APOPTOSIS AND PROLIFERATION OF TUMOR CELLS IN LOCALLY ADVANCED CERVICAL CANCER AFTER NEOADJUVANT INTRAARTERIAL CHEMOTHERAPY

Objective: Through observing the clinical response toneoadjuvant intraarterial chemotherapy in locally advanced cervical cancer and investigating the changes of p53 proteinexpression, proliferation and apoptosis of tumor cells afterchemotherapy, to study the relationship between biological markers and chemotherapeutic response. Methods: 20women with locally advanced squamous cervical cancerreceived consecutive infusion chemotherapy of five days ofcisplatin and adriamycin via the superselective uterineartery. The response to chemotherapy was evaluated bygynecologic examination and ultrasonography 3 weeks after chemotherapy. The changes of apoptotic index (AI), proliferation index (PI) and p53 expression of tumor cellswere detected by immunohistochemical technique.Results: The clinical response rate of locally advancedsquamous cervical cancer to uterine artery infusionchemotherapy was 70%. No change of PI was found 3 weeks after treatment, but AI significantly increased from2.79?.76 to 4.29?.13 (P<0.01), and AI/PI from 5.68?.21 to 9.00?.95 (P<0.05). On the contrary, the expression of p53was significantly decreased (P<0.05). Patients whoresponded to chemotherapy showed higher PI before chemotherapy and significantly increased AI and AI/PIafter chemotherapy than non-responders (P<0.05).Conclusion: Higher PI was an indication for neoadjuvantintraarterial chemotherapy. One more cycle ofchemotherapy should be given to those who have significantly increased AI or AI/PI after chemotherapy, while definite treatment such as surgery or/and radiotherapy should be immediately given to those patients without increased AI or AI/PI.

Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatment of UESL in children.AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019.The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava.The NAT included preoperative transcatheter arterial chemoembol ization(TACE)and systemic chemotherapy.The patients were 4 boys and 2 girls with a mean age of 7 years.The longest tumor at presentation ranged from 8.6 to 14.8 cm(mean,12 cm).Extrahepatic metastases were present in 2 cases.Preoperative systemic chemotherapy was administered 3 wk after TACE.Tumor resection was performed 3 wk after one or two cycles of NAT.The patients received systemic chemotherapy after surgery.RESULTS All patients successfully underwent NAT and complete resection.The tumor volumes decreased by 18.2%–68.7%,with a mean decrease of 36%after 1 cycle of NAT(t=3.524,P=0.017).According to the Response Evaluation Criteria In Solid Tumors criteria,4 patients had a partial response and underwent surgery,while 2 had stable disease and received another cycle of NAT before surgery.Massive tumor necrosis was seen on pathological examination of the surgical specimen:>90%necrosis in two,>50%necrosis in three,and 25%necrosis in 1,with an average of 71.8%.Post-NAT complications included fever,nausea and vomiting,and mild bone marrow suppression.Elevated alanine transaminase levels occurred in all patients,which returned to normal within 7–10 d after treatment.No cardiac or renal toxicity,severe hepatic dysfunction,bleeding and nontarget embolization were observed in the patients.The median follow-up period was 8 years with an overall survival of 100%.CONCLUSION NAT effectively reduced tumor volume,cleared the tumor margin,and caused massive tumor necrosis.This may be a promising choice for successful surgery of UESL in children.

Effect of neoadjuvant chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion

Objective:To evaluate the effect of preoperative chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion.Methods:Sixty two patients with bulky or locally advanced cervical cancer from 1999 to 2004 were underwent internal iliac arte- rial infusion chemotherapy by using Seldinger technique.Combined regimens were applied in- cluding cisplatin as the major drug.Two weeks later,all patients received radical hysterectomy. Results:The local tumor regression rate was 93.55%.Postoperative pathologic examination showed that no cervical tumor residue in stumps were found in 61 of 62 patients who underwent radical hysterectomy.Large quantity of necrotic tissue appeared on primary tumor.In 16 patients with positive lymph nodes,15 demonstrated necrotic lymph nodes.Conclusion:Internal iliac ar- terial infusion chemotherapy could effectively reduce tumor volume,increase surgical success rate and decrease lymph nodes and subclinical metastasis rates.

