术前新辅助化疗加消瘤放疗用于局部晚期宫颈癌的临床分析

目的:研究新辅助化疗加消瘤放疗后手术治疗ⅠB2～ⅡA期宫颈癌的疗效及意义,评估鳞状上皮细胞癌抗原(SCC)对该治疗方案效果的预测意义。方法:本院2003年1月至2010年6月收治的局部晚期宫颈癌(ⅠB2～ⅡA期)101例,其中研究组(术前同步放化疗组)59例,予铂类为基础的化疗1次联合腔内后装放疗2～3次(700～1200cGy/次),2～3周后行宫颈癌根治术;对照组(同步放化疗组)42例予盆腔内外照射的同步放化疗。比较两种治疗方案的近期疗效,毒副反应及患者生存情况。采用化学发光免疫分析法检测患者血清中SCC水平。结果:两组近期疗效差异无统计学意义,研究组手术切除率达100%,病理有效率93.2%。Kaplan-Meier生存分析显示,研究组及对照组的5年无瘤生存率分别为84.3%和92.8%,5年总生存率分别为87.7%和93.8%,Log rank检验显示,两组的无瘤生存及总生存无统计学差异。新辅助化疗及放疗消瘤后血清SCC阴性者有效率及病理完全反应率较阳性者高,差异均有统计学意义(P<0.05)。结论:在ⅠB2～ⅡA期宫颈癌中,应用新辅助化疗加消瘤放疗后手术疗效与同步放化疗治疗一致,副反应轻,可减少患者痛苦,提高生存质量。血清SCC对术前辅助治疗效果有良好预测作用。

Preoperative concurrent chemoradiation for local advanced cervical cancer

Objective:To study the effect of surgery following platinum-based chemotherapy combined radiation therapy in treating cervical cancer of stage ⅠB2~ⅡA and analyze SCC as a predictor of pathologic response.Methods:101 cases cervical cancer of stage ⅠB2~ⅡA which were all treated in our hospital during Jan.2003 and June.2010 were taken in the study.59 patients in studying group,who were underwent surgery following chemotherapy and radiotherapy.42 cases treated by concurrent chemoradiotherapy in contrast group.Results:After treatment the effective rate showed no difference among these two groups.After chemotherapy combined radiation therapy 100% could be operated,93.2% could reach pathological response.Kaplan-Meier analysis showed that in these two groups 5 years-progression-free survival rates were 84.3% and 92.8% respectively,and 5 years-overall survival rates were 87.7% and 93.8%,Log rank test showed there were no difference between the two groups.Serum SCC level of the squamous cell carcinoma after platinum-based chemotherapy combined radiation therapy in studing group(lower than 1.5ng/ml)were associated with a better clinical effect and pathologic response(P<0.05).Conclusion:The effect of surgery following radiotherapy and chemotherapy is as good as concurrent chemoradiotherpy,while with less chance of side effect.SCC can be a useful measurement for the treatment.