新辅助化疗在宫颈癌术前治疗中的评价

Evaluation of Clinical Efficiency of Neoadjuvant Chemotherapy in Early Cervical Carcinoma

【目的】探讨新辅助化疗在早期宫颈癌术前治疗中的疗效。【方法】收集本院2000年3月至2004年11月收入院的33例早期宫颈癌(Ⅰb1期～Ⅰa期),经腹壁下动脉插管后,髂内动脉灌注化疗,药物以顺铂为主的联合方案,所有病人均完成2个疗程化疗,化疗结束后14d经妇科检查,B超测量宫颈肿块消退情况,按UICC疗效标准评价疗效。化疗结束后2周行子宫广泛切除加盆腔淋巴结清扫。【结果】化疗总有效率87.9%,CR57.6%,PR30.3%,SD9.0%,PD3.0%,其中Ⅰb1期全组有效率100%,Ⅰb2期90.0%,Ⅱa期71.4%,鳞癌86.7%,腺癌100%;宫颈肿块<4cm有效率92.3%,≥4cm85.0%。术后病理检查阳性结果。宫颈残留Ⅰb1期33.3%,Ⅰb2期60.0%,Ⅱa期42.8%,宫旁浸润Ⅰb2期5.0%,Ⅱa期14.2%。盆腔淋巴转移Ⅰb2期15.0%,Ⅱa期14.2%,宫颈肿块<4cm7.6%,≥4cm15.0%。术后无一例膀胱输尿管瘘,随访1～3年2例死于复发癌,复发率6.0%。【结论】新辅助化疗作为早期宫颈癌术前治疗,可以明显缩小和消退宫颈肿块,减少术后宫旁浸润,淋巴结转移,降低术后并发症,减少术后复发。

[Objective]To investigate the effect of neoadjuvant chemptherapy （NACT） in early carcinoma of cervix. [Methods]Thirty three patients with stage Ⅰ a to stage Ⅱ a cervical carcinoma received NACT for 2 periods of treatment before operation. The evaluation was made according to UICC on 14 days after NACT, Then the hysterectomy was done. [Results]The total efficient rate of NACT was 87%, CR 57%, PR 30%, SD 9.0%, PD 3.0%. The efficient rates of NACT of stage Ⅰ b1 , Ⅰ b2 , Ⅱa squamous carcinoma, adenocarcinoma, patients with node of tumor .〈 and 〉 4 cm were 100%, 90.0%,71.4% ,86.7% ,100% ,92.3% and 85. 0% respectively. By evaluating the state of illness after operation, the efficient rates of stage Ⅱ b1, Ⅰ b2, Ⅱa, Ⅱ b, patients with lymph node metastasis, patients with node of tumor 〈 and 〉 4 cm were 33.3 %, 60.0 %, 42.8%, 5.0%, 14.2%, 7.6% and 15.0%, respectively. No vesical fistula was found after operation. The recurrence rate was 6.0% （only 2 cases developed recurrence 3 years after operation）. [Conclusion]As a kind of therapy used in early cervical carcinoma before operation, NACT can shrink significantly the cervical tumor, reduce invasion and metastasis, decrease complications and the pelvic recurrence after operation.