Application of Regional Arterial Infusion Chemotherapy in Advanced Gastric Cancer

Gastric cancer ranks as the fifth most common malignant tumor worldwide and is the third most common cause of cancer-related death. For advanced gastric cancer (AGC), neoadjuvant chemotherapy (NAC) can reduce its stage, increase the rate of radical resection, improve response to treatment, reduce the risk of local recurrence and improve survival rate. Regional arterial infusion chemotherapy (RAIC) is a form of NAC that involves directly injecting chemotherapeutic drugs into the tumor site through the tumor-feeding artery. RAIC increases the local drug concentration around the tumor, thereby improving the therapeutic responses and reducing the adverse effects of the drugs. In recent years, RAIC has attracted increasing attention. This article summarizes the basic principles, procedure, chemotherapy regimens, adverse drug reactions and complications, clinical applications and response evaluation of RAIC in the treatment of AGC.

Effects of different administration routes of neoadjuvant chemotherapy on cancer cell growth signal pathway function in cervical cancer

Objective:To study the effects of different administration routes of neoadjuvant chemotherapy on cancer cell growth signal pathway function in cervical cancer.Methods: Patients with cervical cancer who received neoadjuvant chemotherapy in Fufeng People's Hospital between July 2008 and July 2016 were selected as the research subjects and randomly divided into intervention group and intravenous group who accepted the neoadjuvant interventional arterial chemotherapy and neoadjuvant intravenous chemotherapy respectively. After surgical resection, the contents of PI3K/AKT/mTOR, Wnt/β-catenin and MEK/ERK signaling pathway in cervical cancer lesions were determined.Results:p-PI3K, p-AKT, mTOR, MMP2, VEGF,β-catenin, CyclinD1, Twist, Slug, Snail, MEK1, MEK2, ERK1/2 and Bcl-2 protein levels in cervical cancer lesion of intervention group were significantly lower than those of intravenous group whereas E-cadherin and Bax protein levels were significantly higher than those of intravenous group.Conclusion: Neoadjuvant interventional arterial chemotherapy can be more effective than neoadjuvant intravenous chemotherapy to inhibit the cancer cell growth mediated by PI3K/AKT/mTOR, Wnt/β-catenin and MEK/ERK signaling pathway in cervical cancer.

局部晚期宫颈癌患者血清KRT17蛋白表达水平对动脉介入新辅助化疗效果的影响

目的:检测局部晚期宫颈癌(LACC)患者血清角蛋白17(KRT17)的表达水平,及其对动脉介入新辅助化疗(NACT)效果的影响。方法:选取2017年1月—2018年6月就诊的70例LACC患者,采用动脉介入新辅助化疗联合手术治疗,治疗前通过酶联免疫吸附试验(ELISA)检测患者血清KRT17蛋白的浓度,根据其中位数水平,分为低表达组及高表达组,比较两组患者的无进展生存期(PFS)、总生存期(OS)、盆腔无进展生存期(PPFS)、无远处转移生存期(DMFS)的差异,以评价KRT17蛋白在采用新辅助化疗的LACC患者中的表达水平及其临床意义。结果:LACC患者血清KRT17蛋白浓度中位数为0.65μg/L,所有患者的KRT17蛋白浓度范围为0.49~1.26μg/L。34例患者为低表达组,36例患者为高表达组。血清KRT17蛋白浓度用于预测LACC患者的NACT疗效的受试者工作特征(ROC)曲线下面积(AUC)为0.897[95%CI(0.816,0.978)],敏感性和特异性分别为90.6%、81.6%。血清KRT17低表达组和高表达组患者中位PFS分别为57.23和48.75个月;中位OS分别为58.1和55.5个月;中位PPFS分别为56.9和49.9个月;中位DMFS分别为57.1和50.1个月。Kaplan-Meier生存曲线显示血清KRT17表达水平升高与LACC患者PFS、OS、PPFS、DMFS缩短呈现正相关(P<0.01)。结论:KRT17蛋白在LACC患者血清中表达升高,且其升高水平可作为NACT治疗LACC患者预后不良的预测因素。

