宫颈癌新辅助动脉化疗的临床和病理学观察

目的:观察以顺铂为基础的新辅助动脉化疗(NAIC)对宫颈癌手术或放疗前的治疗效果,并分析其影响因素。方法:对58例FIGOⅠb2~Ⅳa期宫颈癌进行NAIC,化疗方案为长春新碱(VCR,1.4mg/m2)+丝裂霉素C(MMC,10mg/m2)+顺铂(CDDP,80mg/m2)。经盆腔检查、影像学方法及病理检查判定疗效,并分析影响NAIC疗效的临床和病理因素。结果:58例宫颈癌患者共进行81次NAIC(39例1次,18例2次,2例3次),临床总有效率81.0%(其中CR14例,PR33例)。在有宫旁浸润的36例中,31例NAIC后宫旁浸润消失或显著减轻,重获手术机会;5例宫旁浸润改善不明显行放疗。经NAIC后手术的53例中,5例鳞癌患者经病理切片检查未见癌细胞,达病理完全缓解(pCR)。统计学分析提示,肿瘤体积是影响NAIC对宫颈癌疗效的重要因素,肿瘤体积大于80cm3的宫颈癌对NAIC的疗效较差。58例患者随访6~67个月(中位19个月)8例复发。53例手术患者的中位无瘤生存期(DFS)为46个月。结论:以顺铂为基础的NAIC对宫颈癌根治性手术或放疗前具有较好的缩减肿瘤的效果。

Clinical and pathological observations of neoadjuvant intraarterial chemotherapy for cerviral cancer

Objective: To evaluate the effects of neoadjuvant intraarterial chemotherapy (NAIC) with cisplatin-based regimen,followed by radical surgery or radiotherapy for cervical cancer,and to analyze clinical and pathological factors influencing the response to NAIC.Methods: Fifty-eight patients with invasive cervical cancer,FIGO stageⅠb2-Ⅳa,were treated with neoadjuvant intraarterial chemotherapy,using a regimen of cisplatin (80mg/m~2),mitomycin-C (10mg/m~2) and vincristine (1.4mg/m~2).The response to chemotherapy was assessed by pelvic examination,imaging diagnostics and histological analysis.Results: The overall clinical response rate of the neoadjuvant intraarterial chemotherapy for the 53 patients was 81.0% with 14 cases complete responses and 33 cases partial remission.Tumor reduction rate after chemotherapy averaged 80.4% with a range of 5.8%~100%.Out of 36 cases who had parametrial invasion,31 cases or 86.1% had a significant reduction or absence after chemotherapy,and subsequently underwent radical surgery.In the 53 patients who received surgery after chemotherapy,pathological complete responses (PCR) were found in 5 cases (9.4%).Multivariate logistic regression analysis indicated that tumor volume prior to treatment was an determining factor affecting the efficacy of intraarterial chemotherapy in cervical cancer.The median follow-up time was 19 months (range 6~67 months) for the 58 patients enrolled and 8 cases had a recurrence during this period.The median disease-free survival for the 53 surgical cases was 46 months.Conclusion: Neoadjuvant intraarterial chemotherapy with a cisplatin-based regimen for cervical cancer is useful for tumor reduction prior to radical surgery or radiation.