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,应用抽签法随机分为新辅助化疗组41例、对照组38例.新辅助化疗组患者,术前采用顺铂+氟脲嘧啶静脉化疗方案(PF方案),化疗2～3个疗程后再行Ⅲ型子宫切除加盆腔淋巴结清扫术.对照组患者,入院后仅行Ⅲ型子宫切除加盆腔淋巴结清扫术.结果 新辅助化疗组41例患者中31例完成2个疗程化疗,10例患者完成3个疗程化疗,无一例患者因化疗副作用而停止化疗,其中完全缓解16例(39.02％),部分缓解18例(43.91％),稳定7例(17.07％),没有患者发生疾病进展,总有效率为82.93％.化疗后宫颈局部肿瘤平均直径缩小为2.71 cm,与化疗前的肿瘤平均直径5.14 cm相比差异有极显著性(P＜ 0.01).79例患者均进行Ⅲ型子宫切除加盆腔淋巴结清扫术,新辅助化疗组的手术时间为(123.7±47.9)分钟,与对照组的(154.2±83.7)分钟相比差异有显著性(P＜0.05);新辅助化疗组的术中出血量为(361.4±173.6) ml,与对照组的(547.8±295.3) ml相比差异有显著性(P＜0.05).术后病理检查发现,新辅助化疗组患者平均淋巴结转移率为2.75％(13/472),与对照组的21.53％(96/446)相比差异有极显著性(P＜0.01);宫旁浸润与脉管癌栓的发生率分别为4.88％(2/41)和7.32％(3/41),均显著低于对照组的23.68％(9/38)和31.58％(12/38),差异有极显著性(P＜0.01).结论 应用PF方案行新辅助化疗可明显缩小局部晚期宫颈癌病灶、缩短手术时间及减少术中出血,提高了手术效率,减少预后不良病理因素,是一种安全有效的治疗方法.%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.
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