两种联合放化疗方案治疗Ⅱ～Ⅳ期宫颈癌比较研究

Comparative study of two kinds of chemotherapy combined with radiotherapy scheme in treatment of cervical cancer in Ⅱ-Ⅳ stage

目的：探讨紫杉醇脂质体与铂类单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌临床疗效和安全性差异。方法研究对象选取四川省自贡市第三人民医院妇产科2006年4月至2014年8月收治的Ⅱ～Ⅳ期宫颈癌患者共98例，采用随机抽样方法分为A组（49例）和B组（49例），分别在盆腔三维适形放疗基础上同期采用铂类和紫杉醇脂质体治疗；比较两组患者临床近期疗效，随访生存率，治疗前后KPS评分及药物毒副作用发生率等。结果两组患者临床近期疗效比较差异无统计学意义（χ2＝0．45，P＞0．05），两组患者随访1年生存率和无进展生存率比较差异均无统计学意义（χ2值分别为0．54、1．33，均P＞0．05）。两组患者治疗前KPS评分无显著性差异（t＝1．33，P＞0．05），治疗后KPS评分均显著增加（t值分别为3．65、4．17，均P＜0．05），而B组患者治疗后KPS评分显著高于A组（t＝2．78，P＜0．05）。 B组患者白细胞减少、血小板减少、恶心呕吐、腹泻及食欲减退发生率均显著低于A组，差异有统计学意义（χ2值分别为5．86、8．61、13．20、4．22、5．15，均P＜0．05），而两组患者肝功能损伤发生率比较差异无统计学意义（χ2＝0．38，P＞0．05）。结论两种单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌临床疗效及生存率接近；但相较于铂类单药化疗，紫杉醇脂质体单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌可有效提高生活质量，降低不良反应发生风险。

Objective To investigate the clinical effects and safety of single paclitaxel liposome and single platinum combined with pelvic three-dimensional conformal radiotherapy in the treatment of cervical cancer in Ⅱ-Ⅳ stage.Methods Totally 98 patients with cervical cancer in Ⅱ-Ⅳstage were chosen in the period from April 2006 to August 2014 in the Third People ’ s Hospital of Zigong City , and they were randomly divided into group A （49 cases） with platinum and group B （49 cases） with paclitaxel liposome on the basis of pelvic three-dimensional conformal radiotherapy .Short-term clinical efficacy , survival rate at follow-up, KPS scores before and after treatment and incidence of drug side effects were compared between two groups .Results There was no significant difference in short-term clinical efficacy between two groups （χ2 =0.45, P〉0.05）.There was no significant difference in survival rate and survival rate without progression in 1 year follow-up between two groups （χ2 value was 0.54 and 1.33, respectively, both P〉0.05）.No obvious difference was found in KPS score before treatment between two groups （t=1.33, P〉0.05）.After treatment KPS score increased in two groups （t value was 3.65 and 4.17, respectively, both P〈0.05）, and that of group B was significantly higher than group A （t=2.78, P〈0.05）.The incidence of aleukocytosis , thrombocytopenia , nausea and vomiting , diarrhea and loss of appetite of group B after treatment was significantly lower than group A （χ2 value was 5.86, 8.61 13.20, 4.22 and 5.15, respectively, all P 〈0.05）.There was no significant difference in the incidence of liver function damage between two groups （χ2 =0.38,P〉0.05）.Conclusion Two kinds of single drug chemotherapy regimen combined with pelvic three-dimensional conformal radiotherapy possess similar effects in the treatment of cervical cancer in Ⅱ-Ⅳ stage. Compared to platinum , paclitaxel liposome combined with pelvic three-dimensional conformal radiotherapy in the treatment of cervical cancer in Ⅱ-Ⅳstage can efficiently improve life quality and reduce the risk of adverse reactions .