新辅助化疗在宫颈癌治疗中的应用价值

Significance of neoadjuvant chemotherapy for preoperative cervical cancer

目的:评价新辅助化疗(NACT)对Ⅰb～Ⅱb期子宫颈癌的术前疗效及手术效果。方法:对13例我院2004年10月～2009年4月诊治的Ⅰb～Ⅱb期子宫颈癌患者手术前进行静脉全身NACT治疗,采用PVB方案,3个疗程以内完成,疗程间隔约3周。13例经NACT治疗后约2周再进行根治性子宫切除术,观察术中出血量、盆腔淋巴结清扫转移、全子宫切除率、术后并发症、术后复发等评价指标。结果:13例Ⅰb～Ⅱb期子宫颈癌均为磷癌,且均能耐受化疗。NACT治疗完全缓解1例、部分缓解7例、稳定3例和进展2例,有效率61.5%(8/13)。13例经NACT治疗后手术中有12例成功进行了广泛性子宫切除术和盆腔淋巴结清扫术,1例出现低估而仅做次广泛子宫切除术,全子宫切除率100(13/13);术中出血量350～1200ml;2例盆腔淋巴结转移;术后除1例切口脂肪液化外,余均未见其他术后并发症发生;术后随访至今,均未见复发。结论:NACT对Ⅰb～Ⅱb期子宫颈癌的术前疗效较好,化疗后全子宫切除率高,手术近期效果好,远期疗效有待观察。

Objective： To evaluate the preoperative effect and postopera- tive outcome of neoadjuvant chemotherapy （NACT） on cervical cancer in stage of Ⅰb-Ⅱb. Methods： During Oct. 2004 and Apr. 2009,13 pa- tients with cervical cancer in stageⅠb-Ⅱb underwent the intravenous NACT scheme administered by PVB and received less than 3 cycles of chemotherapy in our hospital. Two cycles of NACT were initially given at intervals of 3 weeks. Two weeks after the last intervention, 13 patients were undergone radical hysterectomy. The assessment was conducted concerning intraoperative bleeding volume, pelvic lymph node metastasis, total hysterectomy rate, postoperative complications and recurrence. Results： The total 13 cases were squamous tumors in stage Ⅰb-Ⅱb,with tolerance of NACT for each. One patient totally responded to NACT and 7 were seen in partial response. Stable disease was in 3 and progressive dis- ease was in 2. The therapy was effective in 8 out of 13（61.5% ）. Extensive radical hysterectomy with pelvic lymphadenectomy was successfully performed in 12 patients and only one required secondary procedure due to failure of comprehensive preoperative program. 100% of the patients underwent total hysterectomy and the intraoperative bleeding ranged from 350 to1200 ml. Pelvic lymph node metastasis appeared in 2 patients. No serious postoperative complications occurred except 1 incidence of fat liquefaction around the cut. To date,the follow-up showed no case of recur- rence in the 13 patients. Conclusion： NACT is effective in preoperativemanagement for cervical cancer in stage Ⅰb-Ⅱb, leading to a higher total hysterectomy rate. Short-term effect seemed excellent, but long-term resuhs need further study.