子宫动脉介入化疗栓塞术联合放疗治疗子宫颈癌的远期疗效

目的 探讨子宫动脉介入化疗栓塞术联合放疗治疗宫颈癌的远期疗效.方法 回顾性分析兰州军区总医院自1999年1月1日至2009年8月31日间收治的经病理检查证实的632例Ⅱ～Ⅳa期宫颈癌患者的临床资料.其中,126例患者接受子宫动脉介入化疗栓塞术联合根治性放疗(动脉化疗+放疗组),506例患者仅接受根治性放疗(放疗组).晚期放射损伤按美国肿瘤放射治疗协作组和欧洲肿瘤治疗研究协作组(RTOG/EORTC)分级标准评价.对两组患者的预后及并发症的发生情况进行比较,并采用二项分类logistic回归法分析放疗并发症的相关危险因素.结果 (1)生存情况:所有患者总的1、2、5、8年生存率分别为94.4%、82.3%、48.8%、29.1%,其中动脉化疗+放疗组患者分别为96.0%、82.1%、37.2%、25.7%,放疗组分别为94.1%、80.8%、51.1%、31.5%,两组1、2年生存率分别比较,差异均无统计学意义(x2=0.009,P=0.993;x2=0.158,P=0.691),5、8年生存率分别比较,差异均有统计学意义(X2=11.197,P=0.001;x2=9.649,P=0.002).随访期内,动脉化疗+放疗、放疗组患者的复发转移率分别为77.0%(97/126)、73.3%(371/506),两组比较,差异无统计学意义(x2=0.705,P=0.401).(2)放疗并发症及其相关危险因素:所有患者Ⅱ级以上迟发性膀胱损伤发生率为5.5%(35/632),其中动脉化疗+放疗、放疗组分别为11.1%(14/126)、4.2%(21/506),两组比较,差异有统计学意义(x2=9.344,P=o.002).二项分类logistic回归法分析显示,子宫动脉介入化疗栓塞术是与迟发性膀胱损伤相关的危险因素(x2=6.440,OR=2.869,P=0.011).结论 子宫动脉介入化疗栓塞术联合放疗与单纯放疗比较,宫颈癌患者5、8年远期生存率明显降低,且子宫动脉介入化疗栓塞术为迟发性膀胱损伤发生的危险因素.因此,不推荐子宫动脉介入化疗栓塞术作为宫颈癌根治性放疗的常规辅助治疗措施.

Clinical value of the comprehensive treatment in intermediate and advanced cervical cancer with uterine arterial interventional chemoembolization and radiotherapy

Objective To investigate the long-term curative effect of the radiotherapy combined uterine arterial interventional chemoembolization for cervical cancer.Methods Records of 632 patients with cervical cancer stage Ⅱ-Ⅳa proved by pathology in Lanzhou Command General Hospital from January 1st,1999 to August 31st.2009 were retrospective analysed.One hundrand and twenty-six cases of them were treated with radical radiothempy combined uterine arterial interventional chemoembolization(arterial chemoembolization+radiotherapy group).506 cases of them were treated with radical radiotherapy only (radiotherapy group);the evaluation of the late radiation injury was done,according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer(RTOG/EORTC)advanced radiation injury criteria.Prognosis and complications were compared between two groups,relative risk factors of radiothempy complications were identified by method of logistic regression.Results (1)Survival:the total survival mtes of 1-year,2-year,5-year and 8-year were 94.4%,82.3%,48.8%,29.1%,respectively.The survival rates of arterial chemoembolization+radiotherapy group were 96.0%.82.1%,37.2%,25.7%,while the survival rates of radiotherapy group were 94.1%,80.8%,51.1%,31.5%,in which there were significant differences between two groups (x2 = 0.009, P= 0.993; x2 =0. 158, P =0.691;X2 =11. 197,P=0. 001;x2 =9. 649,P =0.002). During the follow-up period, the rate of recurrence and metastasis in arterial chemoembolization + radiotherapy group were 77. 0% (97/126), while 73. 3% (371/ 506) in radiotherapy group ( x2 = 0. 705,P = 0. 401). (2) Radiotherapy complications and relative risk factors; the total incidence of tardive bladder injury higher than RTOG/EORTC stage II was 5.5% (35/632), while it was 11. l%(14/126)in arterial chemoembolization + radiotherapy group, 4.2% (21/506) in the radiotherapy group(x2 =9.344,P =0.002). The results of logistic regression showed that the uterine arterial interventional chemoembolization was relative risk factors of the tardive bladder injury ( x2 =6. 440, OR = 2. 869,P=0. 011). Conclusions Compared with the simple radiotherapy, there are a similar short-term survival rate and significant poor 5-year, 8-year survival rate in the patients treated with the uterine arterial interventional chemoembolization combined with radiotherapy, which also may be strong dangerous factor for the occurrence of tardive bladder injury. The results shown that the uterine arterial interventional chemoem bolization do not recommend to be routine adjuvant therapy for the radical radiotherapy of cervical cancer.