不同放化疗方案对ⅡB-ⅢC期宫颈癌患者的疾病控制效果及不良反应的影响

Effects of Different Radiotherapy and Chemotherapy Regimens on Disease Control and Adverse Reactions in Patients with Stage ⅡB-ⅢC Cervical Cancer

目的探讨不同放化疗方案对ⅡB-ⅢC期宫颈癌患者的疾病控制效果及不良反应的影响。方法选择2013年1月—2016年12月我院收治的宫颈癌患者180例,根据不同治疗方案分为三组,顺铂单药治疗组(DDP组)60例、紫杉醇联合顺铂治疗组(TP组)60例、替加氟联合顺铂治疗组(FP组)60例。三组患者采用统一标准的根治性放疗,所有患者放疗开始的同时给予化疗。采用实体瘤疗效评价标准(RECIST)进行疗效评价,CTCAE 4.0评价标准进行不良反应评价。治疗结束后对患者进行随访,随访截至2018年12月。结果治疗后1个月,DDP组患者疗效显著低于TP组和FP组(P<0.05);治疗后3个月,FP组患者的CR率显著高于治疗后1个月(P<0.05)。TP组患者白细胞减少、血红蛋白下降及血小板减少等Ⅲ-Ⅳ级毒副反应均显著高于DDP组和FP组(P<0.05);FP组患者Ⅲ-Ⅳ级胃肠道反应显著高于DDP组和TP组(P<0.05)。DDP组患者2年无瘤生存率及总生存率均显著低于TP组和FP组(P<0.05);TP组与FP组患者2年无瘤生存率及总生存率比较,差异均无统计学意义(P>0.05)。三组患者远期不良反应发生率比较,差异均无统计学意义(P>0.05)。结论顺铂单药化疗联合放疗对ⅡB-ⅢC期宫颈癌患者的远期疾病控制效果稍逊色于替加氟联合顺铂和紫杉醇联合顺铂同步放疗方案,但其不良反应发生率较低,临床可根据患者的耐受性等具体情况合理选择治疗方案。

Objective To investigate the effects of different radiotherapy and chemotherapy regimens on disease control and adverse reactions in patients with stageⅡB-ⅢC cervical cancer,and to provide basis for clinical practice.Methods A total of 180 cervical cancer patients who were treated in our hospital between January 2013 and December 2016 were selected.The patients were divided into three groups according to the different therapies.The patients in DDP group(n=60)were treated with cisplatin monotherapy,and those in TP group(n=60)with paclitaxel plus cisplatin,and those in FP group(n=60)with tegafur plus cisplatin.All patients were treated with a uniform standard of radical radiotherapy,and were given chemotherapy as soon as radiotherapy started.Efficacy evaluation was performed according to the response evaluation criteria in solid tumor(RECIST),and adverse reactions were observed with the CTCAE4.0 evaluation standard.The patients were followed up after treatment until December 2018.Results One month after treatment,the efficacy of the DDP group was significantly lower than that of the TP and FP groups.The CR rate of patients in the FP group at three months after treatment was significantly higher than that at one month after treatment,and the difference was statistically significant(P<0.05).The incidences of gradeⅢtoⅣtoxicity like leukopenia,hemoglobin and thrombocytopenia were significantly higher in TP group than in DDP group and FP group(P<0.05).But the incidence of gradeⅢtoⅣgastrointestinal response in FP group was significantly higher than in DDP group and TP group(P<0.05).The DDP group had lower 2-year tumor-free survival rate and lower overall survival rate than the TP group and the FP group(P<0.05).There was no significant difference in the 2-year tumor-free survival rate and overall survival rate between the TP group and the FP group(P>0.05).Yet no significant differences were observed in long-term adverse reactions between the three groups(P>0.05).Conclusion The long-term disease control effect of simple cisplatin chemotherapy with concurrent radiotherapy was slightly inferior to that of tegafur or paclitaxel plus cisplatin with concurrent radiotherapy,but the incidence of adverse reactions of simple regimen was lower than that of combination regimen.Clinical selection should be based on patients'tolerance and other specific conditions.