宫颈癌的新辅助化疗

NEOADJUVANT CHEMOTHERAPY IN CERVICAL CARCINOMA

目的对I-IIb期的大菜花型或内生颈管型的宫颈癌于术前先给予新辅助化疗,以求改善治疗效果。方法上述类型的宫颈癌共12例按FIGO分期,Ib4例,IIa3例,IIb5例,病例分类鳞癌7例,腺癌5例;肿瘤最大直径≥4cm者7例,3-4cm者4例,1例颈管扩大至4cm。新辅助化疗采用动脉灌注给药,化疗后均施行子宫广泛切除术及盆腔淋巴结清扫术,3例有淋巴结转移者术后追加放射治疗。结果化疗后4例肿瘤完全消退,其中1例手术后病理标本中未见残留癌,8例肿瘤明显消退,患者全部存活,最长至今8年余两年存活率11/11。结论大菜花型或内生颈管型宫颈癌在手术前给予动脉灌注化疗能使肿瘤缩小,旁组织浸润消退,从而提高手术的彻底性故是一种有效的治疗方法,但是为改善长期预后,对淋巴结转移的患者术后有必要追加放射治疗。

Objective To improve the prognosis of stageI -I Ib cervical carcinoma of cauliflowe r type or endophytic type using neoadjuvant chemotherapy.Methods Preoperative chemotherapy by intra arterial infusion was given to 12cases,including stage Ib 4cases,IIa 3and IIb 5.Pathological classification included sq uamous carcinoma 7cases,and adenocarcinoma 5;as for size,tumor diameters≥4cm 7cases,3～4cm 4cases,and in another one the cervical canal was enlarg ed to 4cm in diameter.Radical hysterectomy and pelvic lym phadenectomy were done after neoadj uvant chemotherapy.Post -operativ e irradiation was added to 3cases with positive pelvic nodes.Results Complete regression after neoadjuvant chemotherapy was found in 4cases,one of whom no residual cancer was fou nd in pathological exam;in another 8cases prominent tumor regression wa s also noted.All12patients survived,2-year surviv e rate was 11/11,with the longest sur vival time of 8years.Conclusions Preoperative in-traarterial infusion as neoadjuvan t chemotherapy was effective in cerv ical and parametrical tumor regress ion,and thus more satis-factory operative results attained.For those with positive nodes,postoperative irradiation was necessary for better long -term sur-vival rate.[