经导管动脉热灌注治疗子宫颈癌的新辅助化疗

Noeadjuvant Chemotherapy by Transcatheter Arterial Hyperthermal Infusion Method for Uterine Cervicl Cancer

目的 :回顾性分析经导管动脉内热灌注化学药物对子宫颈癌预后的影响。材料与方法 :72例原发子宫颈癌病人分别进行了 2～ 3次经导管动脉内热灌注治疗。Ⅰ、Ⅱ、Ⅲ、Ⅳ期病人分别为 7例、2 5例、31例和 9例 ,灌注药物为 :DDP 6 0mgm2 ,ADM30～ 40mg/m2 ,MMC1 5mg/m2 ,5 -Fu5 0 0mg/人 ,经双侧髂内动脉热灌注 ,药物溶液加温至 45～ 48℃ .72例中 5 4例经动脉内热灌注后行根治性子宫切除术。其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为 7、2 1、2 3和 3例。 3例Ⅱ期和 5例Ⅲ期病人进行了根治量放疗 ,其余 1 0例病人 (Ⅱ期 1例 ,Ⅲ期 3例和Ⅳ期 6例 )由于手术时远处转移导致经动脉热灌注后未进行手术和放疗。 5 4例中的 2 6例进行手术后放疗。结果 :先在动脉热灌注后 ,完全组织反应率 (没有活跃的癌细胞 ) ,ⅠⅡ、Ⅲ、Ⅳ期分别为 3/7,4/2 1 ,6 /2 3和 2 /9,动脉热灌注后无宫旁浸犯 ,Ⅰ、Ⅱ、Ⅲ期组织反应率分别为 6 /7,8/2 1t1 5 /2 3,动脉热灌注无淋巴结转移的组织反应率Ⅰ、Ⅱ、Ⅲ期分别为 6 /1 7,8/2 1和 1 7/2 3,Ⅰ、Ⅱ、Ⅲ期 5年生存率分别为 92 .1 % ,5 5 .3%t 6 0 .6 %。Ⅲ期病人放疗的 5年生存率为 73 5 % ,病人的急性并发症 -白细胞和血小板减少分别为 76 %和 70 % ,较晚的并发症 -肠梗阻发生率为 5 %。结论 :动脉?

Objective:To review the effect of transcatheter arterial hyperthermal infusion(TAHI)of anti-cancer drugs on the prognosis of cervical cancer.Methods:Two or three sessions of TAHI therapy were performed in stage Ⅰ,Ⅱ,Ⅲ or Ⅳ were 7,25,31 and 9 respectively.The drugs infused were DDP(60mg/m 2),ADM (30-40mg/m 2),MMC (15mg/m 2)and 5-Fu(500mg/body)were infused via the bilateral internal iliac arteries with hyperthermal anticancer drugs which temperature was 45-48 C,54 of 72 patients underwent radical hysterectomy after arterial hyperthermal infusion:stage Ⅰ(7 of 7),stage Ⅱ(21 of 25),stageⅢ(23 of 31) and stage Ⅳ(3 of 9).Three stage Ⅱ and 5 stage Ⅲ received radical radiation therapy.The other patients had not received and operation and radiation therapy after arterial hyperthermal infusion because of their distant metastasis at the time of operation.26 of 54 patients received postoperative radiation therapy.Results:The complete histological response rates (no active cancer cell) after arterial hyperthermal intusion was 3/7,4/21,6/23 and 2/9.The histological response rates,which showed no parametrical invasion after arterial hyperthermal infustion,were 6/7,8/21 and 17/23 for stage Ⅰ,Ⅱ and Ⅲ.The overall 5-year survival rates of the patients with stage Ⅰ,Ⅱ and Ⅲ were 92.1%,55.3% and 60.6% respectively.The 5-year survival rate of the irradiated patients with stage Ⅲ was 73.5%.leukocytopenia and thrombocytopenia occurred as an acute complication in 76% and 70% of the patients respectively.Ileus occurred in 5% as a late complication.Conclusions:Arterial hyperthermal infusion may improve the prognosis of patient with cervical cancer without inereasing the incidence of late complications.