Ⅰ_(b2)宫颈癌术前化疗效果研究

The effect of preoperative chemotherapy in stage Ⅰ_(b2) cervical cancer

背景与目的:Ⅰ_(b2)宫颈癌肿瘤最大径线大于4cm直接手术出血多,手术比较困难。本文探讨新辅助化疗吉西他滨联合顺铂对Ⅰb2宫颈癌术前应用的临床效果。方法:A组Ⅰ_(b2)宫颈癌患者23例,用吉西他滨(1.5g/m2第一天)联合顺铂(50mg/m2第二天)治疗,2周后重复,至少治疗2个疗程;B组Ⅰ_(b2)宫颈癌患者19例,用长春新碱(1.5g/m2第一天)、顺铂(20mg/m2第一天至第三天)和博来霉素(10mg/m2)治疗,肌内注射,第一天至第三天,3周后重复,至少治疗2个疗程。对药物的临床疗效和毒性进行评价,并对患者进行随访。结果:与B组相比,A组肿瘤最大径线缩小,差异有显著性(P=0.004)。化疗的毒副反应以骨髓抑制常见。术后病理显示:淋巴结转移及脉管内转移在A组明显少于B组,差异有显著性(P<0.05)。结论:吉西他滨联合顺铂对Ⅰ_(b2)宫颈癌术前应用有较好的效果,可以较快的缩小肿瘤体积,缩短发现肿瘤与可以手术的时间,毒副作用可以耐受。并且能减少淋巴结转移及脉管内转移。

Background and purpose： The greastest diameter of cervical cancer with stage Ⅰb2 disease was more than 4 cm in diameter, surgery as the first priority was difficult in these patients, bleeding was the most frequent adverse effect. This article studied the effect of the cervical cancer with stage Ⅰb2 disease underwent neoadjuvant chemotherapy with gemcitabin plus cisplatinum（DDP）. Methods： 23 cases （A groups） stage Ⅰb2 cervical cancer were treated with gemcitabin 1.5 g/m^2 iv infusion at dl, plus cisplatinum（DDP） 20 mg/m^2 iv infusion at d1-3. The interval between the two cycles was two weeks. 19 cases （B groups） were treated with cisplatinum（DDP） 20 mg/m^2 iv infusion at d1-3,plus VCR 1.5 g/m^2 iv infusion at dl, and BLM 10 mg/m^2 im at d1-3, The interval between the two cycles was three weeks. The assessment for clinical effect and side effect were conducted for the patients with completion of at least two cycles of chemotherapy. Results： 42 cases were enrolled in this trial. There was significant（P=-0.004） difference between the two groups with the shrinkage of the greatest diameter after neoadjuvant chemotherapy. The main toxicities were myelosuppression. There was significant （P〈0.05）difference between the two groups in the lymph node metastasis and lymphatic vascular invasion in the pathologic specimen after operation. Conclusions： The neoadjuvant chemotherapy with gemcitabin plus cisplatinum（DDP） has much more better effect for the stage Ⅰb2 cervical cancer before the operation, chemotherapy can more quickly reduce the diameter of the tumor and can shrink the duration time between the diagnosis of cervical cancer and surgery. Its side effect could be tolerance＆ In addition, neoadjuvant chemotherapy could reduce the lymph node metastasis and lymphatic vascular invasion.