同步放化疗与单纯放疗对中晚期宫颈癌患者的有效性及安全性比较

目的 与单纯放疗对比,研究同步放化疗对中晚期宫颈癌有效性、安全性及预后的影响,并以肿瘤组织P53及Bax表达水平为着手点,探讨其疗效。 方法 选取2009年1月-2013年1月杭州市萧山区第一人民医院收治的单纯放疗的中晚期(Ⅱb~Ⅳ期)宫颈癌患者65例为对照组,采用外照射+腔内照射;选择同期、相同条件的65例同步放化疗患者为观察组,放疗方案同对照组,同时联合PF方案进行化疗,每隔3周化疗一次,化疗3次。比较2组近期疗效(近3个月)、不良反应发生率、预后情况(3年生存率、5年生存率、局部复发率、远处转移率),并对比分析治疗前后P53及Bax的表达情况。 结果 观察组有效率高于对照组有效率(63.1% vs. 43.1%,P<0.05);观察组3年、5年生存率分别为78.5%和63.1%,高于对照组的61.5%和40.0%(均P<0.05);观察组局部复发率和远处转移率分别为30.8%和23.1%,低于对照组的47.7%和43.1%(均P<0.05);观察组骨髓抑制和胃肠道反应发生率明显高于对照组(均P<0.05);2组肝肾功能损伤、放射性直肠炎、放射性膀胱炎发生率差异无统计学意义(均P>0.05),对于不良反应患者均可耐受,并未明显影响治疗;治疗后2组患者的P53及Bax阳性率均出现上升,其中观察组上升幅度高于对照组(P<0.05)。 结论 与单纯放疗对比,同步放化疗可提高治疗中晚期宫颈癌的有效性,改善患者预后情况,虽然毒副反应发生率较高,但经积极处理,患者均可耐受;其疗效发挥机制可能与上调Bax的表达并抑制P53突变有关,从而改善放化疗敏感性。 

Comparison on efficacy and safety of concurrent chemoradiotherapy versus radiotherapy alone in patients with middle or late stage cervical cancer

Objective The effect of concurrent chemoradiotherapy on the efficacy, safety and prognosis of advanced cervical cancer was studied comparing with radiotherapy alone. The expression levels of p53 and Bax in tumor tissues were taken as the starting point to discuss the curative effect. Methods Sixty-five patients with advanced cervical cancer (stage Ⅱb~Ⅳ) who were treated by radiotherapy alone in January, 2009 January, 2013 were selected as control group. Sixty-five patients of concurrent chemoradiotherapy were selected for the same period and the same condition as the observation group. The radiotherapy scheme was the same as the control group. The chemotherapy was combined with the PF regimen, 1 times every 3 weeks, and the chemotherapy was 3 times. The short-term effect (nearly 3 months), the incidence of adverse reactions, the prognosis (3, 5 years, local recurrence, distant metastasis) were compared between the 2 groups, and the expression of P53 and Bax before and after the treatment were compared and analyzed. Results The effective rate of the observation group was higher than that of the control group (63.1% to 43.1%, P<0.05). The 3-and 5-year survival rates in the observation group were 78.5% and 63.1%, respectively, higher than those in the control group 61.5% and 40.0% (P<0.05). The local recurrence rate and distant metastasis rate in the observation group were 30.8% and 23.1% respectively, lower than those in the control group 47.7% and 43.1% (P<0.05). The incidence of bone marrow suppression and gastrointestinal reactions in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of liver and kidney function injury, radiation proctitis and radiation cystitis in the two groups (P>0.05), which could be tolerated in patients with adverse reactions and did not significantly affect the treatment. After the treatment, the positive rates of P53 and Bax in the two groups increased, and the increase in the observation group was higher than that in the control group (P<0.05). Conclusion Compared with radiotherapy alone, synchronous radiotherapy can improve the effectiveness of the treatment of advanced cervical cancer and improve the prognosis of patients. Although the incidence of toxic and side effects is high, the patient can be tolerated after active treatment. The mechanism may be related to the up-regulation of the expression of Bax and the inhibition of P53 process, thus improving the chemosensitivity of the patients.