基于CT的动脉增强分数预测胃癌新辅助化疗联合免疫治疗反应的价值

目的 探讨CT动脉增强分数(arterial enhancement fraction,AEF)与胃癌新辅助化疗联合免疫治疗反应的相关性,为胃癌患者化疗联合免疫治疗的疗效预测提供影像学参考。方法回顾性收集经活检病理证实为胃腺癌并接受新辅助化疗联合免疫治疗的52例患者,所有患者均经过治疗前常规增强CT扫描。根据治疗后手术病理结果,将患者分为治疗较好(Becker分级:Grade 1-2:肿瘤残留≤50%)与疗效不佳(Grade 3:肿瘤残留>50%)。记录部分形态学特征,测量肿瘤大小及平扫期和增强动脉期、静脉期CT值,计算动脉增强分数。比较各CT参数的组间差异,采用单因素及多因素logistic回归筛选疗效相关独立预测因子,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估模型的预测效能。结果疗效较好的患者更多表现为浆膜面光滑(44.7%vs7.1%;P=0.019),病灶AEF高于疗效不佳组[82.21 (69.68,107.64) vs 59.31±5.70,P=0.003]。多因素logistic回归(向前)结果显示,具有浆膜面光滑特征(OR=11.317,95%CI:1.169-109.545,P=0.036)和较高的AEF(OR=1.045,95%CI:1.012-1.080,P=0.007)是疗效较好的独立预测因素。ROC曲线显示,多变量logistic回归模型的AUC=0.853,95%CI:0.737-0.970,敏感度:84.2%,特异度:85.7%。结论AEF结合浆膜特征可预测胃癌对新辅助化疗联合免疫治疗的反应,有助于患者术前治疗方案的选择。

动脉灌注化疗在胃癌新辅助治疗中的应用

胃癌是全球范围内的常见恶性肿瘤之一,其发病率及病死率高,严重危害人类生命健康。胃癌早期发病症状不典型,多数患者发病时已为中晚期,对于晚期不可外科切除的胃癌患者仍以多学科综合治疗为主。对于有手术机会的胃癌患者多采用以手术为主的综合治疗。目前,术前动脉灌注化疗作为一种新的治疗方式逐渐受到关注。其具有较传统化疗方式效率更高、不良反应更小以及提高后期手术切除率等优势,逐渐应用于临床并取得一定成果。本文就动脉灌注化疗在胃癌新辅助治疗中的应用及发展现状进行综述。

胃肠道肿瘤根治术后行区域动脉灌注化疗治疗进展期胃肠道肿瘤的临床效果

目的:分析胃肠道肿瘤根治术后行区域动脉灌注化疗治疗进展期胃肠道肿瘤的临床效果。方法:选取2021年4月—2022年8月信宜市中医院收治的进展期胃肠道肿瘤患者80例作为研究对象,以随机数字表法分为观察组和对照组,各40例。两组均行胃肠道肿瘤根治术,观察组术后采用区域动脉灌注化疗,对照组术后采用静脉新辅助化疗。比较两组治疗效果、不良反应发生情况、术后生存情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.006)。观察组不良反应总发生率低于对照组,差异有统计学意义(P=0.023)。术后12、18个月,观察组生存率均高于对照组,差异有统计学意义(P<0.05)。结论:胃肠道肿瘤根治术后行区域动脉灌注化疗治疗进展期胃肠道肿瘤的临床效果较好,不良反应发生率较低,且患者术后生存率较高。

Clinical study of interventional preoperative bronchial artery infusion chemotherapy combined with surgical resection for advanced non-small cell lung cancer

Objective： How to improve the postoperative 5-year survival rate for lung cancer and to give more patients a chance of surgery have become research hotspots. The aim of this research is to evaluate the clinical and pathohistological responses and effects of preoperative bronchial artery infusion （BAI） chemotherapy in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： A total of 92 patients with locally advanced NSCLC were randomly divided into two groups. BAI group received BAI chemotherapy for 2 cycles before surgical resection. Surgery group received operation only. The complete resection rate and clinical response were compared between the two groups. Results： In the BAI group, the clinical response rate and the pathohistological response rate were 68.3% and 51.3%, respectively. The complete resection rate in the BAI group was 89.7%, which was significantly higher than that in the surgery group （72.5%） （P 〈 0.05）. The 1- and 2-year survival rate was 100.0% and 80.6% in the BAI group, and 94.1% and 60.0% in the surgery group. Conclusion： BAI neoadjuvant chemotherapy is safe and effective, which has a good clinical and pathohistological response. It might increase the complete resection rate of the tumor and improve the long term survival rate of stage Ⅲ NSCLC patients.

