紫杉醇联合铂类在局部晚期宫颈癌新辅助化疗中的应用

Neoadjuvant chemotherapy with paclitaxel and cisplantin or carboplatin for patients with locally advanced uterine cervical cancer

目的探讨紫杉醇联合铂类方案在局部晚期宫颈癌新辅助化疗中的疗效及不良反应。方法2007年7月至2010年5月，中国医学科学院肿瘤医院共收治局部晚期宫颈癌（局部肿瘤≥4cm）患者70例，其中Ib2期45例，Ⅱa期21例，Ⅱb期4例；鳞癌65例，腺癌3例，腺鳞癌2例；G1级6例，G2级26例，G3级32例，未分级6例。化疗方案包括紫杉醇（175mg／m^2、第1天）＋卡铂（AUCA-5、第2天）或紫杉醇（175mg／m2、第1天）＋顺铂（75mg／m^2、分2d给药），静脉滴注，间隔21d，共1—2个疗程。结果化疗前宫颈肿瘤直径为4—7cm，化疗后肿瘤直径为2—5cm，差异有统计学意义（P〈0．001）。全组完全缓解（CR）14例，部分缓解（PR）37例，总缓解率为72．9％（51／70）。14例（20％）CR患者中，病理完全缓解12例（17．1％）。有68例患者经新辅助化疗后可行手术治疗，手术率为97．1％，其中67例患者接受了广泛子宫切除＋盆腔淋巴结清扫术，手术切除率为95．7％。术后病理完全缓解率为17．1％（12／70），术后淋巴结转移率为16．2％（11／70）。不同临床分期之间缓解率存在差异，Ib2期缓解率为80．0％，Ⅱa期为52．4％（P〈0．05）。鳞癌的缓解率为73．8％，高于腺癌和腺鳞癌（60．0％）。肿瘤大小、组织学分级、术前新辅助化疗疗程数对疗效无影响。结论紫杉醇联合铂类的新辅助化疗可提高晚期宫颈癌患者的手术切除率，毒副反应轻，耐受性好，具有较肯定的近期疗效，适用于局部晚期宫颈癌的术前化疗。

Objective To investigate the efficacy and toxicity of neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin for patients with locally advanced cervical cancer. Methods A total of 70 patients with locally advanced cervical cancer were treated with neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin in our department from July 2007 to May 2010. The stage distribution among the patients included 45 stage IB2, 21 stage Ⅱ a, and 4 stage Ⅱ b. Of the 70 patients, 6 were G1, 26 were G2, 32 were G3, and the rest 6 patients were not histologically classified. Sixty-five patients had squamous cell carcinoma, 3 had adenocarcinoma, and 2 patients had adenosquamous cell carcinoma. The clinicopathological parameters were analyzed, and their impact on tumor response were investigated. Results Of the 70 patients, 14 （20.0%） showed a complete response, 37 （52.9%） had a partial response to chemotherapy, making an overall response rate of 72.9%. Sixty-eight （95.7%）patients underwent surgery, and among them 12 （ 17.1% ） pathological CR were identified. Eleven （ 16.2% ） patients were found to have lymph node metastasis after surgery. Response rates of stage I b2 and Ⅱ a patients were 73.7% and 52.3%, respectively, P 〈 0.05. Patients with SCC exhibited a better response rate than patients with adenocarcinoma and adenosquamous cell carcinoma （73.8% vs. 60.0% ）. Initial tumor volume, histological classification and cycles of neoadjuvant chemotherapy were not significantly correlated with the response rate. Conclusion Paclitaxel and carboplatin or cisplatin regimen is a promising therapy with definite short-term efficacy, can improve the resection rate with tolerable side effects, and is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvant setting.