局部晚期宫颈癌化疗联合放疗最佳模式探讨

发布时间：2018-04-14 19:22

本文选题：宫颈癌 + 放疗　；参考：《中华肿瘤防治杂志》2017年03期

【摘要】：目的放疗是局部中晚期宫颈癌的主要治疗方式,目前同步放化疗已经成为局部中晚期宫颈癌的标准治疗模式,诱导化疗和辅助化疗在同步放化疗时代的角色未明,其疗效与预后的优劣并未达成共识,本研究旨在通过回顾性分析探讨局部中晚期宫颈鳞癌的最佳治疗模式,为临床治疗提供理论依据。方法回顾性分析2008-01-01-2010-01-31湖南省肿瘤医院收治的212例初治中晚期宫颈鳞癌患者,根据治疗方式分为A、B和C 3组,诱导及辅助化疗为TP方案,即紫杉醇联合顺铂,同步放化疗为顺铂单药或顺铂联合紫杉醇,A组(对照组):同步放化疗82例,B组(观察组):诱导化疗联合同步放化疗98例,C组(观察组):同步放化疗联合辅助化疗32例,观察比较3组的近期疗效、远期疗效和不良反应。结果 A、B和C组近期疗效分别为93.90%、94.90%和96.88%,差异无统计学意义,P0.05;A、B和C组总生存率(OS)第1年分别为90.24%、90.82%和87.50%;第3年分别为85.37%、87.76%和81.25%;第5年分别为82.93%、83.67%和75.00%;3组比较差异均无统计学意义,P0.05。A、B和C组局控率分别为86.58%、86.73%和87.50%,差异性无统计学意义,P0.05;A、B和C组无进展生存率分别为67.07%、74.49%和68.75%,差异均无统计学意义,P0.05;A、B和C组无远处转移生存率分别为70.73%、93.08%和71.88%,差异有统计学意义,P0.05。不良反应主要表现为观察组3级以上白细胞及血小板减少。进一步比较观察组间骨髓抑制差异无统计学意义,P0.05;消化道反应及肝功能损害3组比较差异均无统计学意义,P0.05;晚期放射性损伤主要表现为放射性直肠炎和放射性膀胱炎,3组比较差异无统计学意义,P0.05。结论诱导化疗可以提高局部晚期宫颈癌的无远处转移率,有延长OS趋势;辅助化疗对局部晚期宫颈癌未见明显生存获益;诱导化疗联合同步放化疗是一种较为有效的局部晚期宫颈癌治疗方案,值得临床进一步推广使用,并通过大样本资料研究加以证实。
[Abstract]:Objective radiotherapy is the main treatment method of local advanced cervical cancer. At present, synchronous radiotherapy and chemotherapy have become the standard treatment mode of local advanced cervical cancer. The roles of induction chemotherapy and adjuvant chemotherapy in the times of simultaneous radiotherapy and chemotherapy are unclear.There is no consensus between the curative effect and prognosis. The purpose of this study is to explore the best treatment mode of local advanced cervical squamous cell carcinoma by retrospective analysis, and to provide theoretical basis for clinical treatment.Methods 212 patients with cervical squamous cell carcinoma treated in Hunan Provincial Cancer Hospital from January to January 2010 to 31, 2008 were retrospectively analyzed. According to the treatment methods, 212 patients were divided into two groups: group A (group B) and group C (group C). The regimen of induction and adjuvant chemotherapy was TP regimen (paclitaxel combined with cisplatin).Simultaneous radiotherapy and chemotherapy were cisplatin single drug or cisplatin combined with paclitaxel A group (control group: 82 cases of concurrent radiotherapy and chemotherapy group B) (observation group: induced chemotherapy combined with concurrent chemotherapy group of 98 cases) (observation group: simultaneous chemotherapy and radiotherapy combined with adjuvant chemotherapy 32 cases)The short-term, long-term and adverse reactions were observed and compared among the 3 groups.Results the short-term curative effects of group A B and group C were 93.90% and 96.88%, respectively. There was no significant difference in the overall survival rate of group A (0.05) and group C (90.240.82% and 87.50% respectively in the first year; 85.377.76% and 81.25% in the third year; and 82.93% in the fifth year, 83.67% in group A and 75.00% in group C).The local control rates of group B and C were 86.58% and 87.50%, respectively. The progression-free survival rates of group B and group C were 67.07% and 68.75%, respectively. There was no significant difference between group B and C, and the survival rates of group B and C were 70.739.08% and 71.888.The difference was statistically significant (P 0.05).The main adverse reactions were leukopenia and thrombocytopenia in the observation group.There was no significant difference in bone marrow suppression between the observation group (P 0.05), digestive tract reaction and liver function damage (P 0.05).There was no significant difference among the three groups (P 0.05).Conclusion Induction chemotherapy can increase the rate of local advanced cervical cancer without distant metastasis and prolong OS trend, and adjuvant chemotherapy has no obvious survival benefit for locally advanced cervical cancer.Induction chemotherapy combined with concurrent radiotherapy and chemotherapy is an effective treatment for locally advanced cervical cancer, which is worthy of further clinical application and confirmed by a large sample of data.
【作者单位】：湖南省肿瘤医院·中南大学湘雅医学院附属肿瘤医院妇瘤科;
【分类号】：R737.33

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