介入治疗局部晚期宫颈癌的临床疗效分析

Efficacy analysis of interventional treatment for locally advanced cervical cancer

目的探讨局部晚期宫颈癌介入治疗的临床疗效及安全性。方法经病理证实的122例局部晚期宫颈癌患者均行子宫动脉化疗栓塞或髂内动脉灌注化疗+瘤体靶血管栓塞,化疗方案采用以顺铂为基础的联合方案,栓塞剂选用明胶海绵,并与丝裂霉素或表柔比星制成药物微球。介入治疗后2周进行妇科检查、盆腔CT或B超,观察肿瘤病灶的变化,评价临床疗效及不良反应。结果 122例患者的临床症状缓解率为100.0%,获CR 22例,PR 66例,SD 28例,PD 6例,有效率为72.1%。其中行1次介入治疗者29例,行2次者42例,行3次者35例,行4次者16例。98例患者介入治疗后行手术切除,手术切除率为80.3%(98/122)。主要毒副反应包括发热、消化道反应、白细胞减少、腹痛等,经对症处理后均好转。全组有86例患者获随访,3年及5年生存率分别为81.4%和68.6%。结论介入治疗对局部晚期宫颈癌安全有效,能使大部分宫颈癌的瘤体缩小,降低部分肿瘤分期,提高手术切除率。

Objective To investigate the efficacy and safety of interventional treatment for locally advanced cervical cancer. Methods There were 122 cases of advanced cervical cancer patients diagnosed by pathology. All the patients were treated by the feeding artery embolism together with either uterine artery chemoembolization or internal iliac-arterial infusion chemotherapy. Chemotherapy was based on cisplatin-based combination regimens. The gelfoam particle containing mitomycin or epirubicin was employed as embolic agent. The change of tumor size was observed and clinical data were evaluated 2 weeks after the operation of intervention. Results The clinical remission was 100. 0%. Twenty-two cases achieved CR, 66 cases achieved PR,2$ cases achieved SD and 6 cases achieved PD. The reponse rate was 72. 1%. Among the 122 patients, the interventional treatment was carried out one time in 29, two times in 42, three times in 35 and four times in 16. Ninety-eight cases underwent successful surgical resection. The main adverse reactions after interventional procedure included fever, digestive reaction, lellkocytopenia and abdominal pain, and these could be controlled by symptomatic treatment. Eighty-six patients were followed-up, the survival rates of 3- and 5-year were 81.4% and 68.6% ,respectively. Conclusion Interventional treatment for locally advanced cervical cancer is safe and effective. It reduces the tumor size, decreases tumor staging, and improves the resection rates.