Ⅰb2～Ⅱa2期局部晚期宫颈癌术前辅助治疗的疗效比较

Comparison of efficacy on different preoperative adjuvant treatment in management of stage Ⅰb2～Ⅱa2 locally advanced cervical carcinoma

目的：比较Ib2～Ⅱa2期局部晚期宫颈癌不同术前辅助治疗的疗效。方法：选取中山大学肿瘤防治中心妇科1996～2005年收治的133例IB2～IIA2期局部晚期宫颈癌病例，将患者分为术前腔内放疗组（A组）78例、术前腔内放疗＋化疗组（B组）35例以及直接行宫颈癌根治术组（C组）20例，比较局部控制率（A组和B组）和生存率（A、B、C组）。结果：A组总有效率为70．5％（55／78），B组总有效率为65．7％（23／35），两组差异有统计学意义（P=0．03）。A组与B组的1年、3年、5年总体生存率比较差异无统计学意义（P=0．135）；A、B组分别与C组的1年、3年、5年总体生存率比较差异无统计学意义（P：0．48，P=0．822）。3组手术并发症发生率比较差异无统计学意义（P=0．358）。结论：与直接行宫颈癌根治术相比，术前腔内放疗和术前腔内放疗＋化疗对长期生存影响不大，不会增加手术并发症，术前腔内放疗有较好的局部控制率。

Objective： To investigate the therapeutic effect of different treatment methods on the patients with stage Ⅰb2～Ⅱa2 locally advanced cervical carcinoma. Methods： 133 patients with stage Ⅰb2～Ⅱa2 locally advanced cervical carcinoma at Sun yat -sen University of cancer prevention and control center from 1996 to 2005 were selected ： 78 patients treated by preoperative intracavitary radiotherapy （group A）, 35 cases treated by preoperative chemoradiotherapy （group B）, 20 cases treated by simple surgery （group C） . The survival rate （group A and B） and local control rate （ group A, B and C） were studied. Results ： The effective rate （ CR ＋ PR） of group A and group B were 70. 5% （55/78） and 65.7% （23/35） respectively, and there was significant difference （P = 0. 03 ） . The one -, three - and five - year survival rates in Group A were 93% , 88% , 80% and those in Group B were 85% , 71% , 71% , respectively （P =0. 135）. There were no significant differences respectively comparative with the one - , three - and five - year survival rates in group C （ P = 0. 48 and P =0. 822） . There were no significant differences among the three groups in complications of surgery （P =0. 135 ） . Conclusion： There is no significant difference in long -term survival rate among three groups, and without increase complications of surgery in group A and B, group A may have better local control rate.