顺铂和放疗联合治疗晚期宫颈癌

目的 观察顺铂和放疗在治疗晚期宫颈癌中的作用。方法 从１９８５年３月至１９９０年８月,６０例晚期宫颈癌患者接受单药顺铂（ＤＤＰ）化疗,ＤＤＰ ２０ｍｇ,第１￣５日给药,同时放疗,配对抽取单纯放疗患者６０例供疗效对比观察。结果 化放组和单放组５年生存率分别为６１．０％和４４．０％,Ｐ〈０．０５,Ⅲ期５年生存率化放组高于单放组（Ｐ〈０．０５）,化放组副作用主要是胃肠反应及骨髓抑制,单放组副反应不明显。     

紫杉醇联合顺铂/卡铂在宫颈癌新辅助化疗中的作用

目的探讨紫杉醇联合顺铂/卡铂在宫颈癌新辅助化疗中的作用。方法选择2003年2月~2006年7月经病理确诊的109例Ⅰb2期宫颈鳞癌患者作为研究对象。新辅助化疗联合手术治疗组(以下简称联合治疗组)58例,术前采用紫杉醇联合顺铂/卡铂化疗,2~3周后手术;另51例行单纯手术治疗(以下简称单纯手术组)。观察联合治疗组化疗1个疗程的有效率及2组术后宫颈深间质层浸润、脉管癌栓、淋巴结转移情况,同时观察新辅助化疗的毒副反应及评价新辅助化疗的安全性。结果联合治疗组中,完全缓解10例,部分缓解35例,稳定13例,进展0例,临床有效率为77.6%(45/58);联合治疗组的肿瘤最大横径由化疗前的(4.46 0.31)cm缩小为化疗后的(3.08 0.22)cm,P<0.05;联合治疗组与单纯手术组的术中出血量分别为(379.48 169.45)ml及(398.82 228.10)ml,P>0.05;手术时间分别为(158.70 20.27)min及(160.19 25.82)min,P>0.05;联合治疗组与单纯手术组的宫颈深层间质浸润发生率分别为55.2%(32/58)及56.9%(29/51),P>0.05;脉管癌栓发生率分别为31.0%(18/58)及31.4%(16/51),P>0.05;淋巴结转移率分别为22.4%(13/58)及25.5%(13/51),P>0.05。在联合治疗组中,出现Ⅰ~Ⅲ度的骨髓抑制42例,占72.4%(42/58),经使用粒细胞集落刺激因子,骨髓抑制症状好转,血象恢复正常,无1例化疗相关死亡。结论紫杉醇联合顺铂/卡铂用于宫颈癌新辅助化疗,可缩小瘤体,提高宫颈癌的近期疗效。     

紫杉醇联合顺铂动脉栓塞治疗复发宫颈癌的临床研究

目的　探讨紫杉醇联合顺铂方案经髂内动脉化疗栓塞治疗放疗后复发宫颈癌的近期疗效及毒性。方法　采用紫杉醇联合顺铂方案（紫杉醇１３５ｍｇ／ｍ２,顺铂６０～１００ｍｇ／ｍ２）经髂内动脉化疗栓塞治疗放疗后复发宫颈癌患者３３例,４周重复,２个周期后评价疗效,有效者继续原方案治疗１～３个周期。结果　３３例复发宫颈癌患者的总有效率为５７.６％,其中ＣＲ５例（１５.２％）,ＰＲ１４例（４２.４％）;经治疗后可手术切除为１１例（３３.３％）;临床症状缓解率为１００.０％。治疗相关的常见不良反应轻微。结论　紫杉醇与顺铂联合经髂内动脉化疗栓塞治疗放疗后复发宫颈癌有较好的近期疗效,可明显改善生活质量,值得临床推广应用。     

