宫颈癌新辅助化疗不同方案的临床疗效观察
摘要
宫颈癌发病率在女性恶性肿瘤中仅次于乳腺癌居第二位,在发展中国家居首位,是全世界关注的女性健康问题。我国每年新发病例约占全世界的1/3。近年来,巨块型(肿瘤直径〉4cm)及局部晚期子宫颈癌的发病率呈明显的上升趋势,且近20年发病年龄日趋年轻化特别明显。巨块型或局部晚期宫颈癌患者多有盆腔淋巴结转移等复发高危因素,不论是手术或放疗疗效均不理想,预后差。这些问题的出现向宫颈癌的传统治疗模式提出了挑战。自1982年Feri首次对新辅助化疗做了定义,宫颈癌的新辅助化疗(neoadjuvant chemotherapy,NACT)愈来愈受到国内外学者的重视,其疗效也愈来愈被人们证实和肯定。NACT用药方案多种多样,本文回顾性分析并比较了我院常用的两种化疗方案的疗效及毒副作用,以期更好的指导临床治疗。
目的:探讨不同的宫颈癌新辅助化疗方案在Ib2-IIb期宫颈癌治疗中的近期疗效。
方法:回顾性分析大连市妇幼保健院2002年1月-2007年12月间收治的行PBF/PF和TC方案新辅助化疗的临床病理资料完整的Ib2-IIb期宫颈癌患者共24例,根据所采用化疗方案的不同分为PBF/PF方案组和TC方案组。其中采5-氟尿嘧啶(5-FU)加顺铂(DDP)加或不加博来霉素(BLM)方案治疗者10例,采用多烯紫杉醇+卡铂(CBP)方案治疗者共14例。24例患者均无明显化疗禁忌症,并全部于化疗结束后2周左右行广泛性全子宫切除术及盆腔淋巴结清扫术治疗,年轻患者保留一侧卵巢并移位,同时行阴道延长术。分析比较两组方案的化疗有效率、手术时间、术中出血量、术后病理结果以及化疗毒副反应,从而评价不同化疗方案在宫颈癌新辅助化疗中的价值。
结果:24例Ib2-IIb期宫颈癌患者,术前共行31个疗程化疗。PBF/PF方案组的化疗有效率为70%,TC方案组的有效率为71.4%,两组方案的化疗有效率相比较无明显差异(P>0.05)。PBF/PF方案组10例中,完全缓解1例。两组中均未见肿瘤进展病例。TC方案组化疗后骨髓抑制的发生率高于PBF/PF方案组(p<0.05,p=0.04),其它的化疗毒副反应如胃肠道反应、肾功能损害、出血性膀胱炎等的发生率无显著差异。两组病例的手术时间、术中出血量及术后病理组织学结果比较,差异亦无显著性(p>0.05)。
结论:PBF/PF和TC方案均是Ib2-IIb期宫颈癌新辅助化疗的有效方案,二者都能够缩小肿瘤的体积,改善宫旁浸润,为不能手术的患者赢得了手术机会。
TC方案组的骨髓抑制发生率高于PBF/PF组,故对于体质较弱的患者应慎用。PBF/PF方案组中虽未见明显的化疗副反应,但因为在应用顺铂的过程中为减轻药物对于泌尿系统的损害而需要大剂量的水化,从而给患者的生理和心理造成一定的负担。两组化疗方案的化疗近期有效率相比较虽无明显差异,但仍各有利弊,故在临床治疗中应根据患者的具体情况选择适合的化疗方案,以得到更好的治疗效果。
The incidence of cervical carcinoma represents the second most common malignant tumor among women worldwide, only after the breast cancer, while it is the first one in developing countries. Cervical cancer is a global concentrated problem about the health of the female. New cases that is found every year in our country is almost equivalently one third of all over the world. In recent years, bulky and locally advanced cervical cancer has a increasing tendency, and the age of those patients became more and more young during the last 20 years. The therapeutic effect for those women is not ideal, neither by operation nor radiotherapy. The cause of this result is that the most of the patients of bulky and locally advanced cervical cancer have the high-risk factors to recur, such as the metabasis to pelvic lymphaden. All of these problems raise a challenge to the traditional healing mode of cervical cancer. After Feri firstly defined the neoadjuvant chemotherapy in 1982, NACT received increasing reconstruction by aboard and domestic scholars, and its therapeutic effect is confirmed gradually. Now, there are varied schemes in NACT. We retrospectively analyzed the curative effect and side effects of two different NACT plans, in order to direct the healing of clinic.
