同步放化疗和新辅助化疗治疗ⅡB～ⅢB期子宫颈癌的疗效分析

Analysis of curative effect for concurrent chemoradiotherapy versus neoadjuvant chemotherapy for stage ⅡB～ⅢB cervical cancer

目的探讨同步放化疗治疗ⅡB～ⅢB期子宫颈癌的疗效。方法将126例ⅡB～ⅢB期子宫颈癌患者随机分为同步放化疗组（治疗组）和化疗后放疗组（对照组）。对照组62例外照射加腔内治疗，当放疗剂量达到30Gy时用^192Ir腔内治疗，7．0Gy／次，1次／周。当外照射剂量达到46Gv时中间挡铅。A点剂量65～70Gy，B点剂量50—56Gy结束放疗，在放疗开始前给予顺铂（DDP）20mg静脉滴注，第1天至第5天，5-氟尿嘧啶（5-Fu）750mg静脉滴注，第1天至第5天，每28d重复。2个周期结束后开始放疗，放疗结束后继续原方案化疗2个周期，共4个周期。治疗组64例，放射治疗同对照组，在放疗开始时给予DDP20mg静脉滴注，第1天至第5天，5-Fu 750mg静脉滴注，第1天至第5天，每28d重复，共用4个周期。结果全部病例随访5年以上，随访率9414％。治疗组3、5年生存率分别为82．8％、65．6％；对照组3、5年生存率分别为67．7％、46．8％，两组差异有统计学意义（x^2=3．86，P〈0．05；x^2=5．01，P〈0．05）。两组生存曲线比较差异有统计学意义（x^2=4．26，P〈0．05），不良反应差异无统计学意义。结论同步放化疗治疗晚期子宫颈癌疗效好，可以提高3、5年生存率。不良反应无明显增加。

Objective To observe the effect and side effects of concurrent chemoradiotherapy for stage ⅡB～ⅢB cervical cancer. Methods 126 patients with stage ⅡB～ⅢB cervical cancer were randomly allocated into 2 groups. Concurrent chemoradiotherapy group： radiotherapy carried out same as the neoadjuvant chemotherapy group, i.e.firstly with cisplatin 20 mg iv d1-5, 5-Fu 750 mg iv d1-5, repeated every 28 days, total 4 cycle; the neoadjuvant chemotherapy group i.e.firstly with cisplatin 20 mg iv d1-5, 5-Fu 750 mg iv d1-5, repeated every 28 days, total 2 cycle, after chemotherapy received routine radiotherapy 2 Gy per day, 5 times a week to a total dose of 30 Gy with ^192Ir brachytherapy, 7 Gy per week. When total dose reached 46 Gy, the middle field was shielded by plumbum, then continuous radiotherapy, total dose reach A point 65-70 Gy, B point 50-56 Gy. Results All patients were followed-up for more than five years. The follow-up rate was 94.4 %. In concurrent chemoradiotherapy group the 3 year survival rate and the 5 year survival rate were 82.8 %, 65.6 %, In neoadjuvant chemotherapy group the 3 year survival rate and the 5 year survival rate were 67.7 %, 46.8 %. There was a significant difference in two groups （X^2=3.86, P 〈0.05; X^2= 5.01, P 〈0.05）, no significant difference in toxicity-side effect. Conclusion Concurrent chemoradiotherapy for advanced cervical cancer can significantly improve the 3-year and 5-year survival rate and has little increase in toxicity-side effect.