中晚期宫颈癌术前动脉化疗的临床研究
|
摘要
目的：探讨PVM(卡铂、长春新碱、丝裂霉素)方案超选择性子宫动脉化疗栓塞(transarterial chemoembolization，TACE)治疗中晚期宫颈癌的疗效及临床意义；评价术前化疗后行广泛子宫切除+盆腔淋巴结清扫术的可行性。
方法：收集2001年7月至2004年4月在我院行动脉化疗栓塞的中晚期宫颈癌患者(Ⅱb期-Ⅳa期)25例，包括Ⅱb期17例，Ⅲ期5例，Ⅳa期3例。有3例(Ⅲ期2例，Ⅳa期1例)曾在外院行少量放射治疗，临床症状无变化，其余22例入院前未行任何治疗，即为先期化疗。治疗前已明确病理诊断，鳞癌19例，腺癌5例，透明细胞癌1例。治疗为PVM方案(卡铂CBP400mg-600mg，长春新碱VCR2mg，丝裂霉素MMC16mg)，采用超选择双侧子宫动脉灌注法，化疗后用明胶海绵和聚乙烯醇(PVA)微粒栓塞，经用1-2个疗程后，行手术治疗。观察子宫动脉化疗栓塞的近期疗效、副反应及影响化疗疗效的因素；评价化疗后广泛子宫切除+盆腔淋巴结清扫术的可行性，术后并发症及影响预后的不良因素。
结果：25例患者1例完全缓解，19例部分缓解，3例病情无变化，2例病情进展。动脉化疗栓塞的总体缓解率为80％，先期化疗的总体缓解率为90.9％，既往行放疗的3例患者，病情均无缓解。肿瘤分期对化疗缓解率的影响有统计学意义(P=0.0289)，肿瘤分化程度对化疗缓解
军国州罗笋院硕1学位论文
率的影响无统计学显著差异(P=0 .32)，肿瘤分期与肿瘤大小的交互作
用对化疗缓解率的影响有统计学差异(P=0 .0259)。未放疗的22例患者
获得了广泛子宫切除+盆腔淋巴结清扫术的机会。术中出血量、手术时
间、术后住院日、术后膀肤功能恢复时间与同期行相同术式的Ib及lla
期宫颈癌患者比较无显著性差异，术中、术后未发生严重并发症。22例
手术的患者病理回报断端均无癌细胞，3例宫旁浸润，6例脉管内有癌
栓，8例有淋巴结转移，其中1例完全缓解的患者术后病理未见癌细胞。
结论:动脉化疗栓塞是治疗中晚期宫颈癌安全有效的辅助方法。PVM
方案动脉化疗临床总体缓解率高，毒副作用小，对宫颈鳞癌及腺癌均有
效，对宫颈腺癌中残留副中肾管来源的透明细胞癌1例疗效不明显。肿
瘤分期对化疗缓解率有影响，肿瘤分化程度对化疗缓解率无影响，肿瘤
大小可能通过影响分期从而影响化疗缓解率。TACE可以提高局部治疗作
用，缩小肿瘤的体积和浸润范围，使原来无法手术的患者有可能获得切
除病灶的机会;不增加广泛子宫切除术及盆腔淋巴结清扫术的术中困难
程度及术后并发症。术后病理提示动脉化疗栓塞可以改善影响预后的不
良因素。介入治疗的理想疗效加上及时彻底的手术，有较明显的近期疗
效，对远期疗效及生存率的影响，仍需大量临床病例及长期随访验证。
Purpose To study the curative effect of the treatment for metaphase or advanced cervical carcinoma with chemoembolization of uterine arteries by a combination of carboplatin, vincristin, mitomycin and its clinical significance. To evaluate feasibility of radical hysterectomy and pelvic lymphadenectomy after neoadjuvant chemotherapy(NAC). Methods From Jul 2001 to Apr 2004,25 patients(IIb-IVa) were entered in this study. Stage was II b in 17, III in 5, IVa in 3. Twenty-one cases were untreated before admission while 3 cases were treated with radiotherapy. All patients' pathological diagnosis were definite before chemoembolization as 19 cases in squamous carcinoma, 5 cases in adenocarcinoma and 1 case in clear cell carcinoma. Treatment was consisted of: PVM regime (carboplatin 400mg-600mg, vincristin 2mg, mitomycin 16mg ) transarterial infusion bilateral uterine arteries, then transcatheter arterial embolization(TAE) with gelfoam and polyvinyl alcohol broken pieces for one or two courses followed by radical hys
terectomy. Observed the recent efficacy and toxicity of transarterial chemoembolization(TACE).Evaluated intra-operative and postoperative complications of radical hysterectomy and pelvic lymphadenectomy after NAC.