The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： 92 cases with locally advanced NSCLC patients were randomly divided into two groups： （1） BAI chemotherapy group： 39 cases were received BAI chemotherapy for 2 courses and followed surgery; （2） surgery alone group： 51 cases were treated by operation alone. The complete resection rate and preoperative complications were compared between these two groups. Results： In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity. In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group （72.5%, P 〈 0.05）. No significant differences of blood loss, operative complications and mortality were observed between these two groups. Conclusion： BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.

Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma

Background Regional intra-arterial infusion chemotherapy （RIAC） has been more valuable to improve prognosis and quality of life of patients with inoperable pancreatic adenocarcinomas, and adjuvant RIAC plays an important role in prolonging survival and reducing risk of liver metastasis after radical resection of pancreatic cancer, but the effect of preoperative or multiple-phase RIAC （preoperative combined with postoperative RIAC） for resectable pancreatic cancers has not been investigated. In this prospective study, the effect of multiple-phase RIAC for patients with resectable pancreatic head adenocarcinoma was evaluated, and its safety and validity comparing with postoperative RIAC were also assessed. Methods Patients with resectable pancreatic head cancer were randomly assigned to two groups. Patients in group A （n=-50） were treated with new therapeutic mode of extended pancreaticoduodenectomy combined with multiple-phase RIAC, and those in group B （n=-50） were treated with extended pancreaticoduodenectomy combined with postoperative RIAC in the same period. The feasibility, compliance and efficiency of the new therapeutic mode were evaluated by tumor size, serum tumor markers, clinical benefit response （CBR）, surgical complications, mortality and toxicity of RIAC. The disease-free survival time, median survival time, incidence of liver metastasis, survival rate at 1, 2, 3 and 5 years were also observed. Life curves were generated by the Kaplan-Meier method. Results The pain relief rate and CBR in group A was 80% and 84% respectively. Serum tumor markers decreased obviously and tumors size decreased in 26% of patients after preoperative RIAC in group A. No more surgical complications, mortality or severe systemic side effects were observed in group A compared with group B. The incidence of liver metastasis in group A was 34% which was lower than 50% in group B. The disease-free survival time and median survival time in group A were 15.5 months and 18 months respectively. The 1-, 2-, 3- and 5-year survival rates were 54.87%, 34.94%, 24.51% and 12.25% respectively. There was no significant difference of survival time or survival rates between two groups. Conclusions Multiple-phase RIAC is effective in combined therapy of resectable pancreatic head carcinomas by enhancing inhibition of tumor growth and reduction of liver metastasis, without negative effect on patients＇ safety or surgical procedure.

动静脉结合术前化疗在进展期胃癌治疗中的应用

围术期化疗是进展期胃癌综合治疗的重要组成部分。有别于常规的全身化疗,动静脉结合术前化疗在联合用药的基础上,根据药物作用特点,对给药方式进一步优化,在本中心已有20余年的临床应用和研究历史。本文将从理论基础、发展过程、治疗优势和临床研究进行介绍。通过回顾临床与基础研究,阐述其临床治疗效果和可能的作用机制。

乳腺癌的血液供应及术前动脉灌注化疗

目的探索乳腺癌的血液供应来源和术前动脉灌注化疗的方法及临床价值。方法60例经穿刺细胞学诊断为乳腺癌的患者,经股动脉穿刺插管至患侧锁骨下动脉行数字减影动脉造影,观察乳腺和淋巴结内肿瘤血管、肿瘤染色及其血供来源。根据肿瘤血管多少及来源分别对胸廓内动脉、胸外侧动脉及锁骨下动脉灌注不同剂量的丝裂霉素、表柔比星和5-氟尿嘧啶。结果47例(78.3%)乳腺内见肿瘤血管及肿瘤染色,67支动脉单独或参与乳腺内肿瘤供血,其中胸廓内动脉占56.7%(38/67),胸外侧动脉29.9%(20/67),腋动脉直接乳房支11.9%(8/67),肩胛下动脉1.5%(1/67)。不同肿瘤部位、肿瘤分期和病理类型血供来源无统计学差异。2例纵隔淋巴结为胸廓内动脉供血,35例腋窝淋巴结染色者胸外侧动脉供血占75.6%,肩胛下动脉占24.4%。灌注后4周完全缓解(CR)3例(5%),部分缓解(PR)48例(80%),疾病稳定(SD)9例(15%)。无严重并发症发生。结论胸廓内动脉是乳腺内肿瘤的主要供血动脉,胸外侧动脉是腋窝淋巴结的主要供血动脉。术前动脉灌注化疗可缩小肿瘤体积,降低临床分期,提高保乳手术率。