Objective: To explore the recent curative effect of different NACT schemes in patients with stage Ib2-IIb cervical cancer.
Methods: A retrospective analysis was carried out on 24 patients with stage Ib2-IIb cervical carcinoma. All the patients had the integrated clinical and pathological data, and admitted in the Dalian Maternal and Child Health Hospital from Jan. 2002 to Dec. 2007. These patients divided into two groups: PBF/PF (5-Fu+DDP+BLM/5-Fu+DDP) group (10 cases) and TC groups (14 cases). All of these 24 patients didn’t have the contraindication for NACT, and they were all given an operation after 2 weeks on the end of the last NACT. The value of different NACT was evaluated by contrasted the effective rate, toxin and side effect, operative time, operative hemorrhage, the results of pathology.
Results: 24 patients accepted 31 course of NACT in all. The recent effective rate of PBF/PF and TC were 70% and 71.4%, no obvious difference in statistics (p>0.05). There was a complete response case in PBF/PF group. No progression case occurred in both of two groups. The bone marrow depression in the TC group is higher than PBF/PF group (p<0.05, p=0.04). There were not significant differences in the reaction of gastrointertinal, renal function lesion, and hemorrhagic cystitis. Two groups were almost the same in average operative time, operative hemorrhage and pathology and histology outcomes (p>0.05).
Conclusions: NACT in PBF/PF and TC are efficient in stage Ib2-IIb cervical cancer. Both of them could minificate the tumor volume, reduce parametrial invasion, and degrade clinical stage. Because TC group has a higher bone marrow depression rate, it must be take careful when use it on weaker patients. Hydration is needed during the process of using DDP, so PBF/PF in NACT will cause a burden to patients on physical and mental. Because two schemes have advantages and disadvantages respectively, we should select the correct one on the basis of the patient’s characteristics, by this way we would get a better therapeutic effect in clinic.
目的:探讨不同的宫颈癌新辅助化疗方案在Ib2-IIb期宫颈癌治疗中的近期疗效。
方法:回顾性分析大连市妇幼保健院2002年1月-2007年12月间收治的行PBF/PF和TC方案新辅助化疗的临床病理资料完整的Ib2-IIb期宫颈癌患者共24例,根据所采用化疗方案的不同分为PBF/PF方案组和TC方案组。其中采5-氟尿嘧啶(5-FU)加顺铂(DDP)加或不加博来霉素(BLM)方案治疗者10例,采用多烯紫杉醇+卡铂(CBP)方案治疗者共14例。24例患者均无明显化疗禁忌症,并全部于化疗结束后2周左右行广泛性全子宫切除术及盆腔淋巴结清扫术治疗,年轻患者保留一侧卵巢并移位,同时行阴道延长术。分析比较两组方案的化疗有效率、手术时间、术中出血量、术后病理结果以及化疗毒副反应,从而评价不同化疗方案在宫颈癌新辅助化疗中的价值。
结果:24例Ib2-IIb期宫颈癌患者,术前共行31个疗程化疗。PBF/PF方案组的化疗有效率为70%,TC方案组的有效率为71.4%,两组方案的化疗有效率相比较无明显差异(P>0.05)。PBF/PF方案组10例中,完全缓解1例。两组中均未见肿瘤进展病例。TC方案组化疗后骨髓抑制的发生率高于PBF/PF方案组(p<0.05,p=0.04),其它的化疗毒副反应如胃肠道反应、肾功能损害、出血性膀胱炎等的发生率无显著差异。两组病例的手术时间、术中出血量及术后病理组织学结果比较,差异亦无显著性(p>0.05)。
结论:PBF/PF和TC方案均是Ib2-IIb期宫颈癌新辅助化疗的有效方案,二者都能够缩小肿瘤的体积,改善宫旁浸润,为不能手术的患者赢得了手术机会。
TC方案组的骨髓抑制发生率高于PBF/PF组,故对于体质较弱的患者应慎用。PBF/PF方案组中虽未见明显的化疗副反应,但因为在应用顺铂的过程中为减轻药物对于泌尿系统的损害而需要大剂量的水化,从而给患者的生理和心理造成一定的负担。两组化疗方案的化疗近期有效率相比较虽无明显差异,但仍各有利弊,故在临床治疗中应根据患者的具体情况选择适合的化疗方案,以得到更好的治疗效果。
The incidence of cervical carcinoma represents the second most common malignant tumor among women worldwide, only after the breast cancer, while it is the first one in developing countries. Cervical cancer is a global concentrated problem about the health of the female. New cases that is found every year in our country is almost equivalently one third of all over the world. In recent years, bulky and locally advanced cervical cancer has a increasing tendency, and the age of those patients became more and more young during the last 20 years. The therapeutic effect for those women is not ideal, neither by operation nor radiotherapy. The cause of this result is that the most of the patients of bulky and locally advanced cervical cancer have the high-risk factors to recur, such as the metabasis to pelvic lymphaden. All of these problems raise a challenge to the traditional healing mode of cervical cancer. After Feri firstly defined the neoadjuvant chemotherapy in 1982, NACT received increasing reconstruction by aboard and domestic scholars, and its therapeutic effect is confirmed gradually. Now, there are varied schemes in NACT. We retrospectively analyzed the curative effect and side effects of two different NACT plans, in order to direct the healing of clinic.
