盆腔动脉灌注化疗在晚期及复发性宫颈癌治疗中的应用价值

Pelvic intraarterial chemotherapy in patients with advanced and recurrent cervical carcinoma

目的 探讨髂内动脉灌注化疗在晚期及治疗后复发或未控的宫颈癌综合治疗中的最佳时机及其价值。方法 对 40例晚期 (包括局部晚期 )、治疗后复发或未控的宫颈癌患者进行髂内动脉灌注化疗。患者年龄 2 7～ 6 7岁 ,平均年龄 48岁。全部病例均采用Seldinger技术经右侧股动脉穿刺向双侧髂内动脉内灌注化疗药物。治疗疗效及所致毒性均按世界卫生组织 (WHO)制定标准判定。结果 全部病例随访时间 3 0～ 12 0 0个月 ,平均 30 9个月。总的临床有效率 (完全缓解 +部分缓解 )为5 7 5 %。其中介入治疗前未行其他治疗的 13例全部达到临床有效 (完全缓解 7例 +部分缓解 6例 ) ,其平均生存时间达 10 5 0个月。介入治疗前经过其他治疗 [包括手术和 (或 )放、化疗 ]但病情未控或复发的 2 7例中完全缓解 2例 ,部分缓解 8例 ,其平均生存期为 17 0个月 (3 0～ 40 0 ) ,中位生存期仅为 14 0个月。治疗后最常出现的毒副作用有发热、恶心、呕吐及血白细胞减少症等。其中有 3例患者在灌注化疗后出现了臀及会阴部的皮肤黏膜组织溃疡、坏死。结论 对于晚期宫颈癌患者应尽可能在手术及放射治疗前或与放射治疗同时进行髂内动脉灌注化疗 ,以提高疗效、延长患者生存期。

Objective To evaluate the clinical efficacy of intraarterial chemotherapy (IAC) in patients with advanced and/or recurrent cervical cancer, and to determine the optimal time of chemotherapy administration. Methods From February 1990 to December 1996, 40 patients with pathologically confirmed advanced and recurrent cervical cancer were treated with intraarterial chemotherapy in our hospital. The age of the patients ranged between 27 and 67 years, with a mean age of 48.28 and a median of 49. IAC was administered for 1-3 courses every 4-6 weeks for each patient. The Seldinger′s technique was used in all patients. The catheter was introduced via femoral artery on one side (usually on the right side), and the combined antineoplastic agents were infused into contralateral internal iliac artery and/or the ipsilateral branches supplying the involved area. 13 patients had received no prior therapy before initiating intraarterial chemotherapy, whereas 27 patients had received prior treatment of pelvic surgery, and / or radiotherapy, with or without systematic chemotherapy. If the results of the evaluation indicated that surgery was feasible, radical surgery was performed. The patients whose tumors were inoperable received radiation therapy consisting of external irradiation and intracavity irradiation, with or without systematic chemotherapy. Survival was computed by Kaplan Meier estimate and the difference in the treatment efficacy was evaluated by the Cox regression method. Results The mean follow up was 30.9 months (range, 3 0 to 120 0 months). Nine patients had a complete response, and 14 had a partial response. No change in 12, and disease progressed in 5. The overall response rate was 57.5% (CR, 9, PR, 14). The prolonged survival was observed in patients responding to the treatment (with a mean survival time of 76 months, vs. 14 months for the patients who had not responded to the IAC). For the patients had received no prior therapy before initiating intraarterial chemotherapy, the response rate was 100% with a mean survival duration of 105 months (12.1-120 months). Whereas for patients who had received prior treatment of pelvic surgery, and / or radiotherapy, with or without systematic chemotherapy, the response rate was only 37% with mean survival duration of only 17 months (median 14 0 months). The response to chemotherapy did not relate to clinical stage or the histological types (whether it was squamous cell carcinoma or adenocarcinoma). The most frequently observed adverse effects were fever, leukopenia, nausea, and vomiting. Severe skin and subcutaneous necrosis (erosion or ulceration) on the buttock and vulvae was observed in three patients (7.5%). Conclusion IAC should be administered prior to surgery and/or radiotherapy, or concurrently with pelvic radiation to improve the response and survival rate for patients with advanced and recurrent cervical cancer.