局部晚期宫颈癌患者综合治疗的可行性分析

Feasibility analysis of comprehensive treatment on locally advanced cervical carcinoma

目的探讨术前腔内后装放疗+化疗结合宫颈癌根治术及术后同步放化疗治疗局部晚期宫颈癌方案的可行性。方法研究组36例局部晚期宫颈癌患者腔内后装放疗2～3次加同期动脉介入或静脉化疗一程,休息后行宫颈癌根治术,术后同步放化疗,定期随诊;对照组32例局部晚期宫颈癌患者行根治性放疗加同期化疗(同步放化疗),观察两组的疗效和毒副反应,并进行对照分析。结果在肿瘤盆腔局部控制方面研究组优于对照组(P<0.05),而在肿瘤远处转移及生存方面两组间的差异无统计学意义(P>0.05);研究组患者治疗前后血清鳞状细胞癌相关抗原(SCCAg)值的下降较对照组显著,差异有统计学意义(P<0.001);两组未绝经患者治疗后出现更年期症状的差异有统计学意义(P<0.001);两组毒副反应的差异无统计学意义(P>0.05)。结论术前腔内后装放疗+化疗结合宫颈癌根治术及术后同步放化疗的治疗方案是治疗局部晚期宫颈癌的有效策略。

Objective To explore the feasibility of applying the comprehensive treatment including preoperative intracavitary brachytherapy plus chemotherapy, radical surgery of cervical carcinoma, and postoperative concurrent chemo-radiotherapy for locally advanced cervical carcinoma. Methods A total of sixty- eight patients with locally advanced cervical carcinoma were recruited and divided into study group （n = 36） and control group （n = 32）. Patients in study group were given 2-3 courses of intracavitary brachytherapy and 1 course of arterial interventional or intravenous chemotherapy. After a short period of rest, the patients received radical surgery of cervical carcinoma. Postoperative concurrent chemo-radiotherapy and regular follow-ups were carried out afterwards. Patients in control group received radical radiotherapy plus concomitant chemotherapy （concurrent chemo-radiotherapy）. The effects and toxicity of the treatment were observed, and evaluation indexes were compared between the two groups. Results Patients in study group demonstrated a significantly better control of local pelvic tumor size compared with their counterparts in control group （P〈 0.05）. However, no significant differences were found in distant tumor metastasis and survival rate between the two groups （P 〉 0.05）. The patients in study group showed a significantly sharper decrease in serum SCCAg value compared to those in control group （P〈O. 001）. There was a significant difference in the incidence rate of post-treatment menopausal symptoms among the premenopausal patients in study group and control group （P〈 O. 001）. The two groups did not differ significantly in toxicity （P〉0.05）. Conclusion It is feasible and effective to apply thecomprehensive treatment including preoperative intracavitary brachytherapy plus chemotherapy, radical surgery of cervical carcinoma, and postoperative concurrent chemo-radiotherapy for locally advanced cervical carcinoma.