顺铂和放疗联合治疗晚期宫颈癌

观察顺铂和放疗在治疗晚期宫颈癌中的作用。方法　从 1985年 3月至 1990年 8月 ,6 0例晚期宫颈癌患者接受单药顺铂 (DDP)化疗 ,DDP 2 0mg ,第 1～ 5日给药 ,同时放疗 ,配对抽取单纯放疗患者 6 0例供疗效对比观察。结果　化放组和单放组 5年生存率分别为 6 1 0 %和 44 0 % ,P <0 .0 5 ,Ⅲ期 5年生存率化放组高于单放组 (P <0 .0 5 ) ,化放组副作用主要是胃肠反应及骨髓抑制 ,单放组副反应不明显。结论　顺铂与放疗联合治疗Ⅲ期宫颈癌疗效好且副作用可以耐受。     

紫杉醇联合顺铂同步放疗盆腔淋巴结阳性Ⅲ期宫颈癌

摘 要：［目的］ 探讨紫杉醇联合顺铂同步调强放疗治疗盆腔淋巴结阳性的Ⅲ期宫颈癌的临床疗效及不良反应。［方法］ 回顾性分析2013年4月至2016年4月我科收治90例Ⅲ期宫颈癌患者,其中44例采用紫杉醇联合顺铂方案同步放疗（联合组）,46例患者接受顺铂单药周疗同步放疗（单药组）。［结果］ 紫杉醇联合顺铂组有效率为97.73%,顺铂单药组有效率为82.60%（P<0.05）。联合组和单药组患者3年PFS分别为29.55%（13/44）和4.35%（2/46）（P<0.05）。不良反应方面,联合组和单药组患者Ⅲ/Ⅳ°骨髓抑制发生率分别为38.64%和19.57%（P<0.05）,Ⅲ°以上胃肠道反应分别为22.72%和43.48%（P<0.05）,体重下降发生率分别为11.36%和28.26%（P<0.05）;而血红蛋白下降、放射性膀胱炎和放射性直肠炎的发生率两组均无统计学差异（P>0.05）。［结论］ 紫杉醇联合顺铂同步放疗盆腔淋巴结阳性的Ⅲ期宫颈癌,疗效较好,放化疗的不良反应可以耐受。     

顺铂或紫杉醇联合放射治疗中晚期鼻咽癌临床研究

[目的]比较顺铂和紫杉醇在中晚期鼻咽癌放射治疗中的作用。[方法]在放疗全程中,低剂量每周1次分别应用顺铂或紫杉醇,观察顺铂组和紫杉醇组放疗半量和全量疗效、肿瘤消退时剂量分布以及毒副反应,并与对照组(单纯放疗)比较。[结果]两药在提高放射疗效、肿瘤消退时放射剂量分布和毒副反应方面差异无显著性(P>0.05)。[结论]顺铂或紫杉醇联合放射治疗中晚期鼻咽癌,在提高疗效、放射增敏以及毒副反应方面相近,但顺铂更经济,使用更方便。     

紫杉醇脂质体联合顺铂同步放化疗治疗中晚期宫颈癌疗效观察

目的分析紫杉醇脂质体联合顺铂同步放化疗治疗中晚期宫颈癌的疗效和毒副反应。方法 128例中晚期宫颈癌随机均分为治疗组和对照组,治疗组患者第1天给予紫杉醇脂质体135 mg.m-2静滴,第2天给予顺铂80 mg.m-2静滴;对照组患者第1天给予紫杉醇135 mg.m-2静滴,第2天给予顺铂80mg.m-2静滴;2组患者均给予同步放疗。并评价两组的疗效和毒副反应。结果治疗组有效率、1 a无进展生存率和总生存率分别为87.5%、78.1%和95.3%,对照组分别为81.2%、70.3%和92.2%,差异均无统计学意义(P均>0.05)。治疗组胃肠道反应、脱发、骨髓抑制、肌肉关节酸痛和过敏反应的发生率分别为48.4%、53.1%、67.2%、23.4%和6.2%,低于对照组的75.0%、76.6%、81.2%、42.2%和20.3%,差异均有统计学意义(P均<0.05)。结论紫杉醇脂质体联合顺铂同步放化疗治疗中晚期宫颈癌安全有效。     

