紫杉醇联合卡铂同期放疗对高危险早期宫颈癌患者术后的临床疗效及安全性研究

Research on clinical effect and security of taxol combined with carboplatin oncurrent chemoradio-therapy in treating high risk, early-stage cervical cancer patients

目的探讨紫杉醇联合卡铂同期放疗对高危险早期宫颈癌患者术后的临床疗效及安全性。方法行宫颈鳞癌根治术、分期为ⅠB1~ⅡB且有高危危险因素的患者60例,其中21例放疗1周内行同期放化疗患者作为A组,39例结束放疗后1周开始进行化疗患者作为B组。两组患者均采用紫杉醇联合卡铂进行化疗。比较两组患者的复发率、无进展生存期（PFS）、总生存期（OS）和不良反应发生率。结果两组患者均完成放疗和同期放化疗。随访过程中,A组患者复发率（0）明显低于B组（25.64%）（P〈0.05）;A组患者5例（23.81%）出现远处转移,4例（19.05%）患者死亡;B组患者10例（25.64%）出现远处转移,8例（20.51%）患者死亡。两组患者PFS、OS比较差异均无统计学意义（P〉0.05）。同期放化疗常见的不良反应包括消化道系统和血液系统反应,其中A组患者1~2级血液学不良反应发生率为71.43%（15/21）,3级消化道不良反应发生率为28.57%（6/21）;B组患者1~2级血液学不良反应发生率为5.13%（2/39）,3级消化道不良反应发生率为23.08%（9/39）。A组患者血液学不良反应发生率明显高于B组（P〈0.05）,其余不良反应发生率两组比较差异均无统计学意义（P〉0.05）。A组患者放疗后辅助化疗68周期,B组患者163周期。在放疗后辅助化疗过程中,两组患者多见1~2级血液学和胃肠道不良反应,少见1~2级泌尿生殖系统不良反应。结论紫杉醇联合卡铂同期放疗可有效降低高危险早期宫颈癌患者术后局部复发率,同时患者具有良好的耐受性,值得临床推广应用。

Objective To explore clinical effect and security of taxol combined with carboplatin concurrent chemoradio-therapy in treating high risk, early-stage cervical cancer patients. Methods A total of 60 patients with high risk factors, cervical squamous carcinoma radical prostatectomy, and ⅠB1~ⅡB by stages were selected. There were 21 cases with concurrent chemoradio-therapy within 1 week radiotherapy as group A, and 39 cases with concurrent chemoradio-therapy in 1 week radiotherapy as group B. Both groups received taxol combined with carbopcatin for chemotherapy. Comparison were made on recurrence rate, progression free survival（PFS）, overall survival（OS） and adverse reaction rate. Results Both groups finishede radiotherapy and concurrent chemoradio-therapy. During follow-up, group A had lower recurrence rate（0） than group B（25.64%）（P〈0.05）. Group A had 5 distant metastasis cases（23.81%） and 4 death cases（19.05%）, and group B had 10 distant metastasis cases（25.64%） and 8 death cases（20.51%）. There were no statistically significant difference in PFS and OS between two groups（P〉0.05）. Common adverse reactions of concurrent chemoradio-therapy included digestive system and blood system reactions, group A had blood system adverse reaction rate of grade 1~2 as 71.43%（15/21）, and digestive system adverse reaction rate of grade 3 as 28.57%（6/21）; group B had blood system adverse reaction rate of grade 1~2 as 5.13%（2/39） and digestive system adverse reaction rate of grade 3 as 23.08%（9/39）. Group A had higher blood system adverse reaction rate than group B（P〈0.05）, and the other adverse reaction rate had no statistically significant difference in two groups（P〈0.05）. Group A had adjuvant chemotherapy for 68 periods after radiotherapy, and group B had 163 periods. In the process of adjuvant chemotherapy after radiotherapy, both groups had common blood and gastrointestinal tract adverse reaction of grade 1~2, and little urogenital system adverse reaction of grade 1~2. Conclusion Taxol combined with carboplatin concurrent chemoradio-therapy can effectively decrease postoperative local recurrence rate of high risk, early-stage cervical cancer patients, and patients all have good tolerance. So this method is worth clinical promotion and application.