同步放化疗治疗中晚期宫颈癌

刘少兵; 周祖金; 陈　森; 覃瑞萍

doi:10.3971/j.issn.1000-8578.1532

同步放化疗治疗中晚期宫颈癌

Prospective Trial for Concurrent Chemoradiotherapy Treatment in Medium-term and Advanced Cervical Carcinoma

摘要

摘要: 目的观察化疗联合放疗治疗中晚期宫颈癌的临床疗效和毒副作用。方法 58例中晚期宫颈癌患者随机分成化放组（29例）及单纯放疗组（29例），化放组采用顺铂25mg／m² d1-3，静脉点滴，5-Fu 350mg／m² d1-5静脉点滴，每4周重复，共3个周期，同时进行根治性放疗，化疗第1天开始进行放射治疗。用10MVX线体外全盆照射DT38-40Gy，中间铅挡后照射致宫旁剂量DT50-55Gy，第3周开始行¹⁹²Ir腔内照射，6Gy／次／天／周，A点剂量6Gy，B点剂量5Gy，共6～7次。单纯放射治疗组仅行单纯放疗，方法同化放组，不行化疗。结果于放疗结束时两组有效率分别为96．6％及86．2％，差异无显著（P〉0．05）。放疗后3个月时两组的有效率分别为96．6％及65．5%，差异显著（P〈0．05）。放化组3、5年生存率和无瘤生存率分别为79．3％、68．9％、62．1％，高于单放组的62．1％、51．7％、41．4％，差异显著（P〈0．05），随访5年，化放组的盆腔复发率为17．2％，低于单放组的31．0％，P〈0．05。化放组有较明显的骨髓抑制和消化道反应，但患者经治疗后均可耐受。结论化疗联合放疗治疗中晚期宫颈癌可增强疗效，副作用稍增加，但患者能耐受。

Abstract: Objective 　To investigate the clinical curative effects and side effects of chemoradiotherapy for medium-term and advanced cervical carcinoma. Methods 　Fifty-eight patients of medium-term and advanced cervical carcinoma were randomly divided into two groups : chemoradiotherapy group s and only radiotherapy group. Each patient s of the chemoradiotherapy group was given cisplatin at the dose of 25mg/ m²ivgtt d1-3, 5-Fluorouracil, 350mg/ m² ivgtt, d1-5, repeat every 28 days, total 3 cycles. And radiotherapy was give at the same time, 10 MVX ray was used for external radiation with a total dose of 38～40 Gy ;then the middle field is shielded by plumbum, continuous radiotherapy to total dose of 50～55 Gy ;192 Irhigh-dose-rate af ter loading unit was used for branchytherapy after 3 weeks of external radiotherapy at the dose in A point of 6 Gy per time for total 6～7 times. The patients of radiotherapy group were only received radiotherapy with the same dose and same methods. Results 　The effect rates of the chemoradiotherapy group and radiotherapy group were 96. 6 % and 86. 2 % respectively at the end of the radiotherapy with no difference significantly ( P > 0. 05) ; Three months after radiotherapy the effect rates in both groups were 96. 6 % and 65. 5 %, showing a significant difference ( P < 0. 05) . The overall 32year, 52year survival rates for the patients in chemoradiotherapy group and radiotherapy group were 79. 3 %, 68. 9 % and 62. 1 %, 51. 7 % respectively, P < 0. 05. Disease-free survival rates were 62. 1 % and 41. 4 % respec-tively, P < 0. 05. Pelvic recurrence rates were 31. 0 % and 17. 2 % respectively P < 0. 05. More serious side effects were found in the chemoradiotherapy group. Especially in bone marrow inhibition and reaction of digestive tract, Which could be alleviated. Conclusion 　Concurrent chemotherapy and radiotherapy in medium-term and advanced cervical carcinoma can increase t reatment effect and raise the survival of the patients, obviously improve the short-term curative effect . Toxicity of patients was increasing but the patients could tolerate.

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