紫杉醇联合顺铂用于局部晚期宫颈癌新辅助化疗的近期疗效观察

宫颈癌是全球妇女中仅次于乳腺癌的第二个最常见的恶性肿瘤,发病呈升高和低龄化趋势,虽然手术和放疗技术不断改进,但局部晚期宫颈癌患者的疗效尚不理想,长期存活率不超过40％,在部分患者中术前的新辅助化疗逐渐受到重视。紫杉醇联合顺铂治疗卵巢癌在临床已积累大量的资料,但在宫颈癌治疗中的应用尚属探索阶段。为此,我们通过对12例局部晚期宫颈癌术前采用紫杉醇联合顺铂化疗患者的临床病理资料进行总结分析,探讨此化疗方案的近期疗效及其毒副反应。     

紫杉醇联合顺铂方案同步放疗治疗局部进展期宫颈癌的疗效分析

目的 分析紫杉醇联合顺铂方案同步放疗对局部进展期宫颈癌患者的疗效及不良反应.方法 选取局部进展期宫颈癌患者68例,FIGOⅢ~Ⅳa期,接受根治性放疗,累积剂量为80 Gy,同时每周给予顺铂30 mg/m2+紫杉醇50 mg/m2.观察记录患者的疗效及不良反应.结果 68例患者的不良反应包括胃肠道损害、贫血及脑梗死等,2年累积远期不良反应发生率为25%.中位随访时间27个月,2年PFS为83.8%(75.1%~92.6%),2年OS为92.7%(86.4%~98.9%),2年DM为13.2%(5.2%~21.3%).结论 紫杉醇联合顺铂同步放疗治疗局部进展期宫颈癌的疗效显著,且方案安全可行.     

Neoadjuvant chemotherapy with cisplatin, ifosfamide and paclitaxel for locally advanced squamous-cell cervical cancer

Background: Neoadjuvant chemotherapy is increasingly being used for the treatment of bulky and locally-advanced cervical cancer. Cisplatin and ifosfamide are known to be effective in cervical cancer, while paclitaxel is one of the promising new drugs for the treatment of this neoplasm.Objective: To assess the toxic effects and antitumor activity of a multidrug neoadjuvant regimen consisting of cisplatin, ifosfamide, and paclitaxel in bulky and locally advanced cervical cancer.Patients and methods: Thirty-eight patients with pathology-confirmed squamous-cell cervical cancer (27 IB2-IIA, two IIB, eight IIIB, one IVA) were prospectively enrolled in the study. Their treatment consisted of paclitaxel 175 mg/m² given over three hours on day 1, cisplatin 50 mg/m² (75 mg/m² in 10 patients), ifosfamide 5 g/m² in a 24-hour continuous infusion and mesna 5 g/m² in a 24-hour continuous infusion on day 2, and mesna 3 g/m² in a 24-hour continuous infusion on day 3. The course was repeated every three weeks for three courses and all of the patients, except those with disease progression or who were inoperable, were scheduled for radical hysterectomy and pelvic lymphadenectomy.Results: All patients are evaluable for response. Eleven achieved clinical complete responses, 21 had partial responses, five had stable disease and one had progression of disease. Of 34 patients who underwent surgery, six (16%) had pathology-documented complete responses, seven (18%) had partial responses with only microscopic residual disease in the cervix, 19 had sub-optimal partial responses, and two had stable disease, for an overall response rate of 84% (95% confidence intervals (CI): 68.7%–94%).Grade 3–4 neutropenia was recorded for 27 (71%) patients, grade 3–4 thrombocytopenia for four (10.5%), and grade 2 peripheral neuropathy for two (2.5%).At a median follow-up of 16 months (range 7–22), 29 (76%) women are alive without recurrence, seven are alive with persistent/recurrent disease and two have died of their disease.Conclusions: According to pathology examination, this regimen yields a 34% complete and optimal partial response rate with acceptable toxicity, and it should be prospectively compared to other regimens.     

