局部晚期宫颈癌放疗前新辅助化疗的临床研究

Clinical study of neoadjuvant chemotherapy before radiotherapy for locally advanced cervical cancer

摘要:

目的： 探讨放疗前行新辅助化疗（neoadjuvant chemotherapy，NACT）的局部晚期宫颈癌（locally advanced cervical cancer，LACC）患者治疗情况及临床疗效。方法： 纳入2013年1月至2017年12月重庆大学附属肿瘤医院收治的IB2~IVA期宫颈鳞癌患者150例，均在放疗前行NACT，评估患者的治疗及骨髓抑制发生情况，分析1年和3年总生存率（overall survival，OS）、无进展生存率（progression-free survival，PFS）。结果： 36例（24%）放疗期间未能同步化疗，而同步化疗的患者中有48例（42.11%）未足疗程完成；55例（36.67%）放疗时程>56 d；71例（47.33%）发生了Ⅲ级以上骨髓抑制。近期客观缓解率（objective response rate，ORR）为84.66%，其中完全缓解率（complete response，CR）仅25.33%。112例（74.67%）给予不同程度的后续辅助治疗。1年和3年OS、PFS分别为90.0%和66.7%、66.7%和46.7%。结论： LACC患者放疗前行NACT，降低了放疗的耐受性，延长了放疗时程，影响了同步化疗的实施，未延长患者的OS、PFS，并未改善LACC患者的预后。

Abstract:

Objective: To investigate the therapeutic status and clinical curative effects of patients with locally advanced cervical cancer (LACC) who underwent neoadjuvant chemotherapy (NACT) before radiotherapy. Methods: Totally 150 cases of LACC (IB2-IVA) admitted to Chongqing University Cancer Hospital from January 2013 to December 2017 were collected in this study. All patients underwent NACT before radiotherapy. The therapeutic status and myelosuppression were evaluated, and the overall survival (OS) and progression-free survival (PFS) of 1 year and 3 years were analyzed. Results: The concurrent chemotherapy for 36 cases (24%) were not administered during radiotherapy, and 48 cases (42.11%) did not complete the full course of chemotherapy among patients receiving concurrent chemotherapy. The duration of radiotherapy for 55 cases (36.67%) were more than 56 days. The GradeⅢor higher myelosuppression were occurred in 71 patients (47.33%). The recent objective response rate (ORR) was 84.66%, but the complete response (CR) was only 25.33%. A total of 112 cases (74.67%) were given various forms of follow-up adjuvant therapy. The OS and PFS of 1 year and 3 years were 90.0% and 66.7%, and 66.7% and 46.7%, respectively. Conclusion: The NACT before radiotherapy for LACC patients reduces the tolerance to radiation therapy, prolongs the duration of radiotherapy, affects the implementation of concurrent chemotherapy, and the prognosis of LACC patients is not improved because the OS and PFS are not prolonged.