Neoadjuvant intraarterial chemotherapy followed by radical hysterectomy and/or radiotherapy for locally advanced cervical cancer
Neoadjuvant intraarterial chemotherapy followed by radical hysterectomy and/or radiotherapy for locally advanced cervical cancer
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DOI：
10.1006/gyno.1998.4976
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发表时间：
1998-05-01
影响因子：
4.7
通讯作者：
Yakushiji, M
中科院分区：
文献类型：
--
作者：
Sugiyama, T;Nishida, T;Yakushiji, M
目标.我们评估了局部晚期宫颈癌患者行新辅助动脉化疗（NAC）后行根治性子宫切除术和/或放疗的效果。在5年内，连续招募了48名患有国际妇产科联合会IIb-IVa期宫颈癌的妇女。治疗包括双侧髂内动脉灌注顺铂（100 mg/m2，第1天）或卡铂（400 mg/m2，第1天）和培洛霉素（20 mg/m2，第1天），两个疗程间隔3周。腺癌患者加用阿霉素（30 mg/m2，第1天）。对NAC有反应的III期患者和IIb期患者接受了根治性子宫切除术和盆腔淋巴结切除术。对NAC无反应的III期患者和所有IVa期患者进行盆腔放射治疗。完全缓解5例（10.4%），部分缓解32例（66.78%），病情稳定11例（22.9%）。在25例IIIb期疾病患者中，16例（64.0%）能够接受手术。IIb期患者的4年无病生存率（DFS）为80.0%，III期患者为62.3%。IIIb期手术组4年无病生存率（75.2%）高于放疗组（44.4%）（P < 0.05）。17例（35.4%）患者发生3级或4级白细胞减少。34例（70.8%）发生2级或2级以上恶心和呕吐。16.6%的患者出现了一过性的肌酐清除率降低（≥ 2级）。血清鳞状细胞癌相关抗原（SCC）阴性的患者NAC治疗效果优于SCC阳性患者，SCC阴性患者生存率明显优于SCC阳性患者（P < 0.05）。新辅助动脉化疗与铂安全进行，生存受益后根治性手术后，或不放疗后，对NAC的反应。(C)北京：科学出版社.
Objectives. We assessed neoadjuvant intraarterial chemotherapy (NAC) followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer.Methods. Over 5 years, 48 consecutive women with International Federation of Gynecology and Obstetrics stage IIb-IVa cervical cancer were enrolled. Treatment consisted of bilateral internal iliac artery infusion of cisplatin (100 mg/m(2), day 1) or carboplatin (400 mg/m(2), day 1) and peplomycin (20 mg/m(2), day 1) for two courses separated by 3 weeks. Doxorubicin (30 mg/m(2), day 1) was added for patients with adenocarcinoma. Stage III patients who responded to NAC and Stage IIb patients underwent radical hysterectomy with pelvic lymphadenectomy. Stage III patients not responding to NAC and all stage IVa patients were treated with pelvic radiotherapy.Results. Complete response was achieved in 5 (10.4%) of 48 patients, while a partial response was noted in 32 (66.78) and stable disease in 11 (22.9%). Of 25 patients with stage IIIb disease, 16 (64.0%) were able to undergo surgery. The 4-year disease-free survival (DFS) was 80.0% in patients with stage IIb and 62.3% in patients with stage III. In stage IIIb, the 4-year DFS in patients receiving surgery (75.2%) was higher than the DFS for those receiving radiotherapy (44.4%) (P < 0.05). Grade 3 or 4 leukopenia developed in 17 (35.4%) patients. Nausea and vomiting of grade 2 or higher occurred in 34 (70.8%). Creatinine clearance transiently decreased (greater than or equal to grade 2) in 16.6%. Patients negative for serum squamous cell carcinoma-associated antigen (SCC) responded better to NAC than to SCC-positive cases, and SCC-negative survival was significantly better than SCC-positive survival (P < 0.05).Conclusions. Neoadjuvant intraarterial chemotherapy with platinum was safely performed, and a survival benefit followed radical surgery with or without radiotherapy after response to NAC. (C) 1998 Academic Press.