子宫颈癌放疗前新辅助化疗的临床研究

目的 探讨新辅助化疗在宫颈癌治疗中的应用价值。方法 自1991年1月起山东省肿瘤医院开始进行放疗前新辅助化疗的临床前瞻性研究,选择1991年1月～2003年12月符合入组标准的宫颈癌患者共1609例,放疗前给予2个疗程联合化疗（A组）;另选择1989年1月-1990年12月接受单纯放疗的375例宫颈癌患者作对照（B组）。比较两组患者的近期控制情况、长期生存率及并发症的发生情况。结果 A组化疗2个疗程后总有效率为74．5％（1199／1609）,局部完全缓解率为1．6％（25／1609）。A组的3、5、10年生存率分别为90．3％（1017／1126）、75．3％（652／866）、59．0％（200／339）,其中临床分期Ⅱ期患者的5年生存率显著高于Ⅲ期者（P〈0．05）;而两者的3、10年生存率相近（P〉0．05）。B组的3、5、10年生存率分别为81．1％（304／375）、59．2％（222／375）、40．3％（151／375）,其中Ⅱ期患者的5、10年生存率均显著高于Ⅲ期者（P〈0．05）。A、B两组间5、10年生存率比较,差异均有统计学意义（P〈0．05）。A组宫颈腺癌患者的3、5、10年生存率均显著高于B组（P〈0．05）,且A组Ⅲ期患者的3、5年复发率及转移率明显低于B组（P〈0．05）;A组化疗屙的毒副反应主要为轻、中度消化道反应和骨髓抑制,经处理后均能恢复,其近期、远期放疗并发症发生率和B组比较,差异无统计学意义（P〉0．05）。结论 新辅助化疗对宫颈癌的治疗是安全有效的,能明显提高患者的近期疗效和长期生存率,特别是对于宫颈腺癌及临床晚期患者效果尤为显著。

Neoadjuvant chemotherapy before radiotherapy in treatment of patients with cervical carcinoma

OBJECTIVE: To study the value of neoadjuvant chemotherapy in treatment of cervical carcinoma. METHODS: A clinical prospective study was carried out from Jan 1991 to Dec 2003. Totally 1609 patients with cervical carcinoma were given two cycles of combined chemotherapy before radiotherapy (neoadjuvant chemotherapy group, group A). Another 375 patients who accepted radiotherapy alone in our hospital from Jan 1989 to Dec 1990 were chosen as the control group (group B). Short-term control rate, long-term survival rate and complications were observed and analyzed. RESULTS: In group A, after two cycles of neoadjuvant chemotherapy, the overall response rate was 74.5% (1199/1609), the complete response rate was 1.6% (25/1609). The survival rate of 3, 5 and 10-year was 90.3% (1017/1126), 75.3% (652/866), and 59.0% (200/339), respectively. Five-year survival rate in stage II was higher than that in stage III (P < 0.05), but 3-year and 10-year survival rate were not different between stages II and III (P > 0.05). In group B, 3, 5 and 10-year survival rate was 81.1% (304/375), 59.2% (222/375), and 40.3% (151/375), respectively. The 5-year and 10-year survival rate was significantly higher in stage II than that in stage III (P < 0.05). The 5 and 10-year survival rate was significantly higher in group A than that in group B (P < 0.05). The 3, 5 and 10-year survival rate of patients with adenocarcinoma in group A was obviously higher than that in group B (P < 0.05), and the 3 and 5-year recurrent and metastatic rate was significantly lower in group A than that in group B (P < 0.05). In group A, the short-term toxicity and side-effect of neoadjuvant chemotherapy were mainly slight and moderate, and the short-term and long-term radiation complications had no obvious difference between two groups (P > 0.05). CONCLUSIONS: Neoadjuvant chemotherapy is a safe and effective method for the treatment of cervical carcinoma. Because of satisfactory short-term control rate and high long-term survival rate, neoadjuvant chemotherapy should be popularized in clinical treatment, especially in those patients with adenocarcinoma and in patients at clinically advanced stage of cervical carcinoma.