局部晚期宫颈腺癌新辅助化疗方式探讨

目的：探讨不同用药途径的新辅助化疗对局部晚期宫颈腺癌的疗效,寻找更安全、有效的化疗方法。方法：回顾性分析我院2006年1月-2009年12月期间收治的58例经手术治疗的局部晚期宫颈腺癌,根据新辅助化疗方式不同分为新辅助动脉化疗（neoadjuvant intra-arterial chemotherapy,NAIC）28例和新辅助化疗（neoadjuvant chemotherapy,NACT）30例。NAIC组采用紫杉醇脂质体、博来霉素、顺铂方案,NACT组采用紫杉醇脂质体、顺铂方案化疗,两组均1-2个疗程后行手术,对比两组化疗后肿瘤退缩及术后病理情况。结果：两组化疗有效率差异无显著性（P〉0.05）,NAIC组组织学痊愈率明显高于NACT组（P〈0.05）。NAIC组在宫旁浸润和脉管癌栓的发生率明显低于NACT组（P〈0.05）;NAIC组淋巴结阳性率低于NACT组但无统计学差异（P〉0.05）。两组术后均无阴道切缘阳性病例。两组化疗不良反应差异无显著性（P〉0.05）。结论：新辅助动脉化疗对局部晚期宫颈腺癌产生的组织学痊愈率明显高于静脉化疗,可以减少宫旁浸润和脉管癌栓的发生率,是值得推广的新辅助化疗方式。

Treatment methods of neoadjuvant chemotherapy for locally advanced cervical adenocarcinoma

Objective：To compare the effect of neoadjuvant intra-arterial chemotherapy and neoadjuvant chemotherapy,to search more effective chemotherapy methods.Methods： Retrospectievely analyzed 58 patients with locally advanced cervical adenocarcinoma in our hospital from January 2006 to December 2009,all patients were divided into two groups,28 patients in NAIC group were treated by neoadjuvant intra-arterial chemotherapy with paclitaxel liposome,bleomycin plus cisplatin for 2 cycles followed by radical hysterectomy and lymphadenectomy,30 patients in NACT group were treated by neoadjuvant chemotherapy with paclitaxel liposome and cisplatin for 2 cycles followed by the same operation.To compare the regress rate of tumor,pathologic change of two groups.Results： There was no significant difference in the effective rate of NAIC group and NACT group（P〈0.05）.The rate of histologic healed in NAIC group was more than that of in NACT group（P〈0.05）.The rate of parametrial involvement and vascular involvement in NAIC group was lower than those of in NACT group（P〈0.05）.The rate of lymphnode involvement in NACI group was lower than that in NACT group,but there was no significant difference（P〈0.05）.There was no positive surgical vagina margin in two groups.The side effect had no significant difference between two groups（P〈0.05）.Conclusion： The rate of histologic healed in NAIC group was more than that in NACT group.NAIC with TBP was an effective method to locally advanced cervical adenocarcinoma,which could decrease the primary tumor volume,the rate of parametrical involvement and the rate of vascular involvement.