摘要
目的 评价髂内动脉灌注新辅助化疗在宫颈癌治疗中的作用.方法 对1997年3月-2002年1月间收治的186例巨块型(肿瘤直径≥4 cm)宫颈癌随机分为2组,化疗加放疗组:105例,经髂内动脉灌注化疗,采用Seldinger技术髂内动脉插管或腹壁下动脉插管2种方法注药,化疗以顺铂为主的联合方案,同时采用192Ir高剂量率腔内后装治疗,A点剂量为12～24 Gy,分2～4次;放疗组:81例,术前予腔内后装治疗,A点剂量同前.两组患者均于治疗后2周行子宫颈癌根治术.结果 化疗加放疗组肿瘤消退总有效率为97.1%,明显高于放疗组的79.0%(P<0.01).其中,临床Ⅰb期患者中,化疗加放疗组总有效率为100.0%,明显高于放疗组的78.3%(P<0.01);Ⅱa期患者中,化疗加放疗组总有效率为93.2%、放疗组为79.3%,两组比较,差异无统计学意义(P>0.05);Ⅱb期患者中,化疗加放疗组总有效率为96.1%、放疗组为5/6,两组比较,差异无统计学意义(P>0.05).术后病理检查,宫颈肿瘤残留、宫旁浸润、盆腔淋巴结转移发生率,化疗加放疗组(分别为51.4%、8.6%、7.6%)均明显低于放疗组(分别为79.0%、23.5%、21.0%, P<0.01);而2年内复发率放疗组为23.5%,明显高于化疗加放疗组的6.7%(P<0.01).2年生存率化疗加放疗组为94.5%、放疗组为84.7%,两组比较,差异无统计学意义(P>0.05).结论 髂内动脉灌注化疗可有效缩小肿瘤,减少淋巴结转移和亚临床播散,减少术后复发,但对生存率的价值有待长期随访.
Objective To evaluate the effect of preoperative chemotherapy on bulky cervical cancer by internal iliac arterial infusion. Methods One hundred and eighty-six patients with bulky cervical cancer were randomly divided into two groups: chemotherapy + radiotherapy group (C+R group, n=105) and radiotherapy group (R group, n=81). Patients in C + R group underwent internal iliac arterial infusion chemotherapy by using Seldinger technique internal iliac arterial or epigastric arterial catheterization. Combined regimens were prescribed including cisplatin as the major drug. Meanwhile ~192 Ir high-dose-rate intracavitary radiotherapy was performed,with A point dose at ~12-24 Gy/2-4 times (C + R group). Patients in R group were only given radiotherapy. Both groups of patients received radical hysterectomy two weeks after radiotherapy. Results The tumor regression rate of C+R group was 97.1%, significantly higher than 79.0% in R group(P<0.01).The effective rate for clinical Ib stage cancer in C+R group was 100.0%,significantly higher than 78.3% in R group(P<0.01),but for clinical Ⅱa,Ⅱb stage cancers, the effective rate between two groups had no obvious difference(P>0.05). Postoperative pathologic examinations showed the percentage of cervical tumor residue, parauterine invasion,pelvic lymph node metastasis in C+R group was lower than those of R group(P<0.01).The 2-year recurrent rate in R group(23.5%) was higher than that of C + R group( 6.7%,P<0.01)), but 2-year survival rate between two groups had no obvious difference. Conclusions Internal iliac arterial infusion chemotherapy can effectively reduce tumor volume, decrease lymph node and subclinical metastasis rates and postoperative recurrence rate; it can also improve radical resectability of patients with stage Ⅱb cervical cancer. But the effect on long-term survival rate needs to be further evaluated through long-term follow-up of patients.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2005年第4期231-234,共4页
Chinese Journal of Obstetrics and Gynecology