Results Of the 25 evaluable patients who completed TACE, overall clinical response was noted in twenty patients(80%) including one complete
response and nineteen partial response. Three patients had stable disease and two had progression disease. Overall response was noted 90.9% in the patients with NAC. The response to chemotherapy related to clinical stages significantly(P=0.0289), but not to grade of differentiation (P=0.32) - There was significant interaction between clinical stages and tumor volume (P=0.0289) . The 22 patients underwent radical hysterectomy and pelvic lymphadenectomy four weeks following neoadjuvant chemotherapy. Three cases who had been treated with radiotherapy had no clinical response. The median blood loss, operating time, the length of postoperative hospital stay and bladder rehabilitation time for radical hysterectomy and pelvic lymphadenectomy in patients with metaphase or advanced cervical carcinoma were similar to those in patients with stages I b and II a disease. No intra-operative or immediate postoperative complications were observed. There were not any cancer-cells in all stumps, but pathologic examination of surgical specimens revealed parametrial infiltration in 3 of the 22 patients, vascular invasion in 6 cases, lymph nodes metastasis in 8 cases. Conlusion These results suggest that NACE is safe and effective treatment technic without severe complications for therapy of metaphase or advanced cervical carcinoma. PVM regime yields a high response rate with acceptable toxicity. It is effective for squamous carcinoma and adenocarcinoma except clear cell carcinoma. The response to chemotherapy relates to clinical stages, but not to grade of differentiation. Tumor volume affects the response to chemotherapy by the influence of the clinical stages. NACE is able to increase local therapeutic effects and to diminish effectively
the primary tumor and invasive coverage to decrease staging and improve the operability in patients with metaphase or advanced cervical carcinoma. Intra-operative and postoperative complications of radical hysterectomy and pelvic lymphadenectomy after neoadjuvant chemotherapy are not raised. Pathologic examination of surgical specimens revealed the improvement of prognosis of these patients. The high rate of optimal responses and operation might impact positively on survival, but only a longer follow-up period with allow objective assessment of this impact.
