输尿管逆行插管后吉西他滨同步放疗治疗Ⅲ_B期宫颈癌合并肾积水的临床观察

Retrograde ureteral catheterization followed by gemcitabine concurrent radiotherapy in locally advanced stage Ⅲ_B cervical carcinoma with hydronephrosis

目的观察输尿管逆行插管后吉西他滨同步放疗治疗Ⅲ_B期宫颈癌合并肾积水的疗效和安全性。方法 2008年1月至2009年12月在我院治疗的38例Ⅲ_B期宫颈癌合并肾积水置入双J管的患者,采用吉西他滨200mg/m^2,静脉滴注,每周1次,同步放疗。结果治疗后3个月评价,完全缓解率39.5%,有效率94.7%。9例肾积水消失,12例肾积水较前好转,17例稳定,置管后血尿素氮、血肌酐和肌酐清除率改善,并在放化疗后仍维持稳定。Ⅲ级和Ⅳ级毒性反应主要是粒细胞减少(4.7%)、贫血(2.6%)和腹泻(1.6%)。3年无进展生存率39.4%,3年总体生存率50.0%。结论Ⅲ_B期宫颈癌合并肾积水经输尿管逆行插管后行吉西他滨同步放疗疗效较好,不良反应轻。

Objective To explore the efficacy and safety of gemcitabine concurrent radiotherapy in locally advanced stage ⅢB cervical carcinoma with hydronephrosis after retrograde ureteral catheterization. Method 38 cases of stage ⅢB cer- vie＇a/ cancer patients with hydronephrosis received 200mg/m2 of gemcitabine once per week with concurrent standard radio- therapy ＇after ureteral stent placement. Result The response rate was 94. 7% and a complete response was observed in 15 （39. 5% ） patients at the end of the third month after completing radiation therapy. Hydronephrosis were significantly im- proved. There were no obvious changes of blood urea nitrogen, ereatinine and ereatinine clearance after concurrent chemora- diotherapy. Adverse events of grade m or IV included granulocytopenia, anemia and diarrhea. 3-year disease-free survival was 39. 4% and overall survival was 50. 0%. Conclusion Gemcitabine and concurrent radiation are well tolerated and effeetive for the treatment of stage ⅢB cervical carcinoma with hydronephrosis after retrograde ureteral catheterization.