同步放化疗治疗宫颈癌的探讨

Concomitant chemoradiation for carcinoma of the cervix

目的观察和评价宫颈癌同步放化疗的疗效和毒性及同步放化疗后辅助手术的作用。方法从2002年7月到2004年1月,根据FIGO分期,IB2-IVA期21例宫颈癌行同步放化疗。其中3例术后腹主动脉旁淋巴结转移或/和淋巴血管癌栓行术后同步放化疗,1例单纯同步放化疗,17例术前同步放化疗后68周手术。所有病例盆腔放疗Dt44~46Gy,3例腹主动脉旁淋巴结阳性者行腹主动脉淋巴结放疗Dt40Gy。外照射同时每周一次顺铂30~40mg·m-2,最多5次。腔内治疗应用137铯低剂量率治疗1~2次(A点剂量Dt13~20Gy/次)。结果随访12~36个月(中位23个月),2年盆腔局控率86%(18/21),2年无病生存率及总生存率分别为76%(16/21)及81(17/21)%;17例放化疗后手术,4例手术标本见肿瘤残留,2年生存率94%(16/17)。大多数病人表现为I^II级急性毒性反应,3例Ⅲ级胃肠道反应,3例肌酐升高>130mmol·L-1。结论宫颈癌同步放化疗可获得理想的盆腔局控及生存率,可逆性急性胃肠道反应(Ⅲ级)可耐受及肾功能改变可恢复,同步放化疗后辅助手术可能进一步提高疗效。

Aim To study the efficacy and toxicity of concomitant chemoradiation and the effect of adjuvant surgery after chemoradiation for carcinoma of the cervix. Methods Between July 2002 to Jan 2004,21 cases with cervical cancer underwent chemoradiation. According to FIGO（ Federation International de Gynecologie de Obstetrique）staging classification, these 21 cases were IB2-IVA stage. 3 cases with positive para-aortic lymph nodes or lymphovascular space invasion received post-operation chemoradiation, 1 case exclusive chemoradiation, 17 cases pre-operation chemoradiation and radical surgery performed 6 - 8 weeks after completion of the pre-operation treatment. All cases received Dt 45 Gy of radiation to the pelvis, and 3 patients with positive para-aortic lymph nodes received Dt 40Gy to the paraaortic site. Chemotherapy cisplatin （30 - 40 mg per square meter of body-surface area once a week for five doses）. One or two intracavitary of low-dose rate ^137 Cs were performed after external radiotherapy（ Dt13 - 20Gy/f） ,to deliver a total dose of Dt60Gy to point A for pre-operation cases and of Dt 80Gy for exclusive chemoradiation. Results With median follow-up of 23 months（ range 12-36）, the 2- year pelvis local region control rate was 86% （ 18/21 ） ,the 2-year disease-free survival rate and overall survival rate was 76% （ 16/21 ）, 81% （ 17/21 ） respectively;17 cases received adjuvant surgery after chemoradiation, and 4 had residual tumor in the pathology report,2- year survival rate was 94% （16/17）. Most cases have Ⅰ-Ⅱ grade acute toxicity, severe acute toxicity being adverse gastrointestinal effects （3 cases Ⅲ grade）, 3 cases serum creatinine 〉 130 mmol · L^-1. Conclusion Chemoradiation of cervical cancer is effective for local contral and survival rates. Acute toxicities were toleratant and changes of renal function were reversible. Adjuvant surgery after chemoradiation may improve the. survival rate.