High complete pathological response in locally advanced breast cancer using paclitaxel and cisplatin

Background.In an earlier study, we have demonstrated a high response rate in metastatic breast cancer using paclitaxel (P) and cisplatin (C). A phase II study using the same regimen (PC) has been conducted in locally advanced breast cancer (LABC). Methods.A total of 72 consecutive patients with non-inflammatory LABC (T24cm, T3 or T4, N0–N2, M0). Patients were scheduled to receive 3–4 cycles of the neoadjuvant PC (paclitaxel 135mg/m² and cisplatin 75mg/m² on day 1) every 21 days. Patients were then subjected to surgery and subsequently received 6 cycles of FAC (5-fluorouracil 500mg/m², doxorubicin 50mg/m², and cyclophosphamide 500mg/m²) or 4 cycles of AC (doxorubicin 60mg/m², and cyclophosphamide 600mg/m²). Patients then received radiation therapy, and those with hormone receptor positive tumors were given adjuvant tamoxifen intended for 5 years. Results.The median age was 39 years (range, 24–78). Clinically, 7%, 58%, and 35% of patients had T24cm, T3, and T4, respectively. Disease stage at diagnosis was IIB (33%), IIIA (27%), and IIIB (40%). Complete and partial clinical response to PC was demonstrated in 13 (18%), and 52 (72%) patients, respectively. Of those patients with evaluable pathologic response (68 patients), complete pathologic response (pCR) was achieved in 15 (22%) patients. At a median follow-up of 22 (±3.5) months, 58 (81%) were alive with no recurrence, nine (12%) were alive with evidence of disease, and five (7%) were dead. None of the patients achieving pCR has developed any relapse. The median overall survival has not been reached for all 72 patients with a projected 3-year survival (±SE) of 90% (±4%). The median progression-free survival (PFS) was 42.1 (±4.8) months with a projected PFS of 74%±7% at 3-years (for 68 patients). Conclusions.PC regimen in LABC produced a high pCR. The contribution of the other added modalities to survival could not be assessed.     

紫杉醇联合顺铂治疗复发性宫颈癌的临床观察

Objective： To observe the efficacy and toxicities of paclitaxel plus cisplatin in the treatment of recurrent cervical cancer. Methods： Twenty-three patients with a diagnosis of recurrent cervical cancer were eligible. Three-weekly chemotherapy regimen consisted of paclitaxel 135-150 mg/m^2 infusion for 3 h on day 1, cisplatin 25 mg/m^2 infusion on day 1 to 3. All patients received at least two cycles treatment. Results： The response rates was 47.8%, including CR 2 cases （8.7%）, PR 9 cases （39.1%）. The major toxicity included neutropenia, nausea vomiting, arthralgia, myalgia and alopecia. Conclusion： Paclitaxel combined with cisplatin is an effective therapy with acceptable adverse reactions for recurrent cervical cancer.     

局部晚期子宫颈癌新辅助化疗疗效分析

目的 探讨Ⅰb2~Ⅱb期子宫颈癌新辅助化疗的疗效.方法 回顾性分析手术治疗的84例Ⅰb2~Ⅱb期子宫颈癌患者的病历资料,患者术前均行1~3次静脉或动脉化疗,通过比较和分析化疗前后病灶进展情况、血清鳞状细胞癌抗原(SCC-Ag)值以及术后的总生存率和3年无病生存率,进而评价新辅助化疗的疗效.结果 84例患者化疗有效率为82.1%,完全缓解5例,部分缓解64例,病情稳定13例,疾病进展2例;化疗效果与临床分期、病理类型、肿瘤大小均无关(P﹥0.05);新辅助化疗后患者SCC-Ag水平明显下降(P﹤0.001);随访患者3年总生存率及无病生存率均为93%.结论 子宫颈癌新辅助化疗安全有效,可以有效缩小病灶,提高患者的预后,具有重要的临床意义.     

