单纯放疗、新辅助化疗及同步放化疗治疗宫颈癌临床近期疗效比较

Clinical curative effects of three non-surgical therapies for cervical cancer

目的探讨单纯放疗、新辅助化疗、同步放化疗三种非手术疗法治疗宫颈癌的疗效。方法收集2004-2009年在中国医科大学附属第一医院妇科和放疗科诊治的宫颈癌患者120例,分为两组。(1)术前治疗组:Ⅰb～Ⅱa期患者60例,包括单纯放疗组(20例)、新辅助化疗组(20例)、同步放化疗组(20例)。(2)非手术治疗组:Ⅱb～Ⅲb期患者60例,包括单纯放疗组30例,同步放化疗组30例。进行临床疗效和临床病理资料的分析对比研究。结果术前同步放化疗组和新辅助化疗组近期有效率分别为90%和85%,显著高于术前单纯放疗组(55%)(P<0.05);术后病理淋巴结转移率单纯放疗组(50%)高于同步放化疗组(30%)和新辅助化疗组(10%)(P<0.05);宫旁转移率三者比较差异无统计学意义。术前单纯放疗组低分化者肿瘤缩小率(95.7%)显著高于高中分化者(59.4%),新辅助化疗组高中分化者肿瘤缩小率(87.1%)显著高于低分化者(50.3%)。非手术治疗组中同步放化疗组肿瘤平均缩小率(72.6%)显著高于单纯放疗组(37.7%)(P<0.05)。结论 (1)术前同步放化疗与新辅助化疗可使肿瘤体积在短时间内缩小明显,利于手术治疗,并能降低淋巴结转移率。(2)低分化宫颈癌对放疗敏感,高中分化宫颈癌对化疗敏感。(3)中晚期宫颈癌治疗中同步放化疗较单纯放疗更有效。

Objective To compare the effects of three non-surgical therapies（radiotherapy,neoadjuvant chemotherapy,concurrent chemoradiotherapy）for cervical cancer.Methods 120 cases of cervical cancer were collected in our hospital between 2004 to 2009.60 cases of them which were from Ib to IIa according to（FIGO）criteria had operations after adjuvant therapies,they were divided into radiotherapy group,neoadjuvant chemotherapy group,concurrent chemoradiotherapy group,and 20 cases were in each group.The others which were from IIb to IIIb according to（FIGO）criteria had no operations,30 cases accepted radiotherapy,30 cases accepted concurrent chemoradiotherapy.The relationship between effects and clinical data were analyzed.Results The short-term effect of concurrent chemoradiotherapy group was 90%,and that of neoadjuvant chemotherapy group was 85%,they were significantly higher than that of radiotherapy group（55%）（P0.05）;the metastasis rate of lymph node in radiotherapy group was 50%,which was higher than that of concurrent chemoradiotherapy group（30%）,and was significantly higher than that of neoadjuvant chemotherapy group（10%）（P0.05）,there was no difference of parametrial transformation rates in the three groups（P0.05）;the curative effect of radiotherapy group was significantly better in poorly differentiated group,while in well differentiated group,the curative effect of neoadjuvant chemotherapy group was remarkably improved;the curative effect of concurrent chemoradiotherapy group was significantly higher than that of radiotherapy group when the cases were in later stages（P0.05）.Conclusion（1）Neoadjuvant chemotherapy and concurrent chemoradiotherapy before operations both can reduce the size of tumor,improve the chance of operation,make the metastasis rate of lymph node lower.（2）Poorly differentiated cases were sensitive to radiotherapy,while well differentiated ones were sensitive to chemotherapy.（3）The short-term effect of concurrent chemoradiotherapy in later stages was significantly higher than that of radiotherapy.