同步放化疗和单纯放疗治疗ⅡB～ⅢB期宫颈癌的疗效比较

Concurrent Chemoradiotherapy versus Radiotherapy in Advanced Cervical Carcinoma

背景与目的:同步放化疗已成为局部晚期宫颈癌的标准治疗模式,但对于放疗联合何种方案的化疗效果最佳,目前尚无一致意见。本研究中我们比较同步放化疗与单纯放疗,以及同步放化疗不同化疗方案的疗效及毒副反应。方法:2003年1月至2004年12月江西省妇幼保健院收治的符合入组标准的ⅡB～ⅢB期宫颈癌患者285例,按住院序号随机分为单纯放疗组142例,同步放化疗组143例。同步放化疗组又按化疗方案不同分为:BP(博来霉素+顺铂)方案同步放化疗51例,TP(紫杉醇+卡铂)方案同步放化疗47例,FP(氟尿嘧啶+顺铂)方案同步放化疗45例。比较单纯放疗组与同步放化疗组患者的3年生存率和不良反应,同时对同步放化疗三种不同化疗方案组的3年生存率及不良反应进行比较。结果:全组中位随访时间为42个月,单纯放疗组与同步放化疗组的3年生存率分别为65%和75%,两组比较差异有统计学意义(P=0.042)。单纯放疗组Ⅲ～Ⅳ度急性毒副反应低于同步放化疗组(P<0.001),迟发性毒副反应两组差异无统计学意义(P=0.613)。同步放化疗组BP方案、TP方案、FP方案的3年生存率分别为74%、80%和71%,三组间比较差异无统计学意义(P=0.792)。三组Ⅲ～Ⅳ度急性及迟发性毒副反应发生率相似。结论:与单纯放疗相比,同步放化疗可明显提高ⅡB～ⅢB期宫颈癌患者的疗效。在同步放化疗三种不同的化疗方案中,紫杉醇联合卡铂方案组患者3年生存率略高于其他两种化疗方案,毒副反应可耐受,值得进一步研究。

BACKGROUD ＆ OBJECTIVE： Cisplatin-based concurrent chemoradiotherapy has become the standard treatment modality for locally advanced cervical cancer. However, the optimal chemotherapy regimen combined with radiotherapy remains controversial. This study was to compare the therapeutic efficacy and toxicity of concurrent chemoradiotherapy with those of radiotherapy, and those among different regimens of concurrent chemoradiotherapy for stage ⅡB-ⅢB cervical cancer. METHODS： From Jan. 2003 to Dec. 2004, 285 patients with stage ⅡB-ⅢB cervical cancer treated in Maternal and Child Health Hospital of Jiangxi Province were randomly assigned to receive radiotherapy alone or concurrent chemoradiotherapy. According to different chemotherapy regimens, patients in the concurrent chemoradiotheapy group were randomly chosen to receive radiotherapy with chemotherapy of bleomycin and cisplatin （RT ＋BP）, radiotherapy with chemotherapy of taxol and carboplatin （RT＋TP）, and radiotherapy with chemotherapy of 5-fluorouracil and cisplatin （RT＋FP）. The 3-year survival rates and toxicity of different groups were compared. RESULTS： After a median follow-up of 42 months, the 3-year chemoradiotheray group （75%） than survival was higher in the concurrent n the radiotherapy group （65%） （P= 0.042）. Acute treatment-related toxicity （grade Ⅲ and Ⅳ） was higher in the concurrent chemoradiotherapy group than in the radiotherapy group （P〈 0.001）; while the delayed treatment-related toxicity was similar in the two groups （P =0.613）. The 3-year survival rates of BP, TP and FP chemoradiotherapy groups were 74%, 80% and 71%, without significant differences （P=0.792）. Acute toxicities （grade Ⅲ and Ⅳ） and delayed toxicities were similar among the three groups. CONCLUSIONS： Concurrent chemoradiotherapy significantly improves the survival for patients with stage ⅡB-ⅢB cervical cancer compared to radiotherapy alone. Among the three chemoradiotherapy regimens, radiotherapy combined with taxol and carboplatin exerts a slightly higher 3-year survival than the other two regimens with tolerable toxicity.