术前放化疗对早期巨块型宫颈癌的疗效

Preoperative radiation and chemotherapy in early-stage bulky cervical carcinoma.

目的探讨术前放、化疗在早期巨块型宫颈癌治疗中的作用.方法 129例IB2-IIA巨块型宫颈癌按术前治疗方式分3组.放疗组68例,行术前后装放疗,A点剂量8～40Gy;化疗组25例,接受1～3疗程含顺铂或卡铂为主的新辅助化疗;放化疗组36例,予术前后装放疗结合化疗.结果放疗组、化疗组及放化疗组近期有效率分别是58.82%、72.00%和83.33%,放化疗组与放疗组比较差异显著(P<0.05);鳞癌与非鳞癌术前治疗有效率比较无显著性差异(68.70%vs11/14, P>0.05);术前有无化疗者盆腔淋巴结阳性率无显著性差异(P>0.05);三组术前治疗均未发生严重不良反应,术中出血量、术中术后并发症发生率无显著性差异(P>0.05).结论新辅助化疗对早期巨块型宫颈癌有较高局部控制率;放化疗有协同作用,对浸润性生长局部肿瘤巨大、非鳞癌病例可以迅速缩小肿瘤,提高手术切除率和安全性.

Objective To evaluate the effect of preoperation of radiation and chemotherapy in early - stage bulky cervical carcinoma. Methods Total of 129 cases with bulky IB2 -IIA cervical carcinoma were divided into three groups according to the therapies. The radiation group including 68 cases received afterloadiug radiation of 8 N 40Gy at the A point; The chemotherapy group of 25 cases received 1 N 3 courses of ueoadjuvaut chemotherapy with regime consist of DDP or carboplatin. The cbemoradiatiou group including 36 cases received preoperatlou both of afterloadiug radiation and ueoadjuvaut chemotherapy. Results The response rates of radiation group, chemotherapy group and chemoradiatiou group were 58.82% ,72.00% and 83.33% respectively, and there was significant difference in the efficacy between the cbemoradiatiou group and radiation group （P 〈0.05 ） ;There was no significant difference in the responses rate between squamous and non- squamous cases（68.70% vsl 1/14, P 〉 0. 05） ;There was no significant difference in the lymph node metastasis rate in the cases with or without ueoadjuvaut chemotherapy （ P 〉 0.05 ） ;There was no serious adverse reaction in the three groups; There was no significant difference in the blood loss, surgery complication of the three groups（ P 〉 0.05 ）. Conclusion Neoadjuvaut chemotherapy is effective in the preoperatiou therapy of early -stage bulky cervical carcinoma; Radiation and chemotherapy has synergistic effect; Chemoradiatiou can decrease the local tumor in a relative short time in the infiltrative growth bulky cervical carcinoma or non - squamous type,and improve the surgery rate and safty.