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目的探讨早期高危宫颈癌术后不同时间辅助放化疗的有效性及安全性。方法回顾分析107例早期宫颈癌术后具有高危因素的患者,根据其术后开始同步放化疗的时间将其分为3组,A组≤3周,3周7周。化疗每3周一次,共4周期。方案:紫杉醇+顺铂。放疗于化疗第一疗程结束日开始,采用6MV X线盆腔前后矩形野对照,髂总淋巴结阳性者加腹主动脉旁野,盆腔中心剂量DT 4500~5000 cGy。结果骨髓抑制发生率3组分别为:54.8%,46.8%,48.2%(χ2=1.13,P=0.89)。消化道反应发生率3组分别为:48.3%,31.9%,27.5%(χ2=6.35,P=0.17)。其中A组有4例不完全性肠梗阻,与B组、C组比较差异有统计学意义(χ2=10.187,P=0.006)。3组膀胱反应的发生率分别为:77.4%,78.7%,75.8%(χ2=0.42,P=0.98)。3组局部复发率分别为:6.4%(2/31),6.3%(3/47),24.1%(7/29)(χ2=6.672,P=0.036)。远处转移率分别为:6.4%(2/31),4.2%(2/47),10.3%(3/29)(χ2=1.088,P=0.058)。3年无瘤生存率3组分别为:87.1%(28/31),87.2%(41/47),65.5%(19/29)(χ2=7.774,P=0.021)。结论早期宫颈癌术后具有高危因素的患者术后及时给予同步放化疗,可以提高3年无瘤生存率,降低盆腔复发率;但术后过早开始放化并不能进一步提高疗效,反而增加远期肠道反应。
Objective To investigate the efficacy and safety of adjuvant chemoradiotherapy during early stage of high-risk cervical cancer after operation. Methods A total of 107 patients with early stage cervical cancer who had risk factors after operation were retrospectively analyzed. Patients were divided into 3 groups according to their time after initiating concurrent chemoradiotherapy: group A ≤ 3 weeks, group 3 weeks 7 weeks. Chemotherapy every 3 weeks, a total of 4 cycles. Protocol: paclitaxel + cisplatin. Radiotherapy began on the end of the first course of chemotherapy. The 6MV X-ray pelvic anterior and posterior rectangular field controls were used. The common iliac lymph nodes plus abdominal aorta were perfused. The pelvic center dose was 4500-5000 cGy. Results The incidence of myelosuppression in the three groups was 54.8%, 46.8% and 48.2%, respectively (χ2 = 1.13, P = 0.89). The incidences of digestive tract reactions were 48.3%, 31.9% and 27.5%, respectively (χ2 = 6.35, P = 0.17). Among them, there were 4 cases of incomplete intestinal obstruction in group A, which was significantly different from those in group B and C (χ2 = 10.187, P = 0.006). The incidences of bladder reactions in the three groups were 77.4%, 78.7% and 75.8%, respectively (χ2 = 0.42, P = 0.98). The recurrence rates of the three groups were 6.4% (2/31), 6.3% (3/47), 24.1% (7/29) respectively (χ2 = 6.672, P = 0.036). The distant metastasis rates were 6.4% (2/31), 4.2% (2/47) and 10.3% (3/29) respectively (χ2 = 1.088, P = 0.058). The 3-year disease-free survival rates were 87.1% (28/31), 87.2% (41/47) and 65.5% (19/29) respectively (χ2 = 7.774, P = 0.021). Conclusions Patients with high risk factors for early cervical cancer postoperatively receive concurrent chemoradiotherapy after surgery, which can improve the 3-year disease-free survival rate and reduce the recurrence rate of pelvic cavity. However, premature radiotherapy does not improve the efficacy, but increases far Intestinal reaction.