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目的 评价采用诱导性化疗加照射治疗晚期外阴癌的方法以替代晚期外阴癌根治性手术的效果.方法 1989年5月～1997年5月收治了FIGO分期Ⅱ期外阴癌30例,肿瘤直径均大于4cm,不是累及阴道、尿道、阴蒂,就是累及肛周.中位年龄63岁(43～78岁).化疗用改良VBP方案(VCR1mg/m~2,第1天,CDDP60mg/m~2,第1天,或分3天用,BLM_(A5)25mg/m~2,第1～3天)每10天重复一次,共3个疗程,1周后采用角度楔形野照射,剂量DT65～70Gy/6～7周.结果 全组在30天内完成三程化疗共86个疗程,缓解率达86.7%,完全经解率达30.16%18例随访超过5年,13例无瘤存活,五年生存率达72.2%,主要合并症,近期是放射性外阴炎23%,肛周痛2例,远期合并症,尿道狭窄尿潴留1例,股骨颈病理性骨折1例,无放射性直肠炎和膀胱炎产生.结论 改良VBP方案用于外阴癌化疗对缩小肿瘤体积是有效的,化疗加照射治疗晚期外阴癌与根治性手术治疗疗效相似,保留了女阴形态完整和功能,避免了腹壁造瘘,改善了患者的生活质量.
Objective To evaluate the efficacy of induction chemotherapy plus irradiation for the treatment of advanced vulvar cancer to replace radical vulvar cancer surgery.Methods 30 cases of FIGO stage Ⅱ vulvar cancer were treated from May 1989 to May 1997. The tumor diameters were both larger than 4cm, not involving the vagina, urethra, clitoris, is involving the perianal. The median age of 63 years (43 to 78 years old.) Chemotherapy with modified VBP regimen (VCR1mg / m ~ 2 on the first day, CDDP60mg / 1 day, or 3 days, BLM_ (A5) 25mg / m ~ 2, 1 ~ 3 days) repeated every 10 days, a total of 3 courses, 1 week after the use of angle wedge field irradiation dose DT65 ~ 70Gy / 6 to 7 weeks.Results The whole group completed 86 courses of three courses of chemotherapy within 30 days, the response rate was 86.7%, the complete resolution rate was 30.16%. 18 cases were followed up for more than 5 years, 13 cases survived without tumor, 5 years survival rate Up to 72.2%, the main complication, the recent is 23% of radiological vulvitis, perianal pain in 2 cases, long-term complications, urethral stricture, urinary retention in 1 case, femoral neck pathological fracture in 1 case, no radiation proctitis and cystitis .Conclusion Modified VBP regimen is effective in reducing the tumor volume in vulvar cancer chemotherapy. Chemotherapy plus irradiation in treatment of advanced vulvar cancer is similar to radical surgery Vulva complete the form and function, avoiding the abdominal fistula, improve the quality of life of patients.