Neoadjuvant chemotherapy followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for Stage IB2-IIB cervical cancer-Irinotecan and platinum chemotherapy
Neoadjuvant chemotherapy followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for Stage IB2-IIB cervical cancer-Irinotecan and platinum chemotherapy
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DOI：
10.1016/j.ygyno.2010.07.031
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发表时间：
2010-11-01
影响因子：
4.7
通讯作者：
Takizawa, Ken
中科院分区：
文献类型：
--
作者：
Matsumura, Maki;Takeshima, Nobuhiro;Takizawa, Ken
目标。目的探讨新辅助化疗(NAC)加根治性子宫切除加术后化疗对IB2~IIB期宫颈癌的疗效。连续46例IB2-IIB期宫颈癌患者接受NAC治疗，然后行根治性子宫切除术加术后化疗。患者体重指数(BMI)中位数为20.2(16.2~26.4)。术后化疗方案为伊立替康+顺铂(CPT-11/CDDP)或CPT-11+奈达铂(CPT-11/NDP)。总共开了6个周期的NAC和术后化疗。没有计划使用放射治疗，除非复发。中位生存期38.8个月(24~54个月)，2年和3年无进展生存率分别为91.2%和86.1%。NAC的总有效率为80.4%。有7例患者复发。在没有放射治疗的情况下，只有三名患者观察到盆腔复发；另外两名患者有腹主动脉旁淋巴结，其余两名患者有远处转移。化疗引起的毒性一般是可以耐受的。术后并发症包括尿瘘4例(8.7%)和肠梗阻2例(4.3%)，均需手术干预。结果表明，在IB2-IIB期宫颈癌的治疗中，NAC加手术加术后化疗而不加放疗是一种可行的选择。虽然在低BMI患者中观察到术后并发症的发生率相对较高，但这种治疗方法提供了将放射导致的发病率降至最低的优势，允许将放射治疗保留到可能发生盆腔复发的情况下。(C)2010 Elsevier Inc.保留所有权利。
Objective. To evaluate the effectiveness of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for stage IB2-IIB cervical cancer.Methods. Forty-six consecutive patients with stage IB2-IIB cervical cancer were treated with NAC followed by radical hysterectomy plus postoperative chemotherapy. Median (range) body mass index (BMI) of the patients was 20.2 (16.2-26.4). Regimens for NAC and postoperative chemotherapy were irinotecan and cisplatin (CPT-11/CDDP) or CPT-11 and nedaplatin (CPT-11/NDP). A total of six cycles of NAC and postoperative chemotherapy were prescribed. No use of radiotherapy was scheduled, except in the case of a recurrence.Results. With a median follow-up period for survivors of 38.8 months (range 24-54 months), the 2- and 3-year progression-free survival rates were 91.2% and 86.1%, respectively. Overall response rate of NAC was 80.4%. Recurrence was observed in seven patients. In the absence of radiotherapy, pelvic recurrence was observed in only three patients; another two had para-aortic lymph nodes and the remaining two distant metastases. Toxicities due to chemotherapy were generally tolerable. Postoperative complications included urinary fistula (four patients, 8.7%) and bowel obstruction (two patients, 4.3%), all of which required surgical intervention.Conclusion. The results indicate that NAC followed by surgery plus postoperative chemotherapy but no radiotherapy offers a viable option in the treatment of stage IB2-IIB cervical cancer. Although a relatively large incidence of postsurgical complications was observed among low-BMI patients, this treatment offers the advantage of minimizing radiation-induced morbidity, allowing radiotherapy to be reserved for the possible event of pelvic recurrence. (C) 2010 Elsevier Inc. All rights reserved.