新辅助化疗在局部晚期宫颈癌治疗中的作用

目的 本研究拟探索新辅助化疗(neoadjuvant chemotherapy,NACT)治疗局部晚期宫颈癌的方法,评价其对局部晚期宫颈癌的治疗效果及对根治性手术的价值.方法 选择1997年1月-2006年2月间,在广东省人民医院妇科通过病理及临床确诊为Ⅰ B2～ⅡA期、局部肿瘤直径＞ 4cm的局部晚期宫颈癌患者79例...

Efficancy of neoadjuvant chemotherapy on locally advanced cervical cancer

Objective To study and evaluate the regimens and efficancy ot neoadjuvant chemotherapy (NACT) on locally advanced cervical cancer,which is hard to be controlled.The patients are likely to develop lymphatic or distant metastasis,with a poor prognosis.Methods A total of 79 patients with FIGO stage Ⅰ B2- Ⅱ A locally advanced cervical cancer with tumor size bigger than 4 cm were enrolled and randomized into NACT group (n=41) and control group (n=38).Before type Ⅲ radical hysterectomy and pelvic lymphadenectomy,all patients of the NACT group were treated with 2-3 courses of chemotherapy consisting of cisplatin intravenous infusion (75 mg/m2) on day 1,and 5-fluorouracil (1000mg/m2/d) intravenous infusion continuously for 4 days from day 1.Results The average courses of 41patients were 2.24 in NACT group.Complete response (CR) was achieved in 15 of 41 patients (39.02％),while partial response (PR) was noted in 18 and stable disease (SD) in 7,no patient had progressive disease (PD).The overall response rate was 82.93％.The average tumor size (2.74 cm) after NACT reduced significantly (P ＜ 0.01).Radical hysterectomy and bilateral pelvic lymphadenectomy was performed successfully in 79 patients.In study group,the operation duration of NACT group was (123.7 ± 47.9) minutes,while the control group was (154.2 ± 83.7) minutes ( P ＜ 0.05 ); the amount of bleeding was (361.4 ±173.6) ml in NACT group,and the control group was (547.8 ± 295.3) ml,reducing significantly(P ＜ 0.05).Pathological examination revealed that the ratio of the pelvic lymphatic metastasis (2.75％),positive surgical margin (4.88％) and the rate of vascular embolus (7.32％) were significantly (P ＜ 0.01) lower than those of control group (21.53％,23.68％,31.58％) respectively.Conclusion The NACT can shrink tumor size of locally advanced cervical cancer significantly.NACT can apparently increase the possibility of resection by operation and decrease the harmful factors of prognosis.It is a simple,effective and safe method for the locally advanced cervical cancer treatment.