根治性放疗前子宫动脉化疗栓塞与子宫动脉灌注化疗在中晚期宫颈癌治疗中的应用价值

Investigation for uterine arterial chemoembolization and uterine arterial infusion chemotherapy in advanced cervical cancer before radical radiotherapy

目的探讨子宫动脉化疗栓塞与子宫动脉灌注化疗对进展期宫颈癌根治性放疗疗效及放疗晚期并发症的影响。方法 1999年1月1日至2010年4月30日收治的735例原发性进展期宫颈癌患者(FIGO分期Ⅱ期299例,Ⅲ期359例,Ⅳa期77例)采用外照射及192Ir高剂量近距离放疗。全组中位年龄50岁(24～80岁),其中126例患者放疗前接受子宫动脉灌注化疗栓塞术(uterine arterial chemoembolization,UACE),103例患者放疗前接受子宫动脉灌注化疗术(uterine arterial infusion chemotherapy,UAIC),506例患者单纯行根治性放疗(radiotherapy,RT);三组患者临床资料比较采用四格表法,采用Kaplan-Meier法分析各组患者的疾病相关生存率(disease-specific survival,DSS)、局部控制率(pelvic control,PC)及无远转生存率(dis-tant metastases-free survival,MFS)。迟发性放射损伤按美国肿瘤放射治疗协作组和欧洲肿瘤治疗研究协作组(RTOG/EORTC)分级标准评价,并采用二项分类回归法分析迟发性放射损伤的相关危险因素。结果所有患者总的1、2、5、8年DSS分别为94.5%、82.1%、50.2%、30.7%;与放疗组生存率比较,动脉灌注化疗组较好(P=0.187),动脉化疗栓塞组最差(P=0.010)。动脉灌注化疗组、动脉化疗栓塞组1、2年DSS较放疗组稍高(所有P>0.05),但随着放疗后时间的延长,动脉化疗栓塞组患者的5、8年DSS急剧降低(所有P=0.001)。比较三组患者PC及MFS,动脉灌注化疗组最好,动脉化疗栓塞组最差,但差异均不明显(P>0.05)。动脉化疗栓塞组、动脉灌注化疗组、放疗组并发症比较,迟发性小肠损伤(P=0.961)及迟发性直肠损伤(P=0.968)发生率相近,动脉化疗栓塞组迟发性膀胱损伤发生率高2倍以上(11.1%vs.4.8%vs.4.2%,P=0.008)。子宫动脉化疗栓塞术是与迟发性膀胱损伤相关的危险因素(OR=2.869,P=0.011)。结论根治性放疗前行子宫动脉灌注化疗对提高进展期宫颈癌患者的疗效及改善预后有积极作用,子宫动脉化疗栓塞术却显著降低患者的远期生存率,且是膀胱迟发性放疗损伤发生的强危险因素。

Objective To investigate the contribution of uterine arterial chemoembolization(UACE)and uterine arterial infusion chemotherapy(UAIC)to advanced cervical cancer before radical radiotherapy.Methods 735 patients with primary advanced cervical cancer were studied retrospectively.126 patients underwent UACE,103 patients underwent UAIC before radiotherapy and 506 patients received radical radiotherapy(RT) alone.The major clinical characteristics were analyzed by cross-table comparisons.Kaplan-Meier methods were applied to analyse disease-specific survival(DSS),pelvic control(PC)and distant metastases-free survival(MFS)of each group.Binary logistic regression methods were applied to analyse the risk factors of the late toxicity.Results The DSS of total patients for 1-year,2-year,5-year and 8-year were 94.4%,82.1%,50.2%,and 30.7%,respectively.The DSS of UACE group was slightly higher than that of RT group(P=0.187);while the DDS of UAIC group was lower than RT group(P=0.010).The DSS of 1-year,2-year in UAIC group and UACE group were higher slightly than RT group(P>0.05).The DSS of UACE group in 5-year and 8-year decreased obviously(P=0.001).PC and MFS were highest in UAIC group and lowest in UACE group(P>0.05).The incidence of the late radiation toxicity to the small intestine(P=0.961)and the rectosigmoid(P=0.968)was similar.The incidence of the late toxicity on bladder injury was higher in UACE group(P=0.008)compared with the other two groups.UACE is a risk factor of the late radiation toxicity on the urinary bladder(OR=2.869,P=0.011).Conclusions The use of UAIC before radical radiotherapy could improve treatment outcome and prognosis of the patients with advanced cervical cancer,while the UACE would decrease the long-time survival rate significantly.Furthermore,the later is an important risk factor of the late radiation toxicity.