介入栓塞化疗联合放疗应用于中晚期子宫颈癌治疗的疗效观察

Effect of concurrent intra-arterial infusion of carboplatin on patients with stage Ⅱ or Ⅲ uterine cervical cancer treated with radical radiation therapy

目的观察子宫动脉插管灌注铂类为主的药物加栓塞与放疗联合应用治疗Ⅱ，Ⅲ期宫颈癌的疗效。方法38例（ⅡB3例；ⅢA24例；ⅢB11例）宫颈癌病人随机分为经动脉贯注卡铂和5-Fu并联合放疗组（20例），和单独放疗组（18例），介入加放疗组病人先在X线引导下做双侧髂内动脉插管并超选择插入双侧子宫动脉，分别注入以卡铂和5-FU并用明胶海绵栓塞双侧子宫动脉。3～4周重复治疗，2次后开始放射治疗，放疗采用腔内后装加外照射。另设单纯放疗组作对照，放疗方法两组相同。结果病灶完全缓解率在介入化疗加放疗组为75．0％，在单纯放疗组50．0％，有显著性差异（P〈0．05）。3年生存率介入化疗加放疗组为70．0％，单纯放疗组为72．2％，统计学上无显著性差异。但是介入化疗加放疗组病人副反应较单纯放疗组为明显，差异有显著性（P〈0．05）。结论相比单纯放疗，介入化疗加放疗在控制宫颈癌局部病灶方面有优势，但是在生存率方面两者无明显差别，且介入化疗加放疗组副反应较单纯放疗组明显。所以有必要在获得良好的局部控制率的同时，采取措施减少治疗的副反应。

Aim This study was to explore the effect of concurrent intra-arterial infusion of carboplatin drugs in patients with stage Ⅱ or Ⅲ uterine cervical cancer treated with radical radiation therapy. Methods 38 patients with advanced （ stage ⅡB ,3 ; ⅢA ,24; Ⅲ B, 11 ） uterine cervical carcinoma were randomized into a concurrent intra-arterial infusion of earboplatin drugs with radiation therapy （IAPRT） group （20 patients） and a radiation therapy alone group （18 patients）. For IAPRT group：one-shot infusion of carboplatin （300 mg ·m^-2） ＋ 5-Fu 1.0g twice with a 2-to 3-week interval was performed. Radiation therapy consisted of external - beam irradiation for the whole pelvis with midline block after 30 Gy and intracavitary high-dose-rate brachytherapy 28 Gy/4fractions/4weeks to point A. Results The local complete response rate of the IAPRT group was 75.0% and was significantly higher than that of the radiation therapy group （ 50.0% ）. 3 - year overall survival rates were 70.0% in the IAPRT group, and 72.2% in the radiation therapy group. There was no significant difference between the two groups. Acute bowel complications were seen more in the IAPRT group than in the radiation therapy group. Conclusions IAPRT had a better local response than radiation therapy but had no better survival rate than radiation therapy. Complications of the IAPRT group were very severe. We need to design some methods to decrease these complications to make use of the good local response acquired with IAPRT.