静脉和动脉途径新辅助化疗治疗局部晚期宫颈癌疗效比较

Comparison of the therapeutic effects of neoadjuvant chemotherapy with venous and arterial way in treatment of locally advanced cervical cancers

目的比较静脉和动脉不同给药途径新辅助化疗（NACT）治疗局部晚期宫颈癌（LACC）的临床疗效和副作用。方法对宫颈肿瘤直径≥4cm、FIGO分期Ⅰb～Ⅱb期的LACC患者分别采用静脉注射（56例）和动脉插管化疗（51例），观察并比较其化疗疗效、副作用及生存情况。结果两组共84例获得近期部分缓解，总有效率78．5％，其中静脉组44例（78．6％），动脉组40（78．4％），两组近期有效率差异无统计学意义（P〉005）。静脉组发生的胃肠道反应、骨髓抑制副反应疗程个数明显多于动脉组（均P〈0．01），而两组发生的神经性反应疗程个数差异无统计学意义（P〉005）。两组患者总5年生存率为88．8％，其中静脉组为88．5％，动脉组为89．1％，差异无统计学意义（P〉0．05）。NACT有效者5年生存率静脉组为1000％，动脉组为91．9％，差异无统计学意义（P〉005）。结论不同途径NACT治疗LACC的近期疗效相当，静脉给药操作简单，但副作用相对较大，有条件时以选择动脉途径NACT治疗为好。

Objective To compare the efficacy and toxicity of neoadjuvant chemotherapy with venous and arterial way in patients with locally advanced cervical cancer. Methods A retrospective study was carried out on 107 patients suffering from FIGO stage Ib or lib disease of locally advanced cervical cancer admitted to the Second Affiliated Hospital of Wenzhou Medical College from June 2000 to June 2005. The therapeutic toxic and adverse effects of venous and arterial interventional chemotherapy were analyzed and compared, Results Among 107 patients, 56 were given venous and 51 were given arterial interventional chemotherapy. All patients received platinum-based neoadjuvant chemotherapy. Clinical response to neoadjuvant chemotherapy occurred in 84 patients with a total effective rate of 78.5%; that of venous was 78.6% and that of arterial interventional way was 78.4% （P 〉 0.05）. No intolerable toxic and adverse effects were noticed during neoadjuvant chemotherapy. After neoadjuvant chemotherapy, 96 women underwent surgery, whereas the remaining 11 received radiotherapy. The 5-year survival rate of venous chemotherapy group were 88.5%, and those of arterial interventional chemotherapy group were 89.1% （P〉0.05）. Conclusion The results suggest that the therapeutic effects of venous and arterial interventional chemotherapy was similar,but the adverse effects of venous chemotherapy was more serious than that of arterial interventional chemotherapy.