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目的探索中晚期宫颈癌根治性术后大分割放疗+同期化疗的疗效及毒性。方法 2007年7月至2012年6月,50例行广泛全子宫切除+盆腔淋巴结清扫术后的巨块型Ib、IIa、IIb期宫颈癌患者纳入分析。治疗采用大分割放疗+同步化疗:放疗方案为3 Gy/次,每周5次,总剂量39 Gy;同步化疗方案为顺铂35~40 mg/m2,每周1次的同步化疗。观察5年无局部复发生存率(LRFS)、5年无瘤生存率(DFS)、5年无远处转移生存率(FDMS)、5年总生存率(OS)以及不良反应。结果 5年DFS为74.1%、5年LRFS为86.1%、5年FDMS为80.4%、5年OS为74.7%。所有病例整体治疗耐受性较好,虽然3/4级急性黏膜反应发生率为14%,但未发现严重的胃肠道事件或新的安全性问题。结论宫颈癌术后大分割同步放化疗不良反应可接受,治疗依从性好,总体疗效满意,但需随机对照试验进一步证实。
Objective To explore the curative effect and toxicity of radical segmental radiotherapy + concurrent chemotherapy in advanced cervical cancer. Methods From July 2007 to June 2012, 50 patients with massive type Ib, IIa and IIb cervical cancer after extensive hysterectomy and pelvic lymph node dissection were included in the analysis. Radiotherapy combined with large-dose radiotherapy + concurrent chemotherapy: radiotherapy program for the 3 Gy / times, 5 times a week, the total dose of 39 Gy; synchronous chemotherapy regimen of cisplatin 35 ~ 40 mg / m2, once weekly weekly chemotherapy. Five years of no local recurrence (LRFS), 5-year disease-free survival (DFS), 5-year distant metastasis-free survival (FDMS), 5-year overall survival (OS) and adverse reactions were observed. Results The 5-year DFS was 74.1%, the 5-year LRFS was 86.1%, the 5-year FDMS was 80.4% and the 5-year OS was 74.7%. The overall treatment was well tolerated in all cases, although a 3/4 grade acute mucosal response occurred at 14%, but no serious gastrointestinal events or new safety issues were identified. Conclusions Adverse reactions of concurrent radiotherapy and chemotherapy in patients with cervical cancer after operation are acceptable, and the treatment compliance is good. The overall curative effect is satisfactory, but further randomized controlled trials are needed to confirm.