先期三维腔内放疗+化疗联合手术治疗局部晚期宫颈癌的临床研究

Clinical study of preoperative radiotherapy plus chemotherapy combined with surgery in the treatment of locally advanced cervical cancer

目的探讨先期三维腔内放疗+化疗联合手术治疗局部晚期宫颈癌(LACC)的临床价值。方法选择2012年1月—2016年12月期间收治的LACC患者(ⅠB2期、ⅡA2期和ⅡB期)70例,随机分为观察组和对照组,每组各35例。观察组采用先期三维腔内放疗+化疗联合手术治疗,对照组采用根治性放疗。观察并记录2组病例近、远期相关并发症发生情况。治疗结束后对2组患者进行随访,采用Kaplan-Meier法绘制2组ⅠB2+ⅡA2期和ⅡB期患者的生存曲线,Log-rank法比较2组总生存率的差异。结果近期并发症情况比较:观察组出现直肠反应发生率少于对照组(14.3%vs.37.1%,χ~2=4.786,P<0.05);2组骨髓抑制、胃肠道反应和膀胱反应发生率比较差异均无统计学意义(P>0.05)。远期并发症情况比较:观察组放射性膀胱损伤(8.6%vs.31.4%)和放射性直肠损伤(11.4%vs.34.2%)发生率少于对照组(χ~2分别为5.714和5.185,均P<0.05)。生存分析显示2组ⅠB2+ⅡA2期和ⅡB期患者的累积生存率差异均无统计学意义(Log rankχ2分别为0.081和0.376,均P>0.05)。结论与根治性放疗比较,三维腔内放疗+化疗联合手术治疗LACC患者可减少相关并发症的发生率,两种方法治疗后的总生存率和平均生存时间相似。

Objective To study the clinical data of patients with locally advanced cervical cancer（LACC） treated withpreoperative radiotherapy plus chemotherapy combined with surgery.Methods Seventy patients with LACC（stage ⅠB2,ⅡA2 and ⅡB） who were treated in our hospital from January 2012 to December 2016 were selected in this study.All thecases were randomly divided into two groups.The observation group（n=35） was treated with three-dimensional intracavitarybrachytherapy plus chemotherapy combined with surgery,while the control group（n=35） was treated with radicalradiotherapy.Patients of the two groups were followed up after the treatment.The recent and long term complications wererecorded and observed in the two groups.Meanwhile,the survival curves were drawn by Kaplan-Meier,and the difference oftotal survival rate was compared with the Log-rank method between the two groups.Results The incidence of rectalreaction was less in the observation group than that in the control group（14.3% vs.37.1%,χ2=4.786,P〈0.05）.There wereno significant differences in bone marrow suppression,gastrointestinal reaction and bladder reaction between the two groups（P〈0.05）.The incidence rates of radioactive bladder injury（8.6% vs.31.4%） and radionuclide injury（11.4% vs.34.2%）were less in the observation group than those in the control group（χ2=5.714 and 5.185 respectively,P〈0.05）.The survivalanalysis showed that there was no significant difference in the total survival rate between the two groups of stageⅠB2＋ⅡA2 and stageⅡB patients（Log rank χ2=0.081 and 0.376,P〈0.05）.Conclusion For patients with locally advanced cervicalcancer,preoperative radiotherapy plus chemotherapy combined with surgery can reduce the incidence of relatedcomplications,meanwhile,there is no significant difference in the total survival rate and the mean survival time after thetreatment of the two methods.