放化同步治疗宫颈癌术后脉管癌栓阳性患者的疗效及不良反应观察

Observation of the curative efficacy and adverse reaction in vascular cancer embolus positive patients with postoperative chemoradiotherapy of the cervical cancer

关键词:  放化同步治疗  宫颈癌术后  脉管癌栓  疗效  不良反应

Key words:  [Key words] chemotherapy combined with radiotherapy  cervical cancer surgery  the vascular cancer embolus  curative efficacy  adverse reaction

摘要:

[摘要]　目的　观察放化同步治疗宫颈癌术后脉管癌栓阳性患者的近期疗效及不良反应。　方法　选择宫颈癌术后脉管癌栓阳性患者共118例。按治疗方案的不同分为两组：放化同步治疗组57例，给予术后辅助同步放化疗，同步化疗方案为DDP周疗，于盆腔外照射治疗期间给予，术后病理提示手术切缘阳性、淋巴结阳性和/或宫旁组织阳性的患者予追加192Ir后装腔内放疗；单纯放疗组61例，放疗方案与放化同步组相同。随访、评估和比较分析，两组患者的3年无病生存率、3年总生存率、1年、2年及3年盆腔复发率及治疗相关不良反应。　结果　宫颈癌根治术后脉管癌栓阳性的患者，术后放化同步治疗较单纯放疗降低了1年盆腔复发率（放化同步治疗8.77%，单纯放疗22.95%，P<0.05）及2年盆腔复发率（放化同步治疗12.28%，单纯放疗27.87%，P<0.05），3年盆腔复发率放化同步治疗组与单纯放疗组比较，差异无显著性意义（P>0.05），两组3年无病生存率、3年总生存率相似。放化同步组的早期不良反应较单纯放疗组增加，主要体现在骨髓抑制和胃肠道反应，均在可耐受范围内，经积极对症支持处理未影响后续治疗。晚期不良反应两组患者无差别。　结论　放化同步治疗降低了宫颈癌根治术后脉管癌栓阳性患者近期局部复发率，3年的无进展生存率及总生存率未见明显改善。放化同步治疗的早期不良反应稍有增加。

Abstract:

[Abstract] Objective To observe the curative efficacy and adverse reaction in vascular cancer embolus (+) patients who received postoperative chemoradiotherapy of the cervical cancer, and to determine whether vascular cancer embolus is the evidence of postoperative chemoradiotherapy. 　Methods This study included a total of 118 cases of vascular cancer embolus (+) patients. The patients were classified into two groups based on the therapeutic plans. The chemoradiotherapy group included 57 patients who received concurrent DDP chemotherapy in external irradiation stage. 192Ir intracavitary radiotherapy was appended if postoperative pathology was positive in surgical margins, lymph node or parametrial tissue. The radiotherapy group included 61 patients who received radiation therapy only as same as the first group. The patients were followed up, evaluated and the data were analyzed including 3-year disease-free survival, 3-year overall survival, 1-year, 2-year and 3-year pelvic recurrence rate and adverse reactions. 　Results Compared to the radiotherapy group, the chemoradiotherapy group had reduced one-year pelvic recurrence rate (8.77% in the chemoradiotherapy group versus 22.95% in the radiotherapy group，P<0.05) and two-year pelvic recurrence rate (12.28% in the chemoradiotherapy group versus 27.87% in the radiotherapy group，P<0.05). However, there was no significant difference in three-year pelvic recurrence rate between the two groups (P>0.05). The 3-year disease-free survival rate and the 3-year overall survival between the two groups were similar (P>0.05). The early adverse reactions in the chemoradiotherapy group were more than the radiotherapy group, mainly in the bone marrow suppression and gastrointestinal reactions which were well tolerated did not affect the follow-up treatment by active therapy. The late adverse reactions between the two groups were similar. 　Conclusion Concurrent chemoradiotherapy cuts down the recent local recurrence rate in vascular cancer embolus (+) patients who has received radical hysterectomy, but it makes no significant improvement in 3-year progression-free survival and overall survival. In addition, concurrent chemoradiotherapy induces increased early adverse reaction.