论文部分内容阅读
目的观察新辅助介入化疗对巨块型子宫颈癌的作用。方法对1999年1月至2004年12月收治的126例巨块型子宫颈癌患者,随机分为2组,介入组74例,采用Seldinger技术髂内动脉插管注药。鳞癌采用顺铂+博莱霉素+长春新碱(PVB)方案,腺癌采用顺铂+多柔比星+长春新碱(PAB)方案。放疗组52例,按照宫颈癌放疗常规用6MeV加速器行全盆腔体外照射,总剂量24Gy,中间档野后继续照25Gy,穿插192Ir后装腔内放疗,每周2次,每次A点剂量5Gy,总剂量40Gy。两组患者术后2周决定下一步治疗。结果介入化疗组肿块消退(CR)12例(12/74),占16.21%,肿块缩小≥50%(PR)57例(57/74),占77.02%。适宜Ⅱ期手术67例(67/74),占90.54%;放疗组CR6例(6/52),占11.53%;PR31例(31/52),占59.61%。适宜Ⅱ期手术37例,占71.15%(37/52)。两组比较,PR、2期手术率差异有统计学意义。介入化疗2年复发率6%,3年复发率8%;放疗组2年复发率8%,3年复发率23%;介入组3年总生存率79%,放疗组3年总生存率71%。两组2年复发率与3年总生存率比较,无统计学意义(P>0.05);3年复发率差异有统计学意义(P<0.05)。结论新辅助介入化疗可有效缩小肿瘤,增加Ⅱ期手术率,减少3年复发率,能否减低5年复发率、增加5年生存率,有待进一步随访。
Objective To observe the effect of neoadjuvant chemotherapy on massive cervical cancer. Methods One hundred and sixty-six patients with massive cervical cancer who were admitted from January 1999 to December 2004 were randomly divided into two groups. The intervention group included 74 patients. The drug was infused through the internal iliac artery by Seldinger technique. Squamous cell carcinoma with cisplatin + bleomycin + vincristine (PVB) program, adenocarcinoma with cisplatin + doxorubicin + vincristine (PAB) program. Radiotherapy group of 52 cases, according to the conventional radiotherapy of cervical cancer with 6MeV accelerator in the whole pelvis external irradiation, the total dose of 24Gy, intermediate file field continue to follow the 25Gy, interspersed with 192Ir after insertion of intracavitary radiotherapy twice a week, each dose of A point 5Gy , The total dose of 40Gy. Two groups of patients decide the next step after 2 weeks. Results In interventional chemotherapy group, there were 12 cases (12/74) of remission (CR), accounting for 16.21%, 57 cases (57/74) in ≥ 50% (PR), accounting for 77.02%. 67 cases (67/74) were suitable for stage Ⅱ operation, accounting for 90.54%; 6 cases (6/52) were CR in radiotherapy group, accounting for 11.53%; PR31 cases (31/52) accounting for 59.61%. Appropriate for stage Ⅱ operation in 37 cases, accounting for 71.15% (37/52). The two groups, PR, 2 surgical rate difference was statistically significant. The 2-year recurrence rate was 6%, the 3-year recurrence rate was 8%. The 2-year recurrence rate was 8% and the 3-year recurrence rate was 23% in the radiotherapy group. The 3-year overall survival rate was 79% in the intervention group and 3 years in the radiotherapy group. %. There was no significant difference between the 2-year relapse rate and 3-year overall survival rate (P> 0.05). The 3-year relapse rate had statistical significance (P <0.05). Conclusion Neoadjuvant intervention chemotherapy can effectively reduce the tumor, increase the operation rate of stage Ⅱ, reduce the recurrence rate of 3 years, reduce the 5-year recurrence rate and increase the 5-year survival rate for further follow-up.