术前使用不同顺铂联合化疗方案治疗宫颈癌的近期疗效观察

Short-term Efficacy Observation of Different Chemotherapy Schemes Combined with Cisplatin on Cervical Cancer before Operation

目的:观察术前使用不同顺铂联合化疗方案治疗宫颈癌的近期疗效和安全性。方法:将我院2009年1月-2011年12月的住院宫颈癌患者135例,随机分成治疗1组(67例)和治疗2组(68例),治疗1组采用伊立替康(60mg.m-2,d1、d8)联合顺铂(60mg.m-2,d2)化疗方案;治疗2组采用长春新碱(1mg.m-2,d1)+博来霉素(15mg.m-2,d1、d2)联合顺铂(100mg.m-2,d1)化疗方案。化疗结束15～20d所有患者行广泛全子宫切除术+盆腔淋巴结清扫术。化疗结束后14d评价近期疗效和不良反应,并于术中及术后检查患者局部病灶和盆腔淋巴结肿瘤浸润情况。结果:2组患者完全缓解率、部分缓解率、总有效率比较差异均无统计学意义(P>0.05)。2组经术前化疗后对局部病灶均起到了明显抑制作用,后期手术均获得满意疗效,切缘组织与盆腔淋巴结肿瘤浸润情况比较差异无统计学意义(P>0.05)。2组消化道反应差异亦无统计学意义(P>0.05),但治疗1组的骨髓抑制程度要轻于治疗2组(P<0.01)。结论:术前化疗能对患者病情好转起到积极作用,采用伊立替康联合顺铂或长春新碱+博来霉素联合顺铂均能获得较好的疗效,骨髓抑制程度后者较严重,但可经对症治疗改善。

OBJECTIVE： To observe the short-term efficacy and safety of cisplatin combined with different chemotherapy schemes for cervical cancer before operation. METHODS： 135 inpatients with cervical cancer in our hospital from Jan： 2009 to Dec. 2011 were randomly divided into first treatment group （67 cases） and second treatment group （68 cases）： First treatment group received irinotecan （60mg·m^2 d1, d8） combined with cisplatin chemotherapy （60 mg·m^2, d2）; second treatment group was given leurocristine （ 1 mg·m^2, d1）, bleomycin （ 15 mg·m^2, d,, d2） and cisplatin chemotherapy （ 100mg·m^2, dl）. 15 - 20 days after chemotherapy, all patients received extensive hysterectomy and pelvic lymph node dissection. 14 days after chemotherapy, short-term efficacy and adverse drug reaction were evaluated, and the tumor infiltration of local lesion and lymph node were checked during and after operation. RESULTS： There were no significant difference in CR, PR, ORR between 2 groups （P〉 0.05）. Preoperative chemotherapy inhibited the local lesion significantly in 2 groups, and the operation obtained satisfactory effects. There was no statistical significance in tumor cell infiltration of peripheral tissues and pelvic lymphs between 2 groups （P〉0.05）. There was no statistical significance in gastrointestinal reactions in 2 groups （P〉0.05）. The degree of bone marrow suppression in first treatment group was lighter than in second treatment group （P〈0.01）. CONCLUSION： Preoperative chemotherapy plays a positive role on improvement of disease situation. Both irinotecan combined with cisplatin and leurocristine＋bleomycin combined with cisplatin obtain sound therapeutic efficacies. The degree of bone marrow suppression of the latter is more serious, but it can be improved by symptomatic treatment.