Neoadjuvant chemotherapy for patients younger than 50 years with high-risk squamous cell carcinoma of the cervix
Neoadjuvant chemotherapy for patients younger than 50 years with high-risk squamous cell carcinoma of the cervix
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DOI：
10.1006/gyno.2001.6371
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发表时间：
2001-11-01
影响因子：
4.7
通讯作者：
Tanaka, K
中科院分区：
文献类型：
--
作者：
Aoki, Y;Tomita, M;Tanaka, K
目标。为评价新辅助化疗(NAC)治疗50岁以下局部晚期宫颈鳞癌的有效率和毒副反应，提高生存率。21例术前接受NAC治疗。符合条件的患者包括以前未经治疗的IB期或IIA期，通过磁共振成像评估有深层间质侵犯，或年龄小于50岁的巨大肿瘤或IIB鳞状细胞癌。NAC包括顺铂(60 mg/m(2))第1天，长春花碱(4 mg/m(2)/d)第1、2天，培普霉素(10 mg/d)第1、8、15天(PVP)。每3周重复治疗一次，共两个周期。21例患者均在NAC后行根治性子宫切除术。术后放射治疗18例。我们使用21名接受根治性子宫切除术和术后放射治疗的患者作为非随机对照组。NAC有效率为86%(18/21)。两名患者在一次治疗后分别因4级中性粒细胞减少和血小板减少以及一氧化碳弥散能力下降而需要停止PVP治疗。NAC组间质侵袭明显减少(P=0.0103)，淋巴结转移率降低。没有患者的宫旁和阴道边缘呈阳性。NAC组总的5年生存率为84.0%，明显优于对照组的58.9%(P=0.0434)。对于年轻的局部晚期宫颈癌患者，NAC被认为是安全的、耐受性好的、有效的，并且有助于增加可操作性、减少病理危险因素和提高生存率。(C)2001年学术出版社。
Objective. To evaluate the response rate and toxicity and to improve survival, neoadjuvant chemotherapy (NAC) was utilized in patients younger than 50 years with locally advanced cervical squamous cell carcinoma.Methods. Twenty-one patients were treated with preoperative NAC. Eligibility included patients with previously untreated stage IB or IIA with deep stromal invasion assessed by magnetic resonance imaging or bulky tumor or IIB squamous cell carcinoma who were younger than 50 years. The NAC consisted of cisplatin (60 mg/m(2)) on day 1, vinblastine (4 mg/m(2)/day) on days 1 and 2, and peplomycin (10 mg/day) on days 1, 8, and 15 (PVP). Treatment was repeated every 3 weeks for a total of two cycles. All 21 patients underwent radical hysterectomy following NAC. Postoperative radiotherapy was given to 18 patients. We used 21 patients who underwent radical hysterectomy and postoperative radiation therapy as a nonrandomized control group.Results. The response rate for NAC was 86% (18/21). Two patients required discontinuation of PVP treatment after one a ministration because of grade 4 neutropenia and thrombocytopenia, and decreased carbon monoxide diffusion capacity, respectively. In the NAC group, stromal invasion was significantly reduced (P = 0.0103), and the incidence of lymph node metastasis was decreased. No patients had positive parametrial and vaginal margins. The overall 5-year survival rate was 84.0% in the NAC group, which was significantly better than that in the control group (58.9%) (P = 0.0434).Conclusions. NAC for younger patients with locally advanced cervical carcinoma is thought to be safe, well tolerated, effective, and useful for increasing operability, decreasing pathological risk factors, and improving survival. (C) 2001 Academic Press.