新辅助化疗方案联合手术治疗晚期宫颈癌的效果及安全性探讨

目的 探讨新辅助化疗(NACT)紫杉醇联合顺铂(TP)治疗晚期宫颈癌的临床效果及安全性.方法 收集晚期宫颈癌患者67例作为研究对象,根据手术前新辅助化疗方案分为化疗组37例和对照组30例,化疔组给予1～2个疗程的TP化疗方案治疗后实施广泛子宫切除+盆腔淋巴结清扫术,对照组给予顺铂60 mg+氟脲苷500 mg+亚叶酸钙300 mg+多柔比星30 mg化疗及上述手术治疗.比较两组疗效及生存时间.结果 两组患者在经过1～2个周期的化疗方案治疗后(手术前),化疗组的有效率为54.05％,对照组的有效率为43.33％,两组比较,差异无统计学意义(P＞0.05);化疗组的盆腔淋巴结转移率13.51％、宫旁累及率2.70％、脉管浸润率5.41％、切缘阳性率2.70％均低于对照组,差异有统计学意义(P＜0.05);两组患者的化疗不良反应比较,差异无统计学意义(P＞0.05):化疗组的3年生存率64.86％(24/37)与对照组的43.33％(13/40)比较,差异无统计学意义(P＞0.05);化疗组的3年中位生存期为33.8个月,高于对照组的28.6个月,差异有统计学意义(P＜0.05).结论 晚期宫颈癌患者手术前采用TP化疗方案治疗能够降低淋巴结转移率,缩小病灶范围,延长患者的远期生存时间.     

Phase II study of neoadjuvant paclitaxel and cisplatin for operable and locally advanced breast cancer: analysis of 126 patients

In an earlier study, we have demonstrated a high clinical and pathologic response rate of neoadjuvant paclitaxel (P) and cisplatin (C) for patients with locally advanced breast cancer (LABC). The current phase II study includes larger number of patients who had longer follow-up. A total of 126 consecutive patients with noninflammatory LABC (T2 >4 cm, T3 or T4, N0-N3, M0) were included in the study. Patients were scheduled to receive three to four cycles of the neoadjuvant PC (paclitaxel 135 mg m(-2) and cisplatin 75 mg m(-2) on day 1) every 21 days. Patients were then subjected to surgery and subsequently received six cycles of FAC (5-fluorouracil 500 mg m(-2), doxorubicin 50 mg m(-2), and cyclophosphamide 500 mg m(-2)) or four cycles of AC (doxorubicin 60 mg m(-2) and cyclophosphamide 600 mg m(-2)); all drugs were administered intravenously on day 1 with cycles repeated every 21 days. Patients then received radiation therapy, and those with hormone receptor-positive tumours were given adjuvant tamoxifen intended for 5 years. The median age was 41 years. Clinically, 12, 52, and 37% of patients had T2 >4 cm, T3, and T4, respectively. The mean tumour size was 7 cm (95% CI, 7.3-8.5). The clinical nodal status was N0, N1, and N2-N3 in 32, 52, and 17% of patients, respectively. Disease stage at diagnosis was IIA (2%), IIB (32%), IIIA (28%), and IIIB (39%). Clinical assessment of the primary tumour and the axillary nodal status after primary chemotherapy showed that 35 patients (28%) achieved complete response (cCR), while 80 (63%) demonstrated partial response to PC. Of patients with evaluable pathologic data of the primary tumour (123 patients), complete pathologic response (pCR) was achieved in 29 patients (24%), and an additional nine (7%) only had a microinvasive disease. Moreover, 20 of the 122 patients (16%) had no residual disease in the primary tumour or in the axillary nodes. Failure to attain cCR predicted failure to achieve pCR. At a median follow-up of 37.5 months (95% CI, 31.5-43.3), 71% were alive with no recurrence, 16% were alive with evidence of disease, and 13% were dead. Of the 122 patients who had surgery, 36 (29%) developed recurrence including one of the patients who attained pCR. The median overall or disease-free survival has not been reached with a projected 5-year overall survival (OS) and disease-free survival (DFS) of 85% (+/-4%) and 63% (+/-5%), respectively. On multivariate analysis, clinical response of the primary tumour, pathological response of the primary tumour, and the pathological nodal status were identified as independent prognostic variables for DFS. No variable, however, was identified to prognosticate OS. PC was acceptably safe. Neoadjuvant PC as used in this phase II study in a multidisciplinary strategy was highly effective. Clinical and pathologic responses remain the most important variables that predict outcome.     

