介入栓塞化疗联合HIFU治疗晚期宫颈癌同步放化疗后局部复发的疗效观察

Intraarterial chemotherapy and embolization followed by high intensity focused ultrasound for short-term recurrent locally advanced cervical cancer after concurrent chemoradiotherapy

目的:评价介入栓塞化疗联合高强度聚焦超声(HIFU)治疗晚期宫颈癌根治性同步放化疗后短期局部复发的可行性和疗效。方法:25例晚期宫颈癌根治性同步放化疗后短期局部复发患者,采用Seldinger's法股动脉穿刺插管进行髂动脉介入化疗栓塞,药物为顺铂30mg/m^2,氟尿嘧啶500mg/m^2,表阿霉素20~25mg/m^2,3~4周后重复化疗,左右股动脉交替插管。每例患者行介入栓塞化疗2~3次。介入栓塞化疗结束后2周开始行HIFU治疗。经阴道彩超、CT及MRI测量治疗前后的肿瘤大小,评价近期疗效;随访临床症状和远期疗效。结果:患者治疗前后疼痛评分分别为5.23±1.96和1.15±2.375,KPS评分分别为77.96±5.07和93.29±5.34,差异均有统计学意义(P<0.05)。患者中,完全缓解(CR)4例,部分缓解(PR)16例,稳定(SD)4例,进展(PD)1例,总有效率80%。1、2年总生存率分别为77.8%和36.6%,中位生存时间为19个月;1、2年无进展生存率分别为62.3%和17.3%,中位无进展生存时间为15个月。患者均未发生严重不良反应。结论:介入栓塞化疗治疗联合HIFU治疗晚期宫颈癌局部复发,毒副反应小,可缓解患者疼痛,提高生活质量。

Objective： To evaluate the clinical effects and possibility of intraarterial chemotherapy and embolization followed by high intensity focused ultrasound（ HIFU） for shortterm recurrent locally advanced cervical cancer after concurrent chemoradiotherapy. Methods：25 short-term recurrent patients with FIGO stage ⅡB~ ⅣAcervical cancer after concurrent chemoradiotherapy were enrolled. Treatment consisted of bilateral internal iliac artery infusion of cisplatin 30 mg / m^2,5-Fu 500 mg /m^2,and epirubicin 20~25mg /m^2 for 2 ~ 3 courses separated by 3 ~ 4 weeks and HIFU. Two weeks later,HIFU was carried out after intraarterial chemotherapy and embolization.The tumor size was measured by vagina ultrasonic,CT,and MRI before and after treatment to calculate the shrunk size percent.The changes of clinical symptoms were evaluated before and after treatment.Also the progression-free survival time,overall survival time,toxic and adverse effects,and failure model were analysed.Results： The score of pain was 5.23±1.96 before treatment,and 1.15 ± 2. 375 after treatment（ P〈0. 05）. The KPS score was 77. 96 ± 5. 07 before treatment,and 93.29±5.34 after treatment（ P〈0.05）.The change of tumor size： 4（ 16%）cases achieved complete remission,16（ 64%） cases partial remission,and 4（ 16%） cases stable disease,1（ 4%） case progressive disease,and the total effective rate was 80%.The one and two year survival rate were 77. 8% and 36. 6%,the one and two year progression-free survival rate were 62.3% and 17.3%.The medium survival time was 19 months; the medium progression-free survival was 15 months.There were no severe complications related to intraarterial chemotherapy and embolization and HIFU. Conclusions： The treatment of intraarterial chemotherapy and embolization followed by high intensity focused ultrasound（ HIFU） for short-term recurrent locally advanced cervical cancer after concurrent chemoradiotherapy is effective for local control,relieving pain,and improving the quality of life.