方法：收集2001年7月至2004年4月在我院行动脉化疗栓塞的中晚期宫颈癌患者(Ⅱb期-Ⅳa期)25例，包括Ⅱb期17例，Ⅲ期5例，Ⅳa期3例。有3例(Ⅲ期2例，Ⅳa期1例)曾在外院行少量放射治疗，临床症状无变化，其余22例入院前未行任何治疗，即为先期化疗。治疗前已明确病理诊断，鳞癌19例，腺癌5例，透明细胞癌1例。治疗为PVM方案(卡铂CBP400mg-600mg，长春新碱VCR2mg，丝裂霉素MMC16mg)，采用超选择双侧子宫动脉灌注法，化疗后用明胶海绵和聚乙烯醇(PVA)微粒栓塞，经用1-2个疗程后，行手术治疗。观察子宫动脉化疗栓塞的近期疗效、副反应及影响化疗疗效的因素；评价化疗后广泛子宫切除+盆腔淋巴结清扫术的可行性，术后并发症及影响预后的不良因素。
结果：25例患者1例完全缓解，19例部分缓解，3例病情无变化，2例病情进展。动脉化疗栓塞的总体缓解率为80％，先期化疗的总体缓解率为90.9％，既往行放疗的3例患者，病情均无缓解。肿瘤分期对化疗缓解率的影响有统计学意义(P=0.0289)，肿瘤分化程度对化疗缓解
军国州罗笋院硕1学位论文
率的影响无统计学显著差异(P=0 .32)，肿瘤分期与肿瘤大小的交互作
用对化疗缓解率的影响有统计学差异(P=0 .0259)。未放疗的22例患者
获得了广泛子宫切除+盆腔淋巴结清扫术的机会。术中出血量、手术时
间、术后住院日、术后膀肤功能恢复时间与同期行相同术式的Ib及lla
期宫颈癌患者比较无显著性差异，术中、术后未发生严重并发症。22例
手术的患者病理回报断端均无癌细胞，3例宫旁浸润，6例脉管内有癌
栓，8例有淋巴结转移，其中1例完全缓解的患者术后病理未见癌细胞。
结论:动脉化疗栓塞是治疗中晚期宫颈癌安全有效的辅助方法。PVM
方案动脉化疗临床总体缓解率高，毒副作用小，对宫颈鳞癌及腺癌均有
效，对宫颈腺癌中残留副中肾管来源的透明细胞癌1例疗效不明显。肿
瘤分期对化疗缓解率有影响，肿瘤分化程度对化疗缓解率无影响，肿瘤
大小可能通过影响分期从而影响化疗缓解率。TACE可以提高局部治疗作
用，缩小肿瘤的体积和浸润范围，使原来无法手术的患者有可能获得切
除病灶的机会;不增加广泛子宫切除术及盆腔淋巴结清扫术的术中困难
程度及术后并发症。术后病理提示动脉化疗栓塞可以改善影响预后的不
良因素。介入治疗的理想疗效加上及时彻底的手术，有较明显的近期疗
效，对远期疗效及生存率的影响，仍需大量临床病例及长期随访验证。
Purpose To study the curative effect of the treatment for metaphase or advanced cervical carcinoma with chemoembolization of uterine arteries by a combination of carboplatin, vincristin, mitomycin and its clinical significance. To evaluate feasibility of radical hysterectomy and pelvic lymphadenectomy after neoadjuvant chemotherapy(NAC). Methods From Jul 2001 to Apr 2004,25 patients(IIb-IVa) were entered in this study. Stage was II b in 17, III in 5, IVa in 3. Twenty-one cases were untreated before admission while 3 cases were treated with radiotherapy. All patients' pathological diagnosis were definite before chemoembolization as 19 cases in squamous carcinoma, 5 cases in adenocarcinoma and 1 case in clear cell carcinoma. Treatment was consisted of: PVM regime (carboplatin 400mg-600mg, vincristin 2mg, mitomycin 16mg ) transarterial infusion bilateral uterine arteries, then transcatheter arterial embolization(TAE) with gelfoam and polyvinyl alcohol broken pieces for one or two courses followed by radical hys
terectomy. Observed the recent efficacy and toxicity of transarterial chemoembolization(TACE).Evaluated intra-operative and postoperative complications of radical hysterectomy and pelvic lymphadenectomy after NAC.
