预防性延伸野放疗联合同步化疗与盆腔野放疗联合同步化疗治疗局部晚期宫颈癌的近远期疗效及安全性对比

Short-term and long-term efficacy and safety of prophylactic extended-field radiotherapy combined with concurrent chemotherapy versus pelvic-field radiotherapy combined with concurrent chemotherapy foRtreating locally advanced cervical cancer:a comparative study

目的比较预防性延伸野放疗联合同步化疗与盆腔野放疗联合同步化疗治疗局部晚期宫颈癌的近远期疗效及安全性。方法选择90例局部晚期宫颈癌患者作为研究对象,将其随机分为观察组与对照组,每组45例。给予观察组预防性延伸野放疗联合TP方案(紫杉醇+顺铂)同步化疗,给予对照组盆腔野放疗联合TP方案同步化疗。在同步放化疗结束后4周,评价两组的近期疗效及毒副反应发生情况。比较两组治疗前后血清学肿瘤标志物[鳞状细胞癌相关抗原(SCCA)、癌胚抗原、糖类抗原50(CA50)]水平。统计两组患者3年总生存率、无进展生存率及腹主动脉旁淋巴结(PALN)控制率。结果两组客观缓解率差异无统计学意义(P>0.05)。治疗后,两组患者血清SCCA、癌胚抗原和CA50水平均较治疗前降低,且观察组上述指标水平均低于对照组(均P<0.05);观察组骨髓抑制发生率高于对照组(P<0.05),但两组其他毒副反应发生率差异均无统计学意义(均P>0.05)。观察组3年无进展生存率、PALN控制率均高于对照组(均P<0.05),但两组3年总生存率差异无统计学意义(P>0.05)。结论与盆腔野放疗联合同步化疗相比,预防性延伸野放疗联合同步化疗治疗局部晚期宫颈癌患者可以更好地改善血清学肿瘤标志物水平,提高PALN控制率,远期疗效好,但增加了骨髓抑制的发生风险,两种疗法的近期疗效相当。

Objective To compare the short-and long-term efficacy and safety between prophylactic extended-field radiotherapy combined with concurrent chemotherapy and pelvic-field radiotherapy combined with concurrent chemotherapy for treating locally advanced cervical cancer.Methods A total of 90 patients with locally advanced cervical cancer were selected as the research subjects,and they were randomly divided into observation group or control group,with 45 cases in each group.The observation group received prophylactic extended-field radiotherapy combined with concurrent chemotherapy of TP regimen(paclitaxel+cisplatin),whereas the control group received pelvic-field radiotherapy combined with concurrent chemotherapy of TP regimen.After the end of 4-week concurrent chemoradiotherapy,the short-term efficacy and the occurrence of toxic and adverse effects were evaluated in both groups.The pre-and post-treatment serological tumor markers(squamous cell carcinoma associated antigen[SCCA],carcinoembryonic antigen,carbohydrate antigen 50[CA50])levels were compared between the two groups.The 3-year total survival rate,progression-free survival rate,and control rate of para-aortic lymph node(PALN)of patients in both groups were analyzed.Results The objective remission rate had no statistically significant difference between the two groups(P>0.05).After treatment,the levels of serum SCCA,carcinoembryonic antigen,and CA50 in both groups were decreased as compared with before treatment,and the levels of aforementioned indices were lower in the observation group than in the control group(all P<0.05);in adidition the incidence rate of myelosuppression in the observation group was higher than that in the control group(P<0.05);however,there was no statistically significant difference in the incidence rate of other toxic and adverse effects between the two groups(all P>0.05).The 3-year progression-free survival rate,and PALN control rate in the observation group were higher than those in the control group(all P<0.05);nevertheless,there was no statistically significant difference in 3-year total survival rate between the two groups(P>0.05).Conclusion Compared with pelvic-field radiotherapy combined with concurrent chemotherapy,prophylactic extended-field radiotherapy combined with concurrent chemotherapy for the treatment of patients with locally advanced cervical cancer can preferably ameliorate the levels of serological tumor markers,improve PALN control rate,exerting a good long-term efficacy;nonetheless,it increases the occurrence risk of myelosuppression,and the short-term efficacy of the two treatments is comparable.