两种介入方法联合腔内放疗与根治术治疗宫颈癌的对比研究

Comparison of two interventional therapy followed by intracavitary radiotherapy and radical hysterectomy for the combing treatment for cervical cancer

背景与目的比较子宫动脉化疗栓塞和髂内动脉灌注化疗联合腔内放疗与根治术治疗宫颈癌的疗效。材料和方法将1997年4月～2007年9月间收治的81例宫颈癌患者分为2组。子宫动脉化疗栓塞组43例,双侧子宫动脉插管注入化疗药后行双侧子宫动脉栓塞。髂内动脉灌注化疗组38例,采用双侧髂内动脉插管注入化疗药。两组化疗方案均为以卡铂为主的联合方案。两组患者介入治疗1～2次后1周进行2～4次192Ir高剂量率腔内放疗,放疗后2周进行广泛性子宫切除术和盆腔淋巴结清扫术,术后对32例有病理危险因素的患者加用外放射治疗。结果两组患者在年龄、分期、组织学类型、肿瘤分级、肿瘤大小等方面无显著性差异。子宫动脉化疗栓塞组临床有效率为62.8%,高于髂内动脉灌注化疗组(50.0%,P>0.05)。差异无统计学意义。术后病理显示,子宫动脉化疗栓塞组病理完全缓解率、盆腔淋巴结转移、手术切缘侵犯均略低于髂内动脉灌注化疗组,而脉管浸润与复发率高于髂内动脉灌注化疗组,差异均无统计学意义(P>0.05)。子宫动脉化疗栓塞组5年总生存率(74%)与髂内动脉灌注化疗组(81%)相比差异无统计学意义(P=0.425)。结论子宫动脉化疗栓塞与髂内动脉灌注化疗联合腔内放疗都能有效缩小肿瘤,提高生存率,但在临床疗效、对病理因素的影响以及复发和远期生存方面尚未显示出明显差异。

Background ＆ Objective：This study was to evaluate the curative effects of Uterine Artery Chemoembolization（UACE） and Internal Illiac Artery Infusion Chemotherapy（IAIC） followed by Intracavitary Radiotherapy（IR） and radical hysterectomy for the treatment of cervical cancer.Materials and Methods：Eighty-one patients with cervical cancer treated between April 1997 and September 2007 were retrospectively analyzed.Patients were divided into two groups：the UACE group（n=43） and the IAIC group（n=38）.The UACE group was treated by bilateral UACE.The IAIC group was treated by bilateral IAIC.All patients were treated by carboplatin-based combing chemotherapy and underwent 192 Ir high-dose-rate IR one weeks after 1-2 times of UACE or IAIC,and then radical hysterectomy was performed 2 weeks after IR.External radiotherapy was performed on 32 requisite patients with high risk of pathological conditions after radical surgery.Results：There was no statistical difference between two groups in age,FIGO stage,histological type,tumorous grade,tumor size,depth of invasion,pelvic lymph node metastasis,lympovascular invasion and pathological response（P〉0.05）.The clinical response rate in the UACE group（62.8%） was higher than that in the IAIC group（50.0%,P=0.05）,but there was no statistical difference in two groups.Postoperative pathologic examinations showed the pathological complete response rate,the percentages of pelvic lymph node metastasis and surgical margin involvement in the UACE group were slightly lower than those in the IAIC group（P〉0.05）.The rate of lymphovascular space involvement and recurrent rate in the UACE group was higher than that in the IAIC group（P〉0.05）.The 5-year overall survival rate in the UACE group was slightly lower than that in the IAIC group（74% vs.81%,P=0.425）.Conclusions：This report shows UACE and IAIC followed by IR is effective to reduce the tumor volume of cervical cancer and improve survival rate.But clinical response,the impact of pathological factors,as well as recurrence and long-term survival of cervical cancer between UACE group and IAIC group has yet no statistical differences.