Ⅰ_(B2)~Ⅱ_B期宫颈癌新辅助化学疗法的疗效及安全性分析

Clinical efficacy and safety of neo-adjuvant chemotherapy for stageⅠ_(B2)-Ⅱ_B cervical cancer

目的探讨新辅助化学疗法(化疗)对Ⅰ_(B2)~Ⅱ_B期宫颈癌的疗效及安全性。方法选取2012年6月—2014年12月收治的66例Ⅰ_(B2)~Ⅱ_B期宫颈癌患者,给予PT(顺铂/卡铂+紫杉醇/多西他赛)方案化疗,评估疗效显著者行手术治疗,并观察化疗后肿瘤消退情况、化疗的毒副反应等。结果新辅助化疗肿瘤消退情况:完全缓解10.6%(7/66),部分缓解59.1%(39/66),总有效率69.7%。常见不良反应为骨髓抑制59.1%(39/66)和消化道反应33.3%(22/66),经积极防治均可耐受或较满意缓解。宫颈鳞状细胞癌、腺癌、腺鳞癌化疗的有效率分别为72.6%、33.3%、0%;高、中、低分化宫颈癌化疗的有效率分别为100.0%、77.3%、55.9%,差异均有统计学意义(P<0.05)。结论新辅助化疗是治疗局部晚期宫颈癌的一种安全有效的辅助治疗手段;因样本例数有限,新辅助化疗疗效与肿瘤分化程度和病理类型的相关性仍需临床进一步探讨。

Objective To investigate the efficacy and safety of neo-adjuvant chemotherapy for stage ⅠB2-ⅡB cervical cancer. Methods From June 2012 to December 2014, 66 patients with stage ⅠB2-ⅡB cervical cancer were selected and treated by PT （cisplatin/carboplatin and taxol/docetaxel） as neo-adjuvant chemotherapy prior to surgery. Neo- adjuvant chemotherapy response and toxicity were collected and analyzed. Results The extinctive condition of tumor by neo-adjuvant chemotherapy： the complete remission rate was 10.6% （7/66）, partial remission rate was 59.1% （39/66）, and the total effective rate was 69.7%. The main toxicities were myelosuppression （59.1%, 39/66） and gastrointestinal reactions （33.3%, 22/66）. The toxicities could be tolerated or relieved by prevention and treatment. The effective rate of chemotherapy for cervical squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma was 72.6%, 33.3% and 0%, respectively, with significant differences among the three types （P〈0.05）. The effective rate of chemotherapy for high, medium and low differentiated cervical cancer was 100.0%, 77.3% and 55.9%, respectively, with significant differences among the three degrees （P〈0.05）. Conclusions Neo-adjuvant chemotherapy is proved to be a safe and effective complementary treatment for most patients with locally advanced cervical cancer. Due to the limitation of sample size, the correlations between therapeutic effect and tumor differentiation degree and between therapeutic effect and pathological type need further study.