介入化疗联合根治术治疗局部晚期宫颈癌的疗效

目的评价术前介入化疗联合根治术治疗局部晚期宫颈癌的可行性和疗效。方法59例确诊为局部晚期宫颈癌的患者，采用Seldinger′s法股动脉穿刺插管进行盆腔介入化疗，药物为DDP80mg、5?Fu1500mg、AT125860mg。阴道B超和CT测量化疗前后的肿瘤大小，计算肿瘤消退百分比。经1～3个疗程后行根治性子宫切除和盆腔淋巴清扫术。术后根据病理检查，如有盆腔淋巴结转移、宫旁组织浸润、脉管内有瘤栓或阴道切缘(+)者都给予术后补充外放射治疗。结果化疗总疗程数122次(1～3次/每个病人)，化疗总有效率为95%，其中18例完全缓解(占31%)，38例部分缓解(占64%)，3例无变化，没有病例发生疾病进展。59例中共有14例发现术后盆腔淋巴结转移(占24%)，且均为化疗部分缓解者和无变化者，临床完全缓解者中无一例发生淋巴结转移。18例临床完全缓解者17例无复发，仅1例lla期于术后20月阴道复发，后经综合治疗病灶也消失，18例均无瘤生存。38例部分消退者中3例死亡。3例化疗无效者均已死亡。59例均未发生严重的与化疗和手术相关的并发症。结论术前介入化疗可缩小肿瘤病灶，减少淋巴结转移和亚临床播散。不但方法可行，而且有望提高局部晚期宫颈癌的生存率。

Intraarterial Chemotherapy Followed by Radical Hysterectomy for Locally Advanced Cervical Cancer

Purpose To evaluate the curative effect and possibility of the intraarterial chemotherapy followed by radical hysterectomy for locally advanced cervical cancer. Methods 59 patients with FIGO stage lb lV cervical cancer were enrolled and the tumor size with stage lb and lla must be more than 4 cm.Treatment consisted of bilateral internal iliac artery infusion of cisplatin 80 mg,5 Fu 1 500 mg,and AT1258 60 mg for 1-3 courses separated by 3 weeks.The tumor size was measured by vagina ultrasonic and CT before and after chemotherapy to calculate the shrunk size percent.All patients underwent radical hysterectomy.Patients with disease in the vagina,parametrium,pelvic lymphnodes or microscopic tumor emboli were followed postoperative pelvic irradiation. Results 59 patients underwent 122 courses of intraarterial chemotherapy for 1-3 courses each.The total response rate was 95%.Complete response (CR) was achieved in 18 of 59 patients (31%),while a partial response (PR) was noted in 38 (64%) and stable disease (SD) in 3 (5%).No patient had progressive disease.14 patients with pelvic lymphnode metastasis were all found to have PR and SD.No patient had lymphnode metastasis in CR.Of 18 patients with CR,17 patients had not recurrence.Only one patient with stage lla recurred 20 months after operation.But he also cured.All 18 patients with CR were living free of disease.But 3 in 38 patients with PR died and 3 patients with SD were all died.There were no severe complications related to intraarterial chemotherapy and radical hysterectomy. Conclusions lntraarterial chemotherapy before operation can shrink tumor size,decrease the lymphnode metastasis.It is feasible in helping elevating cure rate of patients with locally advanced cervical cancer who are at high risk for failure with conventional treatment.