早期宫颈癌的新辅助化疗疗效评价

发布时间：2018-06-19 07:41

本文选题：宫颈癌 + NACT　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：观察新辅助化疗用于早期宫颈癌患者的临床疗效。方法：回顾性分析2010年1月-2014年1月就诊于北京军区总医院的45例b1-ēb期宫颈癌患者。采用顺铂、博莱霉素、丝裂霉素（DBM）方案行动脉灌注栓塞化疗1-2个疗程，进行妇科检查、阴道镜检查、妇科超声、盆腔MR及血清SCCA值等多项检测，收集各项检查指标，采用Paired-Sample t Test及Wilcoxon检验对上述指标进行统计学分析，对比化疗前后宫颈局部肿块大小的变化情况、病变对宫旁组织的累及情况及血清肿瘤标志物的变化。观察各项观测指标的差异，并监测化疗副反应。如无手术禁忌症行腹腔镜下广泛性子宫切除术+盆腔淋巴结清扫，否则行放疗。术后将多种检查结果与病理结果进行比较。结果：本研究显示当化疗结束后，1）妇科检查全部病例化疗后宫颈局部病灶均较化疗前缩小或消失；有23例（23/45）患者目测已经完全消失（CR）；其余22例（22/45）患者的宫颈局部肿瘤体积均缩小了50％以上(PR)；化疗有效率（CR+PR）100%。2）将多次阴道镜图像进行测量对比，化疗后宫颈局部病灶不同程度缩小；3）超声检查提示化疗前后宫颈局部病灶大小及肿物血流丰富程度均明显改善，有统计学意义；4）盆腔MR检查提示化疗前后宫颈局部病灶大小明显改善，有统计学意义；5）主要毒副反应为-ē度白细胞减少、消化道症状及轻度脱发，仅1例患者出现ē度骨髓抑制，用药后均缓解。6）化疗后，除3例ēb期患者因宫旁病灶改善不满意改行放疗，其余42例行腹腔镜下广泛性子宫切除术及盆腔淋巴结清扫术，手术成功率100%。7）有14例术后病理结果未发现任何癌组织，在b1及b2期患者中，妇检局部病灶缓解的情况与术后病理结果吻合程度高，分别可达到100%、80%；ēa及ēb期化疗后多未达到完全清除，阴道镜检查可提高残留病灶的检出率。8）血清SCCA仅在化疗前异常时，对评价化疗效果有参考意义。9）所有患者均系统随诊，随诊时间为3-51个月，除有一例患者因远处转移于术后27个月时死亡，其余患者目前均无瘤生存。结论：DBM新辅助化疗方案对于b1-ēb期宫颈癌近期疗效好，副反应相对较轻，具有较好的临床推广应用价值。
[Abstract]:Objective: to observe the clinical effect of neoadjuvant chemotherapy in patients with early cervical cancer. Methods: from January 2010 to January 2014, 45 patients with stage B 1 or B cervical cancer in Beijing military region General Hospital were retrospectively analyzed. One or two courses of arterial infusion embolization chemotherapy were performed with cisplatin, bleomycin and mitomycin (DBM). Gynecological examination, colposcopy, gynecological ultrasound, pelvic Mr and serum SCCA were performed. The Paired-Sample t Test and Wilcoxon test were used to analyze the above indexes. The changes of the size of local cervical mass, the involvement of the lesion to the para-uterine tissue and the changes of serum tumor markers were compared before and after chemotherapy. Observe the difference of observation indexes and monitor the side effects of chemotherapy. If no surgical contraindication is performed, pelvic lymph node dissection is performed under laparoscopy, otherwise radiotherapy is performed. After operation, the results of various examinations were compared with the pathological results. Results: this study showed that the local cervical lesions were reduced or disappeared in all cases after chemotherapy, and 23 cases (23 / 45) were completely disappeared after gynecological examination. In the other 22 patients, the local tumor volume of cervix decreased by more than 50%, and the effective rate of chemotherapy was 100%. 3) Ultrasonography showed that the size of local cervical lesions and the abundance of blood flow were significantly improved before and after chemotherapy, with statistical significance (4) pelvic Mr examination showed that the size of local cervical lesions was significantly improved before and after chemotherapy, with statistical significance. 5) the main side effects were leukopenia, alopecia, gastrointestinal symptoms and mild alopecia. Only one patient developed myelosuppression, all of which were relieved after chemotherapy. The remaining 42 cases underwent laparoscopic extensive hysterectomy and pelvic lymph node dissection. The successful rate of operation was 100. 7%. The remission of local lesions in women's examination was in good agreement with the postoperative pathological results, which could reach 100% and 80% respectively, and most of them were not completely cleared after stage A and B chemotherapy. Colposcopy examination could increase the detection rate of residual lesions. 8) Serum SCCA was only abnormal before chemotherapy. All patients were followed up systematically for 3-51 months. Except one patient died of distant metastasis 27 months after operation, all patients survived without tumor. Conclusion the new adjuvant chemotherapy regimen of 7% DBM has good short-term curative effect and relatively mild side effect in the treatment of B1-B stage cervical cancer, so it has a good clinical application value.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【参考文献】