盐酸伊立替康联合顺铂方案治疗宫颈癌的临床研究

Clinical effects of combination chemotherapy with irinotecan hydrochloride and cisplatin on cervical cancer: study of 46 patients

目的评价盐酸伊立替康联合顺铂方案治疗宫颈癌的疗效,观察该方案治疗宫颈癌的毒副反应,探讨化学治疗在宫颈癌治疗中的地位。方法对46例宫颈癌患者采用了盐酸伊立替康联合顺铂方案治疗,用药方案为盐酸伊立替康60mg/m2于第1、8、15天溶于250ml生理盐水静脉注射1h,顺铂60mg/m2于5%葡萄糖500ml中静脉注射4h,第1天,每28d重复疗程。46例患者的病理类型分别为:鳞状细胞癌43例,腺癌2例,小细胞癌1例。结果41例Ⅰb～Ⅲb患者采用该方案新辅助化疗,化疗1～2疗程后,完全缓解4例,占9.8%;部分缓解30例,占73.2%;疾病稳定7例占17.1%;疾病进展0例;总有效率为82.9%。化疗前Ⅱb期和Ⅲb期患者共29例不能手术,化疗后20例患者的宫旁至盆壁无瘤间隙≥3cm而行根治性子宫切除术,可手术率为69%。5例复发患者化疗4～6个疗程后,完全缓解1例,部分缓解2例,疾病稳定2例,疾病进展0例,总有效3例。主要毒副反应为骨髓抑制和腹泻。结论盐酸伊立替康联合顺铂方案新辅助治疗宫颈癌疗效好,为晚期患者赢得了手术时机,改善了这些患者治疗后的生活质量,且副反应可耐受,易处理。对以前未接受铂类药物化疗的复发宫颈癌患者的近期疗效亦可以。

Objective To evaluate the efficacy and toxicity of the combination chemotherapy of irinotecan hydrochloride plus cisplatin on cervical cancer. Methods Forty-six patients with cervical cancer,43 with squamous cell carcinoma, 2 adenocarcinoma, and 1 small cell carcinoma, 41 being treated initially and 5 being recurrent cases of which 2 had undergone radiotherapy plus chemotherapy, 2 radical hysterectomy plus pelvic radiotherapy after operation, and 1 radical hysterectomy plus chemotherapy, aged 38 （22 -61 ） , were treated with irinotecan hydrochloride, 60 mg/m^2 in 250 ml normal saline administered on days 1,8, and 15 by intravenous infusion over 60 min, plus cisplatin, 60 mg/m^2 in 500 ml 5% glucose given on day 1. This regimen was repeated every 28 days. Effectiveness evaluation was conducted after 1 -2 courses for the initially treated patients and after 2 - 6 courses for the recurrent patients. Results Totally 79 courses of treatment were given to the 41 patients. After 1 - 2 courses 4 （9. 8% ） of the 41 stage I b2 -Ⅲ b initially treated patients achieved complete remission, 30 （73.2%） achieved partial remission, and 7（ 17. 1% ） remained at stationary phase with a overall effective rate of 82. 9%. Of the 29 Ⅱ b and Ⅲb stage advanced patients who failed to receive operation originally 20 patients （69%） succeeded to be treated by radical hysterectomy after 1 to 2 courses when the tumorless space between the uterine and the pelvic wall ≥3 em with an operatibility rate of 69%. Of the 5 recurrent patients 1 case achieved complete remission, 2 partial remission, and 2 remained stable; none progression of disease was observed after 4 -6 courses. The main toxic response and side effect included myelosuppression and diarrhea. Conclusion Effective neoadjuvant chemotherapy on cervical cancer, combination therapy of irinotecan hydrochloride and cisplatin win opportunity for treatment and improves their life quality with tolerable side effects.