Results Of the 25 evaluable patients who completed TACE, overall clinical response was noted in twenty patients(80%) including one complete
response and nineteen partial response. Three patients had stable disease and two had progression disease. Overall response was noted 90.9% in the patients with NAC. The response to chemotherapy related to clinical stages significantly(P=0.0289), but not to grade of differentiation (P=0.32) - There was significant interaction between clinical stages and tumor volume (P=0.0289) . The 22 patients underwent radical hysterectomy and pelvic lymphadenectomy four weeks following neoadjuvant chemotherapy. Three cases who had been treated with radiotherapy had no clinical response. The median blood loss, operating time, the length of postoperative hospital stay and bladder rehabilitation time for radical hysterectomy and pelvic lymphadenectomy in patients with metaphase or advanced cervical carcinoma were similar to those in patients with stages I b and II a disease. No intra-operative or immediate postoperative complications were observed. There were not any cancer-cells in all stumps, but pathologic examination of surgical specimens revealed parametrial infiltration in 3 of the 22 patients, vascular invasion in 6 cases, lymph nodes metastasis in 8 cases. Conlusion These results suggest that NACE is safe and effective treatment technic without severe complications for therapy of metaphase or advanced cervical carcinoma. PVM regime yields a high response rate with acceptable toxicity. It is effective for squamous carcinoma and adenocarcinoma except clear cell carcinoma. The response to chemotherapy relates to clinical stages, but not to grade of differentiation. Tumor volume affects the response to chemotherapy by the influence of the clinical stages. NACE is able to increase local therapeutic effects and to diminish effectively
the primary tumor and invasive coverage to decrease staging and improve the operability in patients with metaphase or advanced cervical carcinoma. Intra-operative and postoperative complications of radical hysterectomy and pelvic lymphadenectomy after neoadjuvant chemotherapy are not raised. Pathologic examination of surgical specimens revealed the improvement of prognosis of these patients. The high rate of optimal responses and operation might impact positively on survival, but only a longer follow-up period with allow objective assessment of this impact.
引文
1．谭道彩，梅卓贤主编．妇科肿瘤学．广州．广东人民出版社，2000，60
2．沈锵，郎景和主编．妇科肿瘤面临的问题和挑战．北京．人民卫生出版社，2002，238
3. Scarabelli C, Zarreli A, Gallo A, etal. Multimodal treament with neoadjuvant intraarterial chemotherapy and radical surgery in patients with stage ⅢB-ⅣA cervical cancer. A preliminary study, Cancer, 1995,76:1019-1026
4. Park SY, Kim JH, Lee JH. Phase Ⅰ/Ⅱ study of neoadjuvant intaarterial chemotherapy with mitomycin-C, vincristine, and cisplatin in patients with stage Ⅱb bulky cervical carcinoma. Cancer, 1995,76:814-823
5. Leone B, Vallejo C, Perez J, etal. Ifosfamide and cisplatin as neoadjuvant chemotherapy for advanced cervical carcinoma. Am J Clin Oncol, 1996,19:132-135
6．宋磊．宫颈癌的化疗．中国实用妇科与产科杂志，2003，19(3)：144-146
7．刘光元，曹建民，陈自谦主编．肿瘤血管介入治疗．江苏．江苏科学技术出版社，2003，13
8. Adachi S, Ogasawara T, Tsubamoto H, etal. Intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical cancer. Int J Clin Pharmacol Res, 2001,21(3-4):105-110
