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目的:探讨动脉灌注新辅助化疗(NeoadjuvantIntra-arterialInfusionChemotherapy,NAIC)联合手术或NAIC和术前放疗联合手术治疗Ib～IIIb期宫颈癌的效果。方法:对象为1997年1月～2002年12月期间连续的59例宫颈活检病理确诊为子宫颈癌FIGO分期为Ib～IIIb期,入该院前没接受过治疗的住院病人。其中22例在接受NAIC后进行手术,被归入NAIC联合手术治疗组;另外37例先后接受NAIC和术前放疗后进行手术,被归入NAIC和术前放疗联合手术治疗组。NAIC的方案为:卡铂200～400mg/m2、氟尿嘧啶1.0～1.5g或博莱霉素30～45mg;次数1～2次,间隔时间4周。术前放疗采用后装腔内放疗,剂量为6～10Gy/次,每周1次,次数2～6次。NAIC或放疗后2周进行广泛全宫切除术及盆腔淋巴结清扫术。结果:NAIC联合手术治疗组5年生存率87.9%,其中IIb～III期宫颈癌患者4年生存率为77.1%。NAIC和术前放疗联合手术治疗组5年生存率81.8%,其中IIb～III期宫颈癌患者4年生存率76.1%。NAIC联合手术治疗组中IIb～III期宫颈癌患者的4年生存率与NAIC和术前放疗联合手术治疗组相比差异无统计学意义(P=0.976)。NAIC联合手术治疗组与NAIC和术前放疗联合手术治疗组3～4度白细胞减少、中性粒细胞减少、贫血、血小板减少的发生率差异无统计学意义(P值分别为0.821、0.677、1.000、1.000)。结论:NAIC联合手术与NAIC和术前放疗联合手术两种方案治疗Ib～IIIb期宫颈癌是有效的。两种方案对IIb～III期宫颈癌患者4年生存率的影响相近。两种方案引起的毒副反应患者均可耐受。
Objective: To investigate the effect of NeiadjuvantIntra-arterial Infusion Chemotherapy (NAIC) combined with surgery or NAIC and preoperative radiotherapy combined with surgical treatment of stage Ib ~ IIIb cervical cancer. Methods: A total of 59 consecutive cervical biopsy specimens from January 1997 to December 2002 were diagnosed as FIGO staging of stage Ib ~ IIIb of cervical cancer and inpatients who had not received any treatment before the hospital. Among them, 22 patients underwent NAIC surgery and were included in the NAIC combined surgery group. Another 37 patients underwent NAIC and preoperative radiotherapy, and were classified as NAIC and preoperative radiotherapy combined with surgery group. NAIC program: carboplatin 200 ~ 400mg / m2, fluorouracil 1.0 ~ 1.5g or bleomycin 30 ~ 45mg; times 1 to 2 times, the interval of 4 weeks. Preoperative radiotherapy with post-cavity radiotherapy at a dose of 6 ~ 10Gy / time, once a week, the number of 2 to 6 times. Extensive hysterectomy and pelvic lymphadenectomy were performed with NAIC or 2 weeks after radiotherapy. Results: The 5-year survival rate was 87.9% in the NAIC combined surgery group, and the 4-year survival rate of patients with stage IIb-III cervical cancer was 77.1%. The 5-year survival rate of NAIC and preoperative radiotherapy combined with surgical treatment group was 81.8%. The 4-year survival rate of patients with stage IIb-III cervical cancer was 76.1%. The 4-year survival rates of patients with stage IIb-III cervical cancer in the NAIC combined surgery group were not significantly different from those of the preoperative radiotherapy combined with NAIC surgery group (P = 0.976). There was no significant difference in the incidence of leukopenia, neutropenia, anemia and thrombocytopenia between the NAIC group and the NAIC group and the preoperative radiotherapy group at 3-4 weeks (P = 0.821, 0.677, 1.000 respectively , 1.000). Conclusion: NAIC combined with NAIC and preoperative radiotherapy combined with surgical treatment of two programs Ib ~ IIIb cervical cancer is effective. The effects of the two regimens on the 4-year survival rates of stage IIb-III cervical cancer patients were similar. Toxic and side effects caused by both programs can be tolerated.