Objective: To explore the recent curative effect of different NACT schemes in patients with stage Ib2-IIb cervical cancer.
Methods: A retrospective analysis was carried out on 24 patients with stage Ib2-IIb cervical carcinoma. All the patients had the integrated clinical and pathological data, and admitted in the Dalian Maternal and Child Health Hospital from Jan. 2002 to Dec. 2007. These patients divided into two groups: PBF/PF (5-Fu+DDP+BLM/5-Fu+DDP) group (10 cases) and TC groups (14 cases). All of these 24 patients didn’t have the contraindication for NACT, and they were all given an operation after 2 weeks on the end of the last NACT. The value of different NACT was evaluated by contrasted the effective rate, toxin and side effect, operative time, operative hemorrhage, the results of pathology.
Results: 24 patients accepted 31 course of NACT in all. The recent effective rate of PBF/PF and TC were 70% and 71.4%, no obvious difference in statistics (p>0.05). There was a complete response case in PBF/PF group. No progression case occurred in both of two groups. The bone marrow depression in the TC group is higher than PBF/PF group (p<0.05, p=0.04). There were not significant differences in the reaction of gastrointertinal, renal function lesion, and hemorrhagic cystitis. Two groups were almost the same in average operative time, operative hemorrhage and pathology and histology outcomes (p>0.05).
Conclusions: NACT in PBF/PF and TC are efficient in stage Ib2-IIb cervical cancer. Both of them could minificate the tumor volume, reduce parametrial invasion, and degrade clinical stage. Because TC group has a higher bone marrow depression rate, it must be take careful when use it on weaker patients. Hydration is needed during the process of using DDP, so PBF/PF in NACT will cause a burden to patients on physical and mental. Because two schemes have advantages and disadvantages respectively, we should select the correct one on the basis of the patient’s characteristics, by this way we would get a better therapeutic effect in clinic.
引文
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2 . Parkin DM, Pisani P, Ferlay J. Global cancer statistics , CA Cancer J Clin, 1999,49:33-64.
3 . M inagawa Y, Kigswa J, Irie T, et al.Radicalangery following neoadjuvant chemotherapy for patients with stage IIIB cervical cancer. Ann Surg Oncol, 1998, 5:539-543.
4 . Frei E. Clinical cancer research:an embattled species [J]. Cancer, 1982, 50(10):1979-1992.
5 . Hwang YY, Moon H, Cho SH, et al. Ten-year survival of patients with locally advanced, stage Ib-Iib cerbical cancer after neoadjuvant chemotherapy and radical hystertctomy[J].Gynecol Oncol, 2001,82(1):88-93.
6 . Creasman WT, Zaino RJ, Major FJ, et al. Early invasive carcinoma of the cervix (3 to 5 mminvasion): risk factors and prognosis1A Gyneco2 logic Oncology Group study. Am J Obstet Gynecol,1998,178: 62.
7 . Nagata Y, Araki N, Kimura H, et al. Neoadjuvant chemotherapy by transcatheter arterial infusion method for uterine cervical cancer[J].J Vasc Interv Radiol, 2000, 11(3):313-319.
8 .邸石,江大琼。25例宫颈癌新辅助化疗临床分析[J]。华中医学杂志, 2005,29(6): 433-434.
9 . Ito T, Ishizuka T, Suzuki K, et al. Cervical cancer in young Janpanese women. Arch Gynecol Obstet, 2000, 264: 68.
10 . Cuzick J, Sasieni P, Singer A. Risk factors for cervix cancer in young women. Eur J Cancer, 1996, 32A: 836.
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