新辅助介入化疗及BOMP方案用于宫颈癌的疗效评价

A Neoadjuvant interverntional chmotherapy with BOMP in locally advanced cervicai cancer

目的评价新辅助介入化疗及BOMP方案用于宫颈癌的疗效。方法对宫颈癌28例,其中I B2 19例,ⅡA-B 6例, ⅢA-B 3例,化疗方案为博来霉索16mg,长春新碱2mg,丝烈霉素10mg,卡铂400mg(BOMP),采用股动脉穿刺,髂内动脉灌注化疗,超选择栓塞技术,于一疗程化疗后根据检查决定,或进入第二疗程化疗或手术或放疗。分析临床近期疗效,病理缓解率、手术率;以及化疗后与手术间隔期。结果新辅助介入化疗的BOMP方案临床近期总有效率26例(92.8%),其中完全缓解率14例(50. 0%),部分缓解率12例(42.8%);术后病理完全缓解率10例(35.7%),26例手术病例无宫旁浸润,淋巴转移和阴道切缘阳性。化疗后行宫颈癌根治术加盆腔淋巴结清扫术26例(92.8%),行根治性放疗2例(7.1%),其中一疗程化疗后手术22例(78.6%),二疗程化疗后手术4例(14.3%)。全部手术病例均在化疗后第3周施行。结论BOMP化疗方案作为宫颈癌术前辅助化疗疗效明显;绝大多数局部晚期病例术前可设计一疗程化疗,从而缩短辅助治疗手段的时间;化疗后第3周施行手术,较为合适,降低了手术难度。

Objective To evaluate the curative ettect of a neoadjuvant interventional chemotherapy with BOMP on locally advanced cervical . Methods The clinical data of 28 patients with locally advanced cervical cancers (19 with stage ⅠB2,6 with stage ⅡA - B, 3 with stage ⅢA -B) treated by a neoadjuvant interventional Chemotherapy with BOMP were analyzed. The treatment regime consisted of bleomycin 16 mg, vincristine 2mg, mitomycin - c 10mg and caboplatin 400mg.The neoadjuvant intraarterial infusion chemotherapy and superselective embolization of the arterial flowing blood to the cancer were performed. One course chemotherapy was follovved by either sencond course chemotherapy or operation or radiotherapy, according to the patients conditions. The valuation was made on the recent clinical effect, phathologic response, operation rate and the interval between the chemotherapy and surgery .Result Total clinic response rate was 92.8% ,including 50% (14/28) complete and 42.8% (12/ 28) partial response. Pathologic complete response was observed for ten (35.7%) patients. The parametrial involvement, pelvic lymph node metastasis, and positive vaginal resection margins were not found in 26 undergoing the surgery. Of 28 patients with cervical cancers,26 were treated by radical hysterectomy (92.8% ) and 2 by radical radiotherapy after the chemotherapy (7. l % ) , of 26 patients undergoing the surgery 22 underwent surgery after one course chemotherapy and 4 after two courses chemotherapy. All operations were perform in the third week after chemotherapy. Conclusion The curative effect of a preoperative neoadjuvant interventional chemotherapy with BOMP on locally advanced cervical cancer is good. One course therapy may be applied to most of the locally advanced cervical cancer cases in order to sorten the time of adjuvant therapy. It' s appropriate to perform surgery the third week after the chemotherapy when the operative difficulty is less .