3种同步化疗方案在中晚期宫颈癌放疗中的疗效及不良反应

Efficacy and Toxicity of Three Different Concurrent Chemoradiotherapy in Local Advanced Cervical Cancer

关键词:  宫颈癌  同步放化疗  顺铂  氟尿嘧啶  紫杉醇

Key words:  cervical cancer  concurret chemoradiotherapy  cisplatin  fluorouracil  paclitaxel

摘要:

目的 比较3种同步化疗方案在中晚期宫颈癌放疗中的疗效及不良反应。方法 将符合入组标准的105例ⅡB-ⅢB中晚期宫颈癌患者随机分为DDP组、FP组、TP组，每组各35例，均行根治性放疗，DDP组放疗期间给予顺铂单药周疗，共4~5程，FP组给予氟尿嘧啶及顺铂联合化疗，间隔3周疗法，共2程，TP组给予紫杉醇及顺铂联合化疗，间隔3周疗法，共2程，对3组患者的疗效及不良反应分别进行记录。结果 根治性放疗结束1月后3组患者的完全缓解率（complete remission rate，CR）分别为88.6%，82.9%，82.9%，部分缓解率（partial remission rate，PR）分别11.4%，17.1%，11.4%；治疗结束3月后3组患者的CR率分别为97.1%，97.1%，94.3%，3组比较差异均无统计学意义。3组的2年总生存率分别为97.1%，85.7%，91.4%，2年的无瘤生存率分别为82.9%，85.7%，88.6%，差异均无统计学意义。主要近期不良反应为骨髓抑制和胃肠道反应，TP组3~4度白细胞减少及中性粒细胞减少的发生率最显著，FD组3~4度恶心、呕吐、腹泻及肠梗阻的发生率最显著，差异均有统计学意义（P<0.05），远期不良反应为放射性肠炎及放射性膀胱炎，3组的发生率均无统计学意义。结论 中晚期宫颈癌根治性放疗中3种同步化疗方案的近期疗效相似，2年的总生存率及无瘤生存率无差异，紫杉醇联合顺铂组的骨髓抑制最严重，氟尿嘧啶联合顺铂组的胃肠道反应最严重。

Abstract:

OBJECTIVE To observe the efficacy and toxicity of three concurrent chemotherapy regimens in the radiotherapy of local advanced cervical cancer. METHODS The 105 patients with FIGO stage IIB-IIIB cervical cancer were treated with concurrent chemoradiotherapy, and all cases were randomly divided into three groups, DDP group(35 cases) received cisplatin weekly for 4-5 cycles, FP group(35 cases) received fluorouracil and cisplatin combined chemotherapy every 3 weeks for 2 cycles, TP group(35 cases) received paclitaxel and cisplatin combined chemotherapy every 3 weeks for 2 cycles. Then compared acute adverse reaction and the efficacy of all patients. RESULTS The complete remission rates of the three groups were 88.6%, 82.9%, 82.9%, the partial remission rates were 11.4%, 17.1%, 11.4% at one month after radiotherapy, the complete remission rates were 97.1%, 97.1%, 94.3% at three months after radiotherapy, there was no significant difference(P>0.05). The 2-year overall survival rates were 97.1%, 85.7%, 91.4%, the 2-year disease-free survival rates was 82.9%, 85.7%, 88.6%, there was no significant difference. The main acute adverse reactions were bone marrow suppression and gastrointestinal reactions. Grade 3-4 leucopenia and neutropenia incidence was more common in paclitaxel and cisplatin group, Grade 3-4 nausea, vomiting, diarrhea and intestinal obstruction were more common in fluorouracil and cisplatin group (P<0.05). The main long-term adverse reactions were radiation enteritis and radiation cystitis, and the incidence of the three groups had no significant difference. CONCLUSION The short-term efficacy of the three concurrent chemotherapy for the treatment of advanced cervical cancer are similar. The 2-year overall survival rate and disease-free survival rate between three groups is similar. The paclitaxel and cisplatin group arise more severe bone marrow suppression. The fluorouracil and cisplatin group arise more severe gastrointestinal reactions.