9. Sugiyamat T, Nishida T, Hasuo Y, etal. Neoadjavant intraarterial chemotherapy followed by radical hysterectomy and/or
radiotherapy for locally advanced cervical cancer. Gynecol Oncol, 1998, 69(2):130-136
10. Kuromatsu H. Neoadjuvant chemotherapy with selective intra-arterial infusion for advanced cervical cancer.J Jpn Soc Cancer rher, 1997,32(5): 335-344
11. Nagata Y, Araki N, Kimura H, etal. Neoadjuvant chemotherapy by transcatheter arterial infusion method for uterine cervical cancer. J Vasc Interv Radiol, 2000,11 (3): 313-319
12. Cromer JK. Use of intra-arterial nitrogen mustard therapy in the treatment of cervical and vaginal cancer. Am J Obstet Gynecol, 1952, 63:538
13. Minagaway Y, Kigawa J, Irie T, etal. Radical surgery following neoadjuvant chemotherapy for patients with stage Ⅲb cervical cancer. Ann Surg Oncoi, 1998,5(6):539-543
14. Benedetti-panici P, Greggi S, Colombo A, etal. Neoadjuvant chemotheraphy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer:results from the Italian multicenter randomized study.J Clin Oncol, 2002,20(i):179-183
15. Minagawa Y, Kigawa J,Irie T, etal. Radical surgery following neoadjuvant chemotherapy for patients with stage Ⅲb cervical cancer. Ann Surg Oncol, 1998,5(6):539-436
16．陈方满，侯书法，张东生等．一侧股动脉插管双侧髂内动脉介入治疗盆腔恶性肿瘤．实用放射学杂志，1999，15(10)：600-602
17. Yalvac S, Kayikcioglu F, Boran N, etal. Embolization of uterine artery in terminal stage cervical cancers. Cancer Invest, 2002, 20(5-6) : 754-758
18. Yamashita Y, Harada M, Yamamoyo H, etal. Transcatheter arterial embolization of obstertric and gynaecological bleeding:efficacy and clinical outcome. Bu J Radiol, 1994,67:530-534
19. Onishi H, Yamaguchi M, Kuriyama K, etal. Effect of concurrent intra-arterial infusion of platinum drugs for patients with stage Ⅲ or Ⅳuterine cervical cancer treated with radical radiation therapy. Cancer J Sci Am, 2000, Jan-Feb, 6(1):40-45
20. Yamakawa Y, Fujimura M, Hidaka T, etal. Neoadjuvant intrarterial infusion chemotherapy in patients with stage ⅠB2-ⅢB cervical cancer. Gynecol Oncoi, 2000,77(2):264-270
21．Phllip J，DiSaia，WilliamT，等主编．郎景和，沈铿，向阳主译．临床妇科肿瘤学．北京．人民卫生出版社，2003， 87
22. Nagata Y, Okajima K, Konishil, etal. Clinical results of trans-catheterarterial infusion for uterine cervical cancer. Am J Clin Onco1,1999, 22(1):97-102
23. Usuki N, Hitokawa K, Tashiro T, etal. Intraarterial chemotherapy for uterine cervical adenocarcinoma evaluation of its efficacy as therapy. Nippon Jgaku Hoshasen Gakkai Zasshi, 1999, 59(12):670-673
24. Kaminski PF, Maier RC. Clear cell adenocarcinoma of the cervix
unrelated to diethystilbestrol exposure. Obstet Gynecol, 1983, 62:720-721
25．江森．子宫颈癌的手术治疗．现代妇产科进展，1996，3(5)：204-209
26. Hili EC,Galante M. Radical surgery in the management of clear cell adenocarcinoma of the cervix and vagina in young women. Am J Obstet Gynecol, 1981,140:221-223
27．楼宝阳，陈海燕，蒋红兰．子宫颈透明细胞癌34例分析．中华肿瘤杂志，2000，4(22)：339-340
28. Kobayashi K, Furukawa A, Takahashi M, etal. Neoadjuvant Intra-Arterial Chemotherapy for Locally Advanced Uterine Cervical Cancer: Clinical Efficacy and Factors Influencing Response. Cardiovasc Intervent Radiol, 2003,26(2):20-25
29. Sardi JE, Giaroli A, Sananes C, etal. Long-term follow up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix:the final results. Gynecol Oncoi, 1997,67:61-65