肝动脉灌注化疗联合热疗治疗肝门部胆管癌的临床价值

[目的]初步评价肝动脉灌注化疗联合局部内生场热疗（热化疗）在肝门部胆管癌治疗的临床应用价值.[方法]对2003年10月至2013年6月期间39例接受介入治疗的肝门部胆管癌病人进行回顾性研究,其中热化疗组20例,于肝动脉置管,灌注吉西他滨后,再行肝动脉持续灌注卡铂及肿瘤区域内生场热疗60 min,热化疗后连续肝动脉灌注5-Fu 3 d,第8天静脉应用吉西他滨1次.对照组19例,肝动脉置管及化疗方案同前,未行热疗.上述治疗每4周为1疗程.化疗期间观察化疗毒副反应、并发症及耐受性,随访期间的疗效评价以无肿瘤进展生存时间（PFS）和生存时间（OS）为主要参考指标,并对两组的生存数据进行生存评估.[结果]热化疗组共行107个疗程治疗,OS为7.2～85.8个月,中位OS为23.7个月,PFS为7.2～80.3个月,中位PFS为20.3个月.对照组共行100个疗程治疗,OS为6.0～22.3个月,中位OS为17.5个月,PFS为3.5～19.5个月,中位PFS为14.2个月.经Log-rank检验显示热化疗在延长患者OS和PFS与对照组的治疗有统计学差异（P＜0.05）.治疗期间两组均无严重的化疗毒副反应和并发症.[结论]肝动脉灌注化疗联合内生场热疗在治疗肝门部胆管癌具有安全、微创、耐受性良好的特点,有望成为一个新的辅助性治疗.

两种用药途径在局部晚期宫颈癌新辅助化疗中疗效比较的Meta分析

目的评价两种不同途径新辅助化疗对局部晚期宫颈癌的疗效。方法计算机检索了MED-LINE、中国期刊全文数据库(CNKI)以及万方数据库,并对文献的参考文献二次检索,检索时间为2012年7月以前,对符合纳入标准的随机对照试验进行质量评价和Meta分析。结果最终纳入12个研究,共765例患者,动脉灌注化疗栓塞组(动脉组)389例,静脉化疗组(静脉组)376例。结果显示:动脉组的完全缓解率和总有效率大于静脉组,两种用药途径疗效差异有统计学意义。动脉组脉管浸润、淋巴结转移和宫旁侵犯少于静脉组,差异有统计学意义。而部分缓解率两种方式之间的差异没有统计学意义。结论综合考虑疗效、安全性及预后不良因素方面的结果,局部晚期宫颈癌患者可能更易从动脉灌注化疗栓塞术中获益。

经动脉新辅助化疗治疗巨块型宫颈癌疗效分析

目的评价经动脉新辅助化疗(Neoadjuvantintra-arterialchemotherapy,NAIC)治疗宫颈癌的疗效。方法随机抽取随访成功的35例采用NAIC方法治疗的宫颈癌病人,与单纯手术的病人在术后病理及生存率等方面进行分析对比。结果经NAIC治疗的病人手术时肿瘤的平均缩小率为82.9%,所有病人手术切缘均未见癌细胞。术后5年生存率为77.14%而单纯手术的病人的5年生存率为51.43%,二者对比具有统计学意义(P<0.05)。结论经动脉新辅助化疗配合妇科手术治疗宫颈癌可以降低手术难度,提高病人生存率。

