic efficacy of concurrent chemoradiotherapy with preoperative neoadjuvant chemotherapy for locally advanced cervical cancer.Methods Totally 90 cases with locally advanced cervical eancer were selected and envelope method was used to randomly divide the cases into two equal groups,concurrent chemoradiotherapy group and neoadjuvant chemotherapy group.Patients with squamous cell carcinoma in the concurrent chemoradiotherapy group were given DDP and bleomycin intravenously weekly repeated every 28 d.Non-squamous cell carcinoma was treated with DDP,5-Fu and mitomycin(MMC) intravenously.A total of four cycles of chemotherapy were provided.From the second day external irradiation plus intracavitary brachytherapy was given for 2-4 times,and surgery was performed one week after the end of radiotherapy.Patients in the neoadjuvant chemotherapy group were given same therapy as those in the concurrent chemoradiotherapy group,and they underwent surgery 10- 14 d after treatment.Response Evaluation Criteria in Solid Tumors were used to evaluate the short-term efficacy.Toxicity during treatment and surgical situation were observed and compared between two groups.Patients were followed up for 5 years to observe the long-term survival.Results The short-term total effective rate of the concurrent chemoradiotherapy group(93.33%) was not significandy different from that(88.89%) of the neoadjuvant chemotherapy group(P > 0.05).One-year survival rate was not significandy different(P > 0.05),but the concurrent chemoradiotherapy group had higher 3-year survival and 5-year survival than the neoadjuvant chemotherapy group with significant difference ix value was 4.94 and 4.41,respectively,both P < 0.05).In the concurrent chemoradiotherapy group the radical surgery rate and negative surgical margin rate were significantly higher than those in neoadjuvant chemotherapy group(x~2 value was 4.44 and 4.41,respectively,both P <0.05).Although diere was no significant difference in hematologic toxicity and gastrointestinal reactions between two groups(both P >0.05),the incidences of radiation proctitis and cystitis in the concurrent chemoradiotherapy group were significantly higher(x~2 value was 5.29 and 4.19,respectively,both P <0.05).Conclusion Long-term efficacy of concurrent chemoradiotherapy is superior to that of neoadjuvant chemotherapy for locally advanced cervical cancer,but the incidence of adverse reaction is high.Clinical situation should be considered in choosing comprehensive therapy for patients.更多还原