紫杉醇联合卡铂在晚期宫颈癌新辅助化疗中的应用研究

Study on application effect of paclitaxel combined with carboplatin neoadjuvant chemotherapy in patients with advanced cervical carcinoma

目的 探讨紫杉醇联合卡铂在晚期宫颈癌新辅助化疗中的应用效果。方法 选择2015年8月~2016年8月就诊的Ⅱa期及以上的宫颈癌患者40例作为研究对象,均经病理检查确诊。随机分为实验组与对照组,均为20例。实验组患者术前均行紫杉醇与卡铂联合静脉化疗,化疗2个周期,2个周期间隔3周,14 d内行广泛子宫切除术＋盆腔淋巴结清扫术。对照组予直接行广泛子宫切除术＋盆腔淋巴结清扫术。按WHO疗效判定标准评估新辅助化疗效果;观察手术情况;按WHO抗癌药物不良反应分级标准评估药物不良反应;并以健康调查简表（the mos item short from health survey,SF-36）评定2组术后生活质量。结果 20例患者均完成化疗,CR5例,PR11例,SD3例,PD1例,临床总有效率（CR＋PR）80%,同期检查宫旁组织均有不同程度的变软,间隙增宽,浸浸润病灶得到不同程度的控制。不良反应均较轻,未行特殊治疗均缓解,无肾脏、心功能损伤。所有病例均于化疗后顺利行清除术,2组的手术时间与术中出血量差异无统计学意义,实验组的淋巴转移率、子宫旁组织浸润率、阴道切缘肿瘤组织残留率均较对照组小（P〈0.01）。2组患者的SF-36评分较治疗前均有升高,但实验组较对照组明显,差异具有统计学意义（P〈0.01）。结论 紫杉醇联合卡铂在晚期宫颈癌新辅助化疗中可以缩小肿瘤体积,增加了手术机会,毒副作用较轻,转移率降低,提高了患者的生活质量,值得临床进一步研究及推荐。

Objective To explore the application effect of paclitaxel combined with carboplatin neoadjuvant chemotherapy in patients with advanced cervical carcinoma. Methods Forty patients with stage II a and above cervical cancer who were treated between August 2015 and August 2016 were selected as the research objectives and all patients were diagnosed by pathological examination. They were divided randomly into experimental group （n, = 20） and control group （ n, = 20 ） . Patients in the experimental group were treated with intravenous chemotherapy before operation. This scheme included paclitaxel and carboplatin. It included 2 cycles, and the interval between the 2 cycles was 3 weeks. Extensive hysterectomy and pelvic lymphadenectomy were made in 14 days after chemotherapy. The patients in the control group were treated only with extensive hysterectomy and pelvic lymphadenectomy. The efficacy of neoadjuvant chemotherapy was evaluated according to WHO criteria, and observed the operation condition. Adverse drug reactions were evaluated according to WHO anti-cancer drug adverse reaction grade. The quality of life of the two groups was evaluated by the mos item short from health survey （SF-36）. Results 20 patients completed chemotherapy, CR5 cases, PR11 cases, SD3 cases, PD1 cases, and the total effective rate （CR ＋ PR） was 80% . At the same time, The paracervical tissue becomed soft in varying degrees, the gap widened, the invasive lesions were controlled in different degrees. Adverse reactions were mild and relieved without special treatment. There was no kidney and heart function damage. All cases were operated successfully after chemotherapy. There were no significant difference in operation time and blood loss between the two groups. The rate of lymph node metastasis, the infiltration rate of uterine tissue and the residual rate of tumor tissue in the vaginal margin were lower than those in the control group （P〈0. 01）. The SF-36 scores of the two groups were higher than those before treatment, but the score of the experimental group was higher significantly than that of the control group, and the difference was statistically significant （ P 〈 0. 01） . Conclusion Paclitaxel combined with carboplatin in neoadjuvant chemotherapy of cervical cancer can reduce the tumor volume,increase the chance of surgery, has less toxic side effects, lower metastatic rate and improve the quality of life of patients. It is worthy of further clinical research and recommendation.