A phase II study of gemcitabine and cisplatin combination as induction chemotherapy for untreated locally advanced cervical carcinoma

Background:Cisplatin-based chemoradiation for locally advanced cervical carcinoma is now the standard of care for most patients with cervical carcinoma. However, induction chemotherapy followed by surgery, particularly with newer agents or combinations remains to be explored. This study was undertaken to evaluate the antitumor activity and toxicity of gemcitabine in combination with cisplatin for untreated locally advanced cervical carcinoma. Patients and methods:Open-label, single center, phase II, non-randomized study of neoadjuvant gemcitabine plus cisplatin. Forty-one patients with histologic diagnosis of cervical carcinoma, with no previous treatment and staged as IB2 to IIIB, were treated with three 21-day courses of cisplatin 100 mg/m² day 1 and gemcitabine 1000 mg/m² days 1 and 8, followed by locoregional treatment with either surgery or concomitant chemoradiation. Response and toxicity were evaluated before each course and at the end of chemotherapy. Results:All patients were evaluated for toxicity and 40 for response. The overall objective response rate was 95% (95% confidence interval (CI): 88%–100%) being complete in 3 patients (7.5%) and partial in 35 (87.5%). A complete pathological response was found in 6 (26%) of the 23 patients that underwent surgery. Granulocytopenia grades 3–4 occurred in 13.8% and 3.4% of the courses, respectively, whereas non-hematological toxicity was mild. Conclusions:Induction chemotherapy with the combination of gemcitabine and cisplatin is highly active for untreated cervical cancer patients and has an acceptable toxicity profile.     

新辅助化疗联合宫颈癌根治术治疗局部晚期宫颈癌的疗效及安全性分析

目的:研究多西他赛+奈达铂的新辅助化疗联合宫颈癌根治术治疗局部晚期宫颈癌的疗效及安全性。方法:收集自2014年1月至2019年10月就诊于陕西省肿瘤医院的248例局部晚期宫颈癌患者的临床资料进行回顾性分析,接受新辅助化疗联合宫颈癌根治术治疗的患者为观察组,只接受宫颈癌根治术的患者为对照组,每组124例。结果:两组患者年龄、体质量指数（BMI）、临床分期、病理分型、初治时肿瘤直径等一般临床资料比较,差异无统计学意义（P＞0.05）,两组具有可比性。平均新辅助化疗次数1.30次,新辅助化疗后肿瘤的体积明显缩小。观察组手术时间更短、术中出血量更少并且手术并发症发生率也降低（P＜0.05）,淋巴结清扫数量、阴道切除长度均无统计学差异（P＞0.05）。术后两组平均化疗次数及化疗不良反应发生率相比未见统计学差异（P＞0.05）。结论:多西他赛+奈达铂的新辅助化疗能够显著缩小宫颈肿瘤体积、降低手术难度、缩短手术时间、减少术中出血量、减低手术并发症发生率,而且在提高临床疗效的同时不增加不良反应发生率。     

Combination therapy with irinotecan and cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer.

To evaluate the response rate and toxicity of the combination of irinotecan (CPT-11) and cisplatin in a neoadjuvant setting, a phase II study was conducted regarding the regimen of this combination in patients with locally advanced cervical cancer. Eligibility included patients with previously untreated stage Ib2, IIb, or IIIb squamous cell carcinoma with good performance status. CPT-11 (60 mg m(-2)) was administered intravenously on days 1, 8 and 15, followed by cisplatin (60 mg m(-2)) given intravenously on day 1. Treatment was repeated every 4 weeks for a total of two or three cycles. Among 23 eligible patients (median age: 59 years), three showed complete response (13%), 15 showed partial response (65%), for an overall response rate of 78% (95% confidence interval 58-90%). Stable disease was observed in four cases (17%) and progressive disease in one (4%). The median time to failure and median survival time have not yet been reached. Of the 52 treatment cycles administered, diarrhoea and grade 3 or 4 neutropenia were observed in 10% and 75% respectively. There were no therapy-related deaths. The combination of CPT-11 with cisplatin is a promising regimen for neoadjuvant chemotherapy in locally advanced cervical cancer. The toxicities of this regimen are well tolerated.