| 摘要: |
| 目的:探讨局部晚期宫颈癌术前新辅助同步放化疗(CCRT)与术后辅助CCRT的临床疗效。方法:回顾性分析2013年1月至2016年12月西京医院妇产科行机器人宫颈癌根治性手术(RS)ⅠB2~ⅡB期宫颈癌患者444例临床资料,根据术前是否接受CCRT分为两组:术前CCRT+RS组(264例)和RS+术后CCRT组(180例)。比较两组患者术中、术后情况及放化疗毒副反应和复发、生存等情况。结果:①术前CCRT+RS组行CCRT后的总有效率(CR+PR)为92.6%,其中CR率9.1%,PR率87.1%。②两组的手术时间、术中出血量、术后住院时间、术后肛门排气时间和术后尿管留置时间差异无统计学意义(P>0.05)。③因两组患者的FIGO分期的构成比比较差异有统计学意义(P<0.05),两组随访的疗效进一步分层(ⅠB2、ⅡA、ⅡB期)比较,ⅡA期患者,其术前CCRT+RS组3年远处转移率、死亡率低于RS+术后CCRT组(P<0.05);3年无瘤生存率、3年总生存率高于RS+术后CCRT组(P<0.05)。而ⅠB2期和ⅡB期患者两组比较,其3年内的随访疗效差异均无统计学意义(P>0.05)。④RS+术后CCRT组患者1~2级急性膀胱毒性及下肢水肿的发生率高于术前CCRT+RS组,差异有统计学意义(P<0.05)。结论:局部晚期宫颈癌采用术前新辅助CCRT联合RS的综合治疗方法可提高近期ⅡA期无瘤生存率和总生存率,不增加手术风险,可减少下肢水肿和1~2级急性膀胱反应的发生率。该结论仍需大样本的临床来验证。 |
| 关键词: 术前新辅助同步放化疗 局部晚期宫颈癌 根治性手术 术后辅助治疗 |
| DOI： |
|
| 基金项目: |
|
| Clinical Study on Preoperative Neoadjuvant Concurrent Chem oradiotherapy Versus Postoperative Adjuvant Concurrent Chem oradiotherapy in the Treatment of Locally Advanced Cervical Cancer |
| GE Junli;SUN Jidong;LI Jia |
| (Xijing Hospital,the Fourth Military Medical University) |
| Abstract: |
| Objective:To explore clinical efficacy of preoperative neoadjuvant concurrent chemoradiotherapy versus postoperative adjuvant concurrent chemoradiotherapy( CCRT) in the treatment of locally advanced cervical cancer( LACC).Methods:The clinical data of 444 LACC patients with stage ⅠB2-ⅡB( International Federation of Gynecology and Obstetrics) receiving robot assisted radical surgery( RS) at the Department of Obstetrics and Gynecology of Xijing Hospital from January 2013 to December 2016 were retrospectively analyzed.According to whether treated with preoperative CCRT,the patients were assigned into two groups.Totally 264 patients with preoperative CCRT were assigned into CCRT+RS group,while the other 180 patients with postoperative adjuvant CCRT and without receiving any adjuvant therapy before operation were assigned into RS +CCRT group. Compared with Intraoperative and postoperative conditions,chemotherapy and side effects,recurrence and survival conditions in two groups.Results:①The total effective rate of preoperative CCRT( CR +PR) was 92. 6%,including 9. 1% in CR rate and 87. 1% in PR rate.②There was no significant difference in operation time,intraoperative blood loss,postoperative hospital stay,postoperative ventilation time and postoperative catheter indwelling time(P>0. 05).③Comparison between the two groups of patients at staging ⅡA,the 3-year distant metastasis rate and mortality rate of CCRT+RS group was lower than that of RS+CCRT group( P<0. 05).The 3-year disease-free survival rate and 3-year overall survival rate were higher in the CCRT+RS group than that in the RS+CCRT group(P<0. 05),The difference was statistically significant(P< 0. 05).④The incidence of acute bladder toxicity and lower extremity edema in patients with RS+CCRT group was higher than those of in the CCRT+RS group,and the difference was statistically significant( P<0. 05).Conclusions:Using preoperative neoadjuvant concurrent chemoradiotherapy combined with radical surgery in the treatment of LACC could improve the recent disease-free survival and overall survival,without increasing the risk of surgery,and can reduce the incidence of lower extremity edema and 1-2 acute bladder reaction.The conclusion still requires a large sample of clinical validation |
| Key words: Preoperativeconcurrentchemoradiotherapy Locallyadvancedcervicalcancer Radicalsurgery Postoperativeadjuvanttherapy |
