宫颈癌新辅助动脉化疗的临床和病理学观察

Clinical and pathological observations of neoadjuvant intraarterial chemotherapy for cervical cancer.

目的：观察以顺铂为基础的新辅助动脉化疗（NAIC）对宫颈癌手术或放疗前的治疗效果，并分析其影响因素。方法：对58例FIGO Ⅰb2～Ⅳa期宫颈癌进行NAIC，化疗方案为长春新碱（VCR，1．4mg／m^2）＋丝裂霉素C（MMC，10mg／m^2）＋顺铂（CDDP，80mg／m^2）。经盆腔检查、影像学方法及病理检查判定疗效，并分析影响NAIC疗效的临床和病理因素。结果：58例官颈癌患者共进行81次NAIC（39例1次，18例2次。2例3次），临床总有效率81．0％（其中CR14例，PR33例）。在有宫旁浸润的36例中，31例NAIC后宫旁浸润消失或显著减轻，重获手术机会；5例宫旁浸润改善不明显行放疗。经NAIC后手术的53例中，5例鳞癌患者经病理切片检查未见癌细胞，达病理完全缓解（pCR）。统计学分析提示，肿瘤体积是影响NAIC对宫颈癌疗效的重要因素，肿瘤体积大于80cm^3的宫颈癌对NAIC的疗效较差。58例患者随访6～67个月（中位19个月）8例复发。53例手术患者的中位无瘤生存期（DFS）为46个月。结论：以顺铂为基础的NAIC对宫颈癌根治性手术或放疗前具有较好的缩减肿瘤的效果。

Objective： To evaluate the effects of neoadjuvant intraarterial chemotherapy （NAIC） with eisplatin-based regimen, followed by radical surgery or radiotherapy for cervical cancer, and to analyze clinical and pathological factors influencing the response to NAIC. Methods： Fifty-eight patients with invasive cervical cancer, FIGO stage Ⅰ b2-Ⅳ a, were treated with neoadjuvant intraarterial chemotherapy, using a regimen of eisplatin （80mg/m^2）, mitomyein-C （ 10mg/m^2 ） and vineristine （ 1.4mg/m^2 ）. The response to chemotherapy was assessed by pelvic examination, imaging diagnostics and histological analysis. Results： The overall clinical response rate of the neoadjuvant intraarterial chemotherapy for the 53 patients was 81.0% with 14 cases complete responses and 33 cases partial remission. Tumor reduction rate after ehemotherapy averaged 80.4% with a range of 5.8% - 100%. Out of 36 cases who had parametrial invasion ,31 cases or 86.1% had a significant reduction or absence after chemotherapy, and subsequently underwent radical surgery. In the 53 patients who received surgery after chemotherapy, pathological complete responses （PCR） were found in 5 cases （ 9.4% ）. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was an determining factor affecting the efficacy of intraarterial chemotherapy in cervical cancer. The median follow-up time was 19 months （range 6 -67 months） for the 58 patients enrolled and 8 cases had a recurrence during this period. The median disease-free survival for the 53 surgical cases was 46 months. Conclusion： Neoadjuvant intraarterial chemotherapy with a cisplatin-based regimen for cervical cancer is useful for tumor reduction prior to radical surgery or radiation.