早中期巨块型子宫颈癌术前同步放化疗的临床研究

 目的 研究早中期巨块型子宫颈癌进行同步放化疗（CCR）后再接受根治性手术治疗的可行性和疗效，分析影响有残余肿瘤患者的预后因素。方法 随机选取了2001年1月至2003年9月Ⅰb2、Ⅱa、Ⅱb巨块型（宫旁内1／3受浸）子宫颈癌35例，子宫颈肿瘤≥4 cm，手术前10 MV X线全盆前后野常规放疗，总剂量3060 cGy17次；在放疗开始的前96 h和最后96 h，用5-氟尿嘧啶（5-Fu） 4 g静脉滴注，在放疗第1、8、15、22天分别用顺铂（DDP）20 mg／m2静脉滴注；休息4周，接受根治性子宫切除和盆腔淋巴结清扫术。结果 35例临床完全缓解（CR）率54.29 %，临床部分缓解（PR）率31.43 %，临床总有效率（CR+PR）85.71 %。手术后病理显示子宫颈标本中无残余肿瘤16例，有残余肿瘤19例，病理CR率45.71 %。35例3年总生存率为87.14 %。同步放化疗后有残余肿瘤患者的3年生存率为76.32 %，明显低于无残余肿瘤患者，3年生存率为100.00 %（P = 0.0358）；手术后病理显示浸润至浅肌层和浸润至外膜者3年生存率分别为100.00 %、41.67 %（P = 0.0109），差异有统计学意义；有脉管瘤栓与无脉管瘤栓者3年生存率分别为0和85.29 ％，差异有统计学意义（P＝0.0148）。结论 术前全盆外照射加同步化疗治疗巨块型早中期子宫颈癌近期疗效较好，并发症可耐受；肿瘤残余情况是影响预后的重要因素，并为手术后的个体化治疗提供了信息。

Preoperation concurrent radiation therapy and chemotherapy for operable bulky carcinomas of uterine cervix stages Ⅰ and Ⅱ with proximal parametrial invasion

Objective To investigate the feasibility and efficacy of combined preoperative chemora－diation program followed by radical surgery in bulky early or moderate uterine cervical cancer. To determine the incidence and predictive value of rasidual disease in the radical hysterectomy specimens after CCR. Methods Thirty-five patients with uterine cervix carcinoma from January 2001 to September 2003 were treated with preoperative external beam radiotherapy to 3060 cGy in 4 weeks. Patients received concurrent continuous infusion cisplatin (20 mg/m2) on day 1, 8, 15, 22 of four weeks and 5-Fu(4 g) chemotherapy during the first four days and the last four days of the radiation course. Radical surgery was not performed until 4 weeks after the completion of the preoperative treatment. Results Clinical response was 85.71 %, complete response, 54.29 %; partial response, 31.43 %. The analysis of the surgical specimens showed 19 patients had revealed residual disease and 16 patients had revealed no residual disease, the complete pathological response hed been 45.71 %. Three-year survival rate was 87.14 % in 35 patients. Three-year survival rate of residual disease patients (76.32 %) was significantly lower than that of no residual disease (100.0 %) (P =0.0358). Three-year survival of cervical stromal invasion less than 1/2 and invasion extra stromal was 100.0 %, 41.67 % respectively (P =0.0109); three-year survival of lymph-vascular space involvement and no lymph-vascula space involvement was 0, 85.29 %, respectively(P =0.0148). Conclusion Combined preoperative chemoradiation program followed by radical surgery in bulky early or moderate cervical cancer could reveal an effective efficacy with a tolerant complication. Residual disease is an independent and strong predictive factor.