阴道腔内消除量联合放化疗治疗巨块型子宫颈鳞癌临床观察

Clinical observation on the treatment of massive cervical squamous cell carcinoma by vaginal anti-tumor volume combined with chemoradiotherapy

目的探讨阴道腔内消除量在巨块型子宫颈鳞癌联合放化疗治疗中的有效性及安全性。方法将2013年3月至2019年12月重庆大学附属肿瘤医院收治的子宫颈鳞癌、肿瘤大小>4cm、有随访经历的132例患者纳入研究,分为消除量组(阴道腔内消除量+根治性放化疗)38例,对照组(根治性放化疗)94例。结果消除量组与对照组2年局控率(97.4%vs. 91.5%),无进展生存期(79.4%vs. 69.3%),总生存率(81.6%vs. 98.9%)差异均无统计学意义(P>0.05)。消除量组与对照组3~4级不良反应:急性期骨髓抑制52.6%vs. 56.4%(P>0.05),急性期放射性直肠炎31.6%vs. 24.5%(P<0.05),急性期放射性膀胱炎21.1%vs. 6.4%(P<0.05),晚期放射性直肠炎28.9%vs.9.6%(P<0.05)、晚期放射性膀胱炎10.5%vs. 8.5%(P>0.05)。结论阴道消除量对巨块型子宫颈鳞癌的疗效及2年无病生存期及总生存期无贡献,而且增加3~4级急性期放射性直肠炎、膀胱炎及远期放射性直肠炎等不良反应。建议临床使用阴道腔内消除量时除止血目的外,谨慎选用。

Objective To observe the effectiveness and safety of vaginal anti-tumor volume in the treatment of massive cervical squamous cell carcinoma combined with chemoradiation.Methods A total of 132 patients with cervical squamous cell carcinoma,tumor size>4 cm and follow-up experience were admitted to Chongqing University Cancer Hospital from March 2013 to December 2019.The patients were divided into two groups:38 cases in vaginal elimination group(vaginal tumor elimination+chemoradiotherapy+brachytherapy) and 94 cases in control group(chemoradiotherapy+brachytherapy).Results The two-year local control rate was 97.4% and 91.5%,the progression-free survival was79.4% and 69.3%,and the overall survival rate was 81.6% and 98.9% in vaginal elimination group and control group,respectively.There was no statistical difference between the two groups.Grade 3 to 4 adverse reactions in the elimination group and the control group were:myelosuppression 52.6% and 56.4%(P> 0.05),recent radiation proctitis 31.6% and24.5%(P<0.05),and recent radiation cystitis 21.1% and 6.4 %(P<0.05),long-term radiation proctitis 28.9% and9.6%(P<0.05),long-term radiation cystitis 10.5% and 8.5%(P> 0.05).Conclusion The vaginal anti-tumor volume doesn’t improve the efficacy of massive cervical squamous cell carcinoma and the 2-year disease-free survival and overall survival;besides,it increases the adverse reactions of grade 3 to 4 recent radiation proctitis,cystitis,and longterm radiation proctitis.lt is recommended vaginal elimination be used cautiously except for the purpose of hemostasis in clinical practice.