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目的研究同步放化疗治疗子宫颈癌的疗效及副反应。方法158例Ⅰb2～Ⅳ期子宫颈癌患者接受同步放化疗。盆腔体外放射治疗DT 45 Gy/25f,腔内后装放疗7～9次,宫颈黏膜下0.5 cm,大块肿瘤消除量为10～30 Gy,A点(42±7)Gy。同步化疗用药为5-氟尿嘧啶(5-Fu) 2400 mg、m2,96 h持续泵入,第1天和第29天;顺铂(DDP)60 mg/m2,分1～4 d静脉滴入,第1～4天和第29～32天。结果全组总5年生存率为66.3%。宫颈局部未控率为4.4%(7/158),盆腔复发率为3.2%(5/158),远处转移率为17.1%(27/158)。毒副反应中,Ⅲ、Ⅳ级白细胞下降为12.7%(20/158),血小板下降为1.3%(3/158),中、重度贫血为3.2%(5/158),胃肠道反应腹泻为17.8%(28/158),心脏毒性为10.1%(16/158),放射性直肠炎为13.3%(21/158),放射性膀胱炎为0.6%(1/158)。结论采用含5-Fu和DDP的药物同步放化疗治疗子宫颈癌,总治疗时间没有延长,5年生存率亦未见提高。治疗中,相关毒副反应增加,但可以接受。
Objective To study the efficacy and side effects of concurrent chemoradiotherapy in the treatment of cervical cancer. Methods 158 patients with stage Ⅰ 2b ~ Ⅳ cervical cancer received concurrent chemoradiotherapy. The pelvic external beam radiotherapy DT 45 Gy / 25f, intracavitary posterior radiotherapy 7 to 9 times, cervical submucosa 0.5 cm, large tumor elimination amount 10 ~ 30 Gy, A point (42 ± 7) Gy. The concurrent chemotherapeutic drugs were 2,4-D 5-FU (2,4-mg, m2, 96 h), and were continuously pumped on day 1 and day 29. DDP 60 mg / 1st to 4th days and 29th to 32nd days. Results The overall 5-year overall survival rate was 66.3%. Uncontrolled cervical rate was 4.4% (7/158), pelvic recurrence rate was 3.2% (5/158), distant metastasis rate was 17.1% (27/158). Toxicity, Ⅲ, Ⅳ leukopenia was 12.7% (20/158), thrombocytopenia was 1.3% (3/158), moderate and severe anemia was 3.2% (5/158), gastrointestinal reactions diarrhea 17.8% (28/158), cardiotoxicity 10.1% (16/158), radiation proctitis 13.3% (21/158) and radiation cystitis 0.6% (1/158). Conclusion Simultaneous radiochemotherapy with 5-Fu and DDP for cervical cancer did not prolong the total treatment time and did not improve the 5-year survival rate. In treatment, the related side effects increased, but acceptable.