不同化疗方案同期联合放疗治疗中晚期宫颈癌的临床观察

目的 探讨紫杉醇脂质体（力扑素）对比顺铂同期联合放疗治疗中晚期宫颈癌的疗效及不良反应。方法 选取45例ⅠB2期以上的局部中晚期宫颈癌患者分为力扑素组（n=26）和顺铂组（n=19），分别给予力扑素55mg／m2或顺铂30mg/m2每周静滴1次，共5次，两组均同时给予盆腔三维适形放疗（全盆腔总剂量45Gy／25次）或后装治疗（A点剂量30～36Gy／5～6次），比较两组的疗效及不良反应。结果 45例患者均顺利完成同期放化疗。力扑素组获CR 13例，PR 10例，SD 3例，无PD，有效率（RR）为88.5％；顺铂组获CR 12例，PR 3例，SD 3例，PD 1例，RR为84.2％，两组RR差异无统计学意义（P＞0.05）。力扑素组和顺铂组的1年生存率分别为96.2％和89.5％，1年无进展生存率分别为92.3％和73.7％，两组比较差异无统计学意义（P＞0.05）。不良反应均以1～2级为主，力扑素组的血液学毒性及消化道不良反应均低于顺铂组。结论 对局部中晚期宫颈癌患者采用力扑素或顺铂周化疗方案同期放疗的疗效相当，但力扑素周方案化疗同期联合放疗的不良反应较轻，值得临床推广应用。

Clinical observation of different concurrent chemoradiotherapy in locally advanced cervical carcinoma

Objective To evaluate the efficacy and toxicity of paclitaxel liposome or cisplatin concurrent chemoradiotherapy for locally advanced cervical carcinoma. Methods Forty-five patients with locally advanced cervical carcinoma（ FIGO stage B2-1V A）were enrolled into the study and divided into paclitaxel group（n=26） and cisplatin group（n= 19）. Radiotherapy included external three dimensional conformal radiotherapy （45Gy/25f） and 792 Ir brachytherapy（ 30-36Gy/5-6） at point A）. In paclitaxel group, patients received paclitaxel liposome 55mg/mz per week for 5 weeks, and others in cisplatin group received cisplatin 30mg/m2 per week for 5 weeks.The efficacy and toxicity in each group were compared. Results All patients finished concurrent chemoradiotherapy. In paclitax- el group, 13 cases achieved CR, 10 PR, 3 SD, and the response rate（RR） was 88. 5%;in cisplatin group, 12 cases achieved CR, 3 PR,3 SD,1 PD,and RR was 84. 2%. The 1-year survival rate was 95.2% and 89.5% for paclitaxel group and cisplatin group, and 1-year progression-free survival rate was 92. 3% and 73.7% respectively, but there was no significant difference between two groups（ P 〉 0.05 ）. The toxicities in the two groups were mainly in grade 1-2, and the incidence of blood and gastrointestinal tract toxicities in pa- clitaxel liposome was lower than that of cisplatin group. Conclusion Paclitaxel liposome based and cisplatin-based concurrent chemo- radiotherapy present a similar efficacy for locally advanced cervical carcinoma and the toxicities of paclitaxel liposome-based concurrent chemoradiotherapy is mild.