调强适形放疗同步紫杉醇加卡铂与同步单药顺铂方案治疗晚期宫颈鳞癌的比较研究

Clinical study of concurrent chemoradiotherapy of IMRT with paclitaxel and carboplatin versus IMRT with cisplatin in treatment of patients with advanced uterine cervix cancer

目的:通过比较调强适形放疗(IMRT)同步紫杉醇加卡铂方案与同步单药顺铂方案治疗晚期宫颈癌患者的效果、生存期和毒副反应,探讨晚期宫颈癌最佳治疗手段。方法:回顾性分析扬州大学附属苏北人民医院2007年1月至2008年12月间收治的70例晚期宫颈鳞癌(ⅡB-ⅣA期)患者临床资料。其中调强适形放疗同步紫杉醇加卡铂方案组(TC组)38例,接受紫杉醇40 mg.m-2+卡铂AUC1.5第1、8、15天方案化疗,28 d后重复,放疗期间共完成2个周期;同步单药顺铂组(P组)32例,接受顺铂40 mg.m-2,每周方案化疗1次,放疗期间共完成6周期。结果:两组治疗有效率分别为94.74%、78.13%,局部控制率分别为97.37%、84.38%;无疾病进展时间(PFS)分别为40.3个月、25.5个月,3年生存率分别为85.29%、72.41%,TC组优于P组;急性血液毒性发生率分别为92.11%、12.50%,Ⅲ度及以上血液毒性比例分别为39.47%、12.50%;胃肠道毒性发生率分别为78.95%、78.13%,Ⅲ度及以上胃肠道毒性比例分别为5.26%、37.50%。TC组较P组有效率及局部控制率高、无疾病进展时间长、血液学毒性及Ⅲ度及以上胃肠道毒性比例低。结论:对晚期宫颈鳞癌,调强适形放疗同步紫杉醇加卡铂方案临床疗效优于同步单药顺铂方案,且毒副反应小,应成为晚期期宫颈鳞癌治疗的首选。

Objective： To explore the better treatment of advanced uterine cervix cancer by comparing the therapeutic effect, survival time and side effect of concurrent chemoradiotherapy of IMRT with paclitaxel and earboplatin versus IMRT with cisplatin for advanced uterine cervix cancer patients. Methods ： 70 cases of complete clinical data of advanced uterine cervix cancer came from Subei People＇s Hospital were analyzed retrospectively,Concurrent chemoradiotherapy of IMRT with paclitaxel and carboplatin group（TC group） ： 38 cases received IMRT with 2 cycle paclitaxe and carboplatin, Concurrent chemoradiotherapy of IMRT cisplatin group（ P group） ： 32 cases received IMRT with 6 cycles cisplatin. Results： The effective rate and local control rate of TC group versus P group： 94. 74% vs 78.13% , 97.37% vs 84. 38% ; PFS： 40. 3 mvs 25.5 m, 3 years survival rate： 85.29% vs 72. 41% ,TC group was better than P group, acute hematotoxieity rate： 39.47% vs 12.50% ; gastrointestinal tract toxicity rate： 78.95% vs 78.13% ,high level gastrointestinal tract toxicity rate： 5.26% vs 37.50%. The effective rate and local control rate were higher, PFS was longer, hematotoxicity rate and high level gastrointestinal tract toxicity were lower than P group. Conclusion： The clinical effect of concurrent chemoradiotherapy of TC group was superior to cisplatin P group, and side reaction was less. Concurrent chemotherapy of IMRT with paclitaxel and carboplatin should become the first treatment choice of advanced uterine cervix cancer.