中心型非小细胞肺癌术前支气管动脉灌注化疗疗效分析

目的 评价非小细胞肺癌 (NSCLC)术前支气管动脉灌注化疗 (BAI)近期疗效。方法 经影像学判断手术切除难度较大 ,或不能手术切除的中心型NSCLC患者 2 0例行前瞻性术前BAI。BAI后行手术切除。结果 BAI治疗前后TNM分类改变 5例 ,其中N下降 1例 ,5例均有T改变 ;临床分期下降 2例。PR 8例 ,缓解率为 40 % ,其中鳞癌 6例 ,腺癌 2例 ;NC 12例 ,其中腺癌 1例 ,其余为鳞癌。BAI前后肺不张改善的 9/ 12例 ( 75 % ) ;与周围组织关系密切或受侵改善的 6 / 15例 ( 37 5 % ) ;纵隔淋巴结肿大缩小的 12 / 18例 ( 6 6 6 7% )。结论 BAI作为NSCLC ,尤其是鳞癌的术前辅助治疗 ,具有一定的近期疗效 ,与其它辅助治疗具有同样重要的临床意义 ,是一种特殊的NSCLC新辅助化疗形式。BAI后CT扫描尚不能完全反应残存肿瘤及肿瘤坏死、纤维化等组织学方面的改变 ,具有局限性。CYFRA2 1

骶骨肿瘤术前供血动脉栓塞的临床应用

目的评估骶骨肿瘤供血动脉的来源及术前栓塞的价值。方法对42例骶骨肿瘤手术切除前24 h内以明胶海绵颗粒对供血动脉进行栓塞。肿瘤包括脊索瘤14例、神经鞘瘤8例、转移瘤7例、骨软骨肉瘤3例、骨肉瘤1例、骨巨细胞瘤5例、成血管细胞瘤1例、多发性骨髓瘤1例、血管肉瘤1例、成软骨细胞瘤1例。结果根据骶骨肿瘤的位置及大小不同,供血动脉来源不一致。42例造影提示肿瘤供血动脉有98支,其中右腰2动脉1支、左腰3动脉1支、右腰3动脉3支、左腰4动脉6支、右腰4动脉8支、左腰5动脉1支、左骶外侧动脉9支、右骶外侧动脉11支、左髂腰动脉1支、右髂腰动脉6支、骶正中动脉1支、左臀上动脉10支、右臀上动脉8支、左臀下动脉10支、右臀下动脉8支、左阴部内动脉8支、右阴部内动脉6支。肿瘤染色均较术前减少75%以上,栓塞24 h内行肿瘤切除术,术中、术后24 h内出血量40~7 200 m L,平均(1 255.2±982.1)m L。所有肿瘤均顺利切除,无严重并发症。结论骶骨肿瘤血供来源复杂,术前充分栓塞供血动脉能有效减少术中出血,降低手术危险性,提高肿瘤手术切除率。

NAIC联合手术与NAIC和术前放疗联合手术两种方案治疗Ib～IIIb期宫颈癌的临床研究

目的:探讨动脉灌注新辅助化疗(NeoadjuvantIntra-arterialInfusionChemotherapy,NAIC)联合手术或NAIC和术前放疗联合手术治疗Ib～IIIb期宫颈癌的效果。方法:对象为1997年1月～2002年12月期间连续的59例宫颈活检病理确诊为子宫颈癌FIGO分期为Ib～IIIb期,入该院前没接受过治疗的住院病人。其中22例在接受NAIC后进行手术,被归入NAIC联合手术治疗组;另外37例先后接受NAIC和术前放疗后进行手术,被归入NAIC和术前放疗联合手术治疗组。NAIC的方案为:卡铂200～400mg/m2、氟尿嘧啶1.0～1.5g或博莱霉素30～45mg;次数1～2次,间隔时间4周。术前放疗采用后装腔内放疗,剂量为6～10Gy/次,每周1次,次数2～6次。NAIC或放疗后2周进行广泛全宫切除术及盆腔淋巴结清扫术。结果:NAIC联合手术治疗组5年生存率87.9%,其中IIb～III期宫颈癌患者4年生存率为77.1%。NAIC和术前放疗联合手术治疗组5年生存率81.8%,其中IIb～III期宫颈癌患者4年生存率76.1%。NAIC联合手术治疗组中IIb～III期宫颈癌患者的4年生存率与NAIC和术前放疗联合手术治疗组相比差异无统计学意义(P=0.976)。NAIC联合手术治疗组与NAIC和术前放疗联合手术治疗组3～4度白细胞减少、中性粒细胞减少、贫血、血小板减少的发生率差异无统计学意义(P值分别为0.821、0.677、1.000、1.000)。结论:NAIC联合手术与NAIC和术前放疗联合手术两种方案治疗Ib～IIIb期宫颈癌是有效的。两种方案对IIb～III期宫颈癌患者4年生存率的影响相近。两种方案引起的毒副反应患者均可耐受。