紫杉醇脂质体联合奈达铂同步放疗在中晚期宫颈癌中的临床研究

Clinical study of paclitaxel liposome and nedaplatin combined with radiotherapy in advanced cervical cancer

目的：比较紫杉醇脂质体联合奈达铂同步放疗与氟尿嘧啶联合奈达铂同步放疗治疗中晚期宫颈癌的疗效和不良反应。方法回顾性分析2010年5月至2012年5月收治的中晚期宫颈癌患者58例，分为紫杉醇脂质体联合奈达铂组（ A组，n＝30）和氟尿嘧啶联合奈达铂组（ B组，n＝28）。两组同步放疗均为盆腔三维适形放疗加后装放疗，保证A点总剂量70～85Gy，B点总剂量50Gy。两组患者在放疗第1天同步进行化疗。 A组：紫杉醇脂质体135mg/m2静滴，d1；奈达铂80mg/m2静滴，d1；B组：氟尿嘧啶500mg/m2静滴，d1～d5；奈达铂80mg/m2静滴，d1。两组化疗均21～28天为1周期，化疗2个周期。结果全部患者均按计划完成治疗。 A组的有效率为76．7％（ CR 13例，PR 10例，SD 6例，PD 1例），B组为57．1％（ CR 9例， PR 7例，SD 7例，PD 5例），两组差异有统计学意义（P＜0．05）。 A组1、2年生存率分别为100％和92％，B组分别为88％和75％，两组差异有统计学意义（ P＜0．05）。两组不良反应主要为骨髓抑制和消化道反应，A组的不良反应发生率低于B组，差异有统计学意义（ P＜0．05）。结论紫杉醇脂质体联合奈达铂同步放疗治疗中晚期宫颈癌疗效确切，不良反应轻，值得临床推广应用。

Objective To compare the effect and adverse reaction of paclitaxel liposome and nedaplatin combined with radio-therapy versus fluorouracil and nedaplatin combined with radiotherapy in advanced cervical cancer. Methods A retrospective analysis of 58 cases of advanced cervical cancer patients from May 2010 to May 2012 was made. Fifty-eight patients were divided into paclitaxel liposome and nedaplatin combined with radiotherapy group （ A group, n=30） , and the other 28 cases were treated by fluorouracil and nedaplatin combined with radiotherapy （ B group, n=28） . The radiotherapy included pelvis three-dimensional conformal radiotherapy plus brachytherapy, and the total dose of A point was 70-85Gy, while the B point was 50Gy. Chemotherapy was applied at the first day of radiotherapy. Paclitaxel liposome and nedaplatin regimen was given as follows： paclitaxel liposome 135mg/m2 iv d1 , nedaplatin 80mg/m2 iv d1 . Fluorouracil and nedaplatin regimen was applied as follows： fluorouracil 500mg/m2 iv d1-d5 , nedaplatin 80mg/m2 iv d1 . For both regimens, 21-28 days was a cycle with a total of 2 cycles. Results The treatment was completed in both groups. The ef-fective rate of A group was 76. 7% （ CR 13,PR 10,SD 6,PD 1） , and it of B group was 57. 1%（ CR 9,PR 7,SD 7,PD 5） with statisti-cal difference（ P〈0. 05） . The 1-,2-year survival rates of A group were 100% and 92%, and the rates in B group were 88% and 75%, with statistical difference（ P〈0. 05） . The main adverse reactions in the two groups were myelosuppression and digestive tract reaction. The occurrence of adverse reactions in A group was lower than B group, and the difference was statistically significant （P〈0. 05）. Conclusion The curative effect of clinical application of paclitaxel liposome and nedaplatin combined with radiotherapy in the treat-ment of advanced cervical cancer is satisfied with tolerable adverse reactions. It is worth of clinical application.