子宫颈癌新辅助化疗中不同化疗途径的疗效比较

目的观察新辅助化疗不同化疗途径对巨块型(肿瘤直径≥4cm)或局部晚期子宫颈癌的疗效及毒副反应比较。方法回顾性分析1997年9月至2003年9月四川大学华西第二医院收治的174例巨块型或局部晚期子宫颈癌患者的临床病理资料,根据化疗途径的不同分为两组,动脉介入化疗(动脉化疗组)69例及静脉化疗(静脉化疗组) 105例,并对两组的毒副反应和疗效进行比较。结果动脉化疗组中,化疗有效率为81%,化疗后手术率为67%。静脉化疗组中,化疗有效率为83%,化疗后手术率为70%,两组分别比较,差异均无统计学意义(P>0 05)。化疗期间未发现不能耐受的毒副反应。动脉化疗组3、5年生存率分别为76%、70%;静脉化疗组3、5年生存率分别为78%、71%,两组分别比较,差异均无统计学意义(P>0 05)。结论新辅助化疗对巨块型或局部晚期子宫颈癌治疗是安全有效的。静脉化疗使用简便、经济,无需特殊设备,有较大的临床应用价值。

Comparison of therapeutical effect between arterial interventional chemotherapy and venous chemotherapy on bulky or locally advanced cervical cancer

Objective To investigate the therapeutical effect of arterial interventional chemotherapy and venous chemotherapy on bulky or locally advanced cervical cancer. Methods A retrospective study was carried out on 174 patients with bulky or locally advanced cervical cancers admitted to our hospital from Sept 1997 to Sept 2003. The therapeutical, toxic and adverse effects of either arterial interventional or venous chemotherapy were analyzed and compared. Results Among those 174 patients, 69 were given arterial interventional chemotherapy. Patients with cervical adenocarcinoma received cisplatin, fluorouracil, mitomycin C, and patients with squamous carcinoma of cervix were treated with bleomycin, cisplatin. The effective rate was 81%, and the rate of surgery after chemotherapy was 67%. While in the venous chemotherapy group, 105 patients were treated with the same chemotherapeutical schemes and doses as in arterial interventional chemotherapy group. The effective rate was 83% and the rate of surgery after chemotherapy was 70%. The differences between these two groups showed no significance (P>0.05). No intolerable toxic and adverse effects were noticed during neoadjuvant chemotherapy. The 3-and 5-year survival rates of arterial interventional chemotherapy group were 76%, 70% respectively, and those of venous chemotherapy group were 78%, 71% respectively, without significant difference (P>0.05). Conclusions Neoadjuvant chemotherapy is a safe and effective means for treating patients with bulky or locally advanced cervical cancer. The therapeutical effects of venous and arterial interventional chemotherapy are similar. And no intolerable toxic and adverse effects were noticed during neoadjuvant chemotherapy. Venous administration is easy and inexpensive and less demanding for special equipments. It shows promising prospect in clinical application.