基于介入治疗的两种新辅助化疗方案在局部晚期宫颈癌疗效的比较

Comparison of two kinds of interventional neoadjuvant chemotherapy in locally advanced cervical cancer

目的:比较基于介入治疗的两种新辅助化疗方法对局部晚期宫颈癌的近期及病理疗效。方法:2009年8月-2011年10月进行新辅助化疗的局部晚期宫颈癌患者32例,根据不同的治疗方案分成两组,A组18例,单纯行双侧子宫动脉化疗栓塞术,术中用药为顺铂、丝裂霉素、5-氟尿嘧啶。B组14例,用艾素全身静脉化疗联合双侧子宫动脉化疗栓塞,术中只用顺铂行化疗栓塞。结果:A组患者经新辅助化疗后总有效率为94%(17/18),B组为93%(13/14),两组差异无统计学意义(P>0.05)。A组经新辅助化疗后可手术率为83%(15/18),B组为85%(12/14),两组差异无统计学意义(P>0.05)。两组患者新辅助化疗后手术时间、出血量和并发症发生率比较,差异无统计学意义(P>0.05)。Ⅱb期患者经新辅助化疗后手术者,术后病理检查发现盆腔淋巴结转移率两组差异无统计学意义(P>0.05),而宫旁浸润率两组比较B组发生率低于A组(P<0.05)。结论:两种途径的新辅助化疗有效率和手术难度相当,艾素联合子宫动脉介入化疗栓塞对改善宫旁浸润效果更好。

Objective： To compare the recent and pathological effects of two kinds of neoadjuvant chemotherapy （NACT） in locally advanced cervical cancer. Methods： Thirty-two cases of locally advanced cervical cancer were divided into two groups according to the different treatment options. Group A （18 cases） were treated with bilateral uterine artery che moembolization alone using cisplatin,mitomycin C, 5-fluorouraeil. Group B （14 cases） were treated with systemic intrave nous chemotherapy using docetaxel combined with bilateral uterine artery chemoembolization using cisplatin only. Results： the total effective rate after NACT of group A and group B was 94% （17/18） and 93%（13/14） ,respectively （P〉0.05）, without significant differences. The surgical resectable rate after NACT of group A and group B was 83% （15/18） and 85 % （12/14）, respectively, without significant differences. There were no significant differences in operation time, blood loss and side-effects between these two groups （P〉0.05）. There were no significant differences in lymph node metastasis rate between these two groups （P〉0.05）. Occurrence of parametrial infiltration after NACT in group B （8.3%） was sig nificantly lower than that of group A （26.7%,P〈0.05）. Conclusion：The effective rate, resectahle rate and surgical diffi culties are similar between the two kinds of NACT for locally advanced cervical cancer. Venous combined with arterial NACT show better effect on parametrical infiltration.