30. Brader KR, Morris M, Levenback C, etal. Chemotherapy for cervical carcinoma: factors determining response and implications for clinical trial design. J Clin Oncol, 1998,16(5):1879-1884
31. Fujiwaki R, Maede Y, Ohnishi Y, etal. Prognosis of patients with stage Ⅲb-Ⅳa squamous cell carcinoma of the cervix Following intra-arterial neoadjuvant chemotherapy.J Exp Clin Cancer Res, 1999,18(2):143-146
32. Meden H, Farrahi-Meibodi A, Osmers R, etal. Wertheim's hysterectomy after neoadjuvant carboplatin-based chemotherapy in patients with cervical cancer stage ⅡB and ⅢB.Anticancer Res, 1998, 18(6B):4575-4580
33. Fujiwaki R,lida K, Ohnishi Y, etal. Intra-arterial neoadjuvant chemotherapy followed by radical surgery and radiotherapy for stage Ⅱb cervical carcinoma. Anticancer Res ,1997 ,17(5B):3751-3755
34. ScambiaG, FerrandinaG, Distefano M, etal.Is there aplace for a less extensive radical surgery in locally advanced cervical cancer patients? Gynecol Oncol, 2001,83:319-324
35. Panetta A, AngelelliB , Martoni A. Pilot study on induction chemotherapy with cisplatin, epirubicin, etoposide and bleomycin in cervical stage Ⅰb, Ⅱa and Ⅱb. Anticancer Res, 1999, 19(1B):765-768
2．沈锵，郎景和主编．妇科肿瘤面临的问题和挑战．北京．人民卫生出版社，2002，238
3. Scarabelli C, Zarreli A, Gallo A, etal. Multimodal treament with neoadjuvant intraarterial chemotherapy and radical surgery in patients with stage ⅢB-ⅣA cervical cancer. A preliminary study, Cancer, 1995,76:1019-1026
4. Park SY, Kim JH, Lee JH. Phase Ⅰ/Ⅱ study of neoadjuvant intaarterial chemotherapy with mitomycin-C, vincristine, and cisplatin in patients with stage Ⅱb bulky cervical carcinoma. Cancer, 1995,76:814-823
5. Leone B, Vallejo C, Perez J, etal. Ifosfamide and cisplatin as neoadjuvant chemotherapy for advanced cervical carcinoma. Am J Clin Oncol, 1996,19:132-135
6．宋磊．宫颈癌的化疗．中国实用妇科与产科杂志，2003，19(3)：144-146
7．刘光元，曹建民，陈自谦主编．肿瘤血管介入治疗．江苏．江苏科学技术出版社，2003，13
8. Adachi S, Ogasawara T, Tsubamoto H, etal. Intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical cancer. Int J Clin Pharmacol Res, 2001,21(3-4):105-110
9. Sugiyamat T, Nishida T, Hasuo Y, etal. Neoadjavant intraarterial chemotherapy followed by radical hysterectomy and/or
radiotherapy for locally advanced cervical cancer. Gynecol Oncol, 1998, 69(2):130-136
10. Kuromatsu H. Neoadjuvant chemotherapy with selective intra-arterial infusion for advanced cervical cancer.J Jpn Soc Cancer rher, 1997,32(5): 335-344
11. Nagata Y, Araki N, Kimura H, etal. Neoadjuvant chemotherapy by transcatheter arterial infusion method for uterine cervical cancer. J Vasc Interv Radiol, 2000,11 (3): 313-319
12. Cromer JK. Use of intra-arterial nitrogen mustard therapy in the treatment of cervical and vaginal cancer. Am J Obstet Gynecol, 1952, 63:538
13. Minagaway Y, Kigawa J, Irie T, etal. Radical surgery following neoadjuvant chemotherapy for patients with stage Ⅲb cervical cancer. Ann Surg Oncoi, 1998,5(6):539-543
14. Benedetti-panici P, Greggi S, Colombo A, etal. Neoadjuvant chemotheraphy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer:results from the Italian multicenter randomized study.J Clin Oncol, 2002,20(i):179-183
15. Minagawa Y, Kigawa J,Irie T, etal. Radical surgery following neoadjuvant chemotherapy for patients with stage Ⅲb cervical cancer. Ann Surg Oncol, 1998,5(6):539-436
