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1、宫颈癌术前新辅助化疗探讨研究生:杨筱导师:彭芝兰教授中文摘要目的:探讨宫颈癌术前新辅助化疗(NeoadjuvantChemotherapy,NACT)对于改善宫颈癌患者近期疗效与远期预后的作用。方法:1991一2001年间四川大学华西第二医院行宫颈癌根治手术(广泛子宫切除术+淋巴结清扫术)的患者619例,纳入其中巨块型宫颈癌(宫颈局部癌灶直径大于4cm)的IB-IIIB期患者228例,按治疗方法分为3组;ONACT+S组:术前接受BP方案(BLM+DDP)的新辅助化疗的患者(n=63),②RT+S组:术前给予放疗的
2、患者(n=11),OS组:同期单纯手术患者(n=154),②③两组为对照组。观察指标:1、术前NACT对宫颈癌的疗效;2、三组患者术后病理分期与术前临床分期间的差异,切缘阳性率及淋巴结转移率;3、三组患者手术质量相关情况:手术失血量、术后并发症、术后尿管留置时间;4、三组患者的五年生存率。结果:NACT对巨块型宫颈癌有良好的疗效(CR+PR=83Yo),且动脉介入化疗与静脉全身化疗的疗效没有明显差别;NACT十S组在降低分期方面优于RT+S组及S组(P<0.05);切缘阳性率及淋巴结转移率低于RT+S组及S组,但差
3、别无统计学意义(P>0.05);手术质量相关因素比较:NACT+S组手术失血量、术后留置尿管时间均低于S组〔P<0.05),与RT+S组的差别无统计学意义(P>0,05);术后并发症低于RT+S组及S组,但差别无统计学意义(P>0.05);所有化疗病例均未出现不能耐受的毒副作用;三组患者之间五年生存率无明显统计学差异(P>0.05).结论:1,BP方案的新辅助化疗对巨块型宫颈癌安全而有效;2、新辅助化疗降分期的作用确切;3、新辅助化疗有助于改善手术质量;4,尚不能证明新辅助化疗对于宫颈癌患者的五年生存率有改善的作用
4、。关键词宫颈癌化学疗法广泛子宫切除术放射疗注Pre-operativeNeoadjuvantChemotherapyFollowedbyRadicalSurgeryintheTreatmentofCervicalCarcinoma尸ostgraduateYangXiaoProfessorPengZhilanAbstractOBJECTIVE:ToinvestigatetheefectofNeoadjuvantChemotherapy(NACT)oncervicalcarcinoma.METHODS:Among619
5、patientsexperiencedradicalsurgery(radicalhysterectomy+lymphadenectomy)forcervicalcarcinoma,228patientswithdiameteroflocallesions>4cmandstage(FIGO)fromIB-111Bwereincludedinourstudy.Patientsweredividedinto3groupsaccordingtodiferenttreatments:1)NACT+Sgroup(n=63):
6、patientsacceptedNACTwithBleomycinandCisplatin,2)RT+Sgroup(n=11):patientsunderwentprimaryradiotherapy,2)Sgroup(n=154):patientswenttoradicalsurgerydirectly.Theresponserateoftumor,downstagingefect,lymphnodemetastasisandtumorpositiverateoftheincisalmarginwereobser
7、ved;Andwealsocomparedtheoperativequalityrelatingfactorsandfive-yearsurvivalrateamongthethreegroups;ThesideefectsoftheNACTwerereviewed,too.RESULTS:TheresponseratetoNACTissatisfying(CR+PR=83%);ThedownstagingeffectofNACTisconfirmed(P<0.05);Asfarasfactorsrelatedto
8、surgeryqualityareconcerned,NACT+SgroupissuperiortoSgroupandRT+Sgrouponthewhole;AndthereisnoseveresideeffectresultedfromNAC又Whencometofive-yearsurvivalrate,thereisnodiferencewithsta