超选择动脉导管化疗治疗Ib巨块型及晚期宫颈癌临床研究

Evaluation intraarterial neoadjuvant chemotherapy in locally adv anced cervical carcinoma.

目的了解宫颈癌术前动脉插管化疗前后临床及组织病理的变化，以明确动脉导管化疗的疗效。方法自2000～2004年共计25例宫颈癌病例。临床分期为Ⅰ期巨块型或Ⅱb期以上病人。采用双侧超选择性子宫动脉导管化疗，化疗方案：PDD50mg/m^2双侧＋Bleomycin 30mg/m^2双侧，每两周重复最多2次。观察给药前后肿瘤病变大小、子宫旁转移病灶、淋巴结转移灶及血肿瘤标记SCC变化。同时观察化疗副反应及组织学改变。结果25例中23例化疗后成功行扩大全子宫切除并且宫旁未见癌灶。仅一次导管化疗15例，完全缓解10例，部分缓解5例，总缓解率60％。行第二次导管化疗10例，完全缓解6例。部分缓解2例，2例无变化改放疗，总缓解率为92％（23／25）。其中完全缓解率80％（16／25），部分缓解率35％（7／20）。无变化2例接受放疗。观察血SCC变化，16例不同程度下降。导管治疗后手术切除标本有肿瘤组织变性、坏死。组织学有效率24％。结论（1）动脉导管术前化疗能够控制局部巨块及晚期官颈癌肿瘤的生长，使癌灶缩小，降低肿瘤的分期，从而为手术的彻底切除创造条件。（2）降低肿瘤细胞活力，减少术中肿瘤播散及术后转移。（3）清除亚临床病灶减少复发危险。（4）年轻患者卵巢功能保留对性生活及生活质量均有提高。

Objective The purpose of this study to investigate the effect of neoadjuvant intraarterial chemotherapy （NAIC） on the prognosis of patients with locally advanced cervical cancer. Methods From January 2000 to January 2004, 25 previously untreated patients with stage Ⅰb with big tumor size, Ⅱ , Ⅲa cervical cancer were enrolled in the study. NAIC was administered at least two courses every 2 weeks using a combination of 30mg/m^2 bleomycin, 50mg/m^2 cisplatin via the bilateral uterus artery. Study the change in size of the primary and invaded cancer, metastatic lympha node , the level of SCC in blood and side effect of chemical treatment, and pathologic change of surgical specimens. Results 23 （92.0%） of the 25 patients responded to chemotherapy, permitting a radical hysterectomy with pelvic lymphadenectomy.The overall response rate and partical response rate were 80% （16/25）, 35% （7/20） resectively.2 patients received radlotherapy.The level of SCC of blood significandy declined after NACT. Pathologic complete responses were found in 6 of the 23 patients who underwent radical surgery. Conclusions These preliminary results suggest that NAIC is able to improve the operability in patients with stage IB with big size of cervical tumor and stage Ⅱ , Ⅲ a considered inoperable, eliminate effectively the pathologic risk factors in the pelvic cavity, and improve the prognosis of patients with locally advanced cervical cancer and remain the function of ovary.