16．陈方满，侯书法，张东生等．一侧股动脉插管双侧髂内动脉介入治疗盆腔恶性肿瘤．实用放射学杂志，1999，15(10)：600-602
17. Yalvac S, Kayikcioglu F, Boran N, etal. Embolization of uterine artery in terminal stage cervical cancers. Cancer Invest, 2002, 20(5-6) : 754-758
18. Yamashita Y, Harada M, Yamamoyo H, etal. Transcatheter arterial embolization of obstertric and gynaecological bleeding:efficacy and clinical outcome. Bu J Radiol, 1994,67:530-534
19. Onishi H, Yamaguchi M, Kuriyama K, etal. Effect of concurrent intra-arterial infusion of platinum drugs for patients with stage Ⅲ or Ⅳuterine cervical cancer treated with radical radiation therapy. Cancer J Sci Am, 2000, Jan-Feb, 6(1):40-45
20. Yamakawa Y, Fujimura M, Hidaka T, etal. Neoadjuvant intrarterial infusion chemotherapy in patients with stage ⅠB2-ⅢB cervical cancer. Gynecol Oncoi, 2000,77(2):264-270
21．Phllip J，DiSaia，WilliamT，等主编．郎景和，沈铿，向阳主译．临床妇科肿瘤学．北京．人民卫生出版社，2003， 87
22. Nagata Y, Okajima K, Konishil, etal. Clinical results of trans-catheterarterial infusion for uterine cervical cancer. Am J Clin Onco1,1999, 22(1):97-102
23. Usuki N, Hitokawa K, Tashiro T, etal. Intraarterial chemotherapy for uterine cervical adenocarcinoma evaluation of its efficacy as therapy. Nippon Jgaku Hoshasen Gakkai Zasshi, 1999, 59(12):670-673
24. Kaminski PF, Maier RC. Clear cell adenocarcinoma of the cervix
unrelated to diethystilbestrol exposure. Obstet Gynecol, 1983, 62:720-721
25．江森．子宫颈癌的手术治疗．现代妇产科进展，1996，3(5)：204-209
26. Hili EC,Galante M. Radical surgery in the management of clear cell adenocarcinoma of the cervix and vagina in young women. Am J Obstet Gynecol, 1981,140:221-223
27．楼宝阳，陈海燕，蒋红兰．子宫颈透明细胞癌34例分析．中华肿瘤杂志，2000，4(22)：339-340
28. Kobayashi K, Furukawa A, Takahashi M, etal. Neoadjuvant Intra-Arterial Chemotherapy for Locally Advanced Uterine Cervical Cancer: Clinical Efficacy and Factors Influencing Response. Cardiovasc Intervent Radiol, 2003,26(2):20-25
29. Sardi JE, Giaroli A, Sananes C, etal. Long-term follow up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix:the final results. Gynecol Oncoi, 1997,67:61-65
30. Brader KR, Morris M, Levenback C, etal. Chemotherapy for cervical carcinoma: factors determining response and implications for clinical trial design. J Clin Oncol, 1998,16(5):1879-1884
31. Fujiwaki R, Maede Y, Ohnishi Y, etal. Prognosis of patients with stage Ⅲb-Ⅳa squamous cell carcinoma of the cervix Following intra-arterial neoadjuvant chemotherapy.J Exp Clin Cancer Res, 1999,18(2):143-146
32. Meden H, Farrahi-Meibodi A, Osmers R, etal. Wertheim's hysterectomy after neoadjuvant carboplatin-based chemotherapy in patients with cervical cancer stage ⅡB and ⅢB.Anticancer Res, 1998, 18(6B):4575-4580
33. Fujiwaki R,lida K, Ohnishi Y, etal. Intra-arterial neoadjuvant chemotherapy followed by radical surgery and radiotherapy for stage Ⅱb cervical carcinoma. Anticancer Res ,1997 ,17(5B):3751-3755
34. ScambiaG, FerrandinaG, Distefano M, etal.Is there aplace for a less extensive radical surgery in locally advanced cervical cancer patients? Gynecol Oncol, 2001,83:319-324
35. Panetta A, AngelelliB , Martoni A. Pilot study on induction chemotherapy with cisplatin, epirubicin, etoposide and bleomycin in cervical stage Ⅰb, Ⅱa and Ⅱb. Anticancer Res, 1999, 19(1B):765-768