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目的评价紫杉醇联合卡铂同期放疗(CCRT)在治疗有高危因素早期宫颈癌术后的疗效和毒副反应。方法收集本科2008年7月1日至2011年6月30日收治ⅠB1～ⅡB宫颈鳞癌根治术后有高危因素的患者54例,其中行同期化放疗15例,39例行序贯放疗。同期化疗方案为紫杉醇(135 mg/m~2)联合卡铂(AUC=5)于放疗第一周进行一个疗程。辅助化疗方案同同期化疗,于放疗结束后开始,每21天一个疗程。比较同期化放疗和序贯放疗的复发率、无进展生存期(PFS)和总生存期(OS)以及急性期和晚期不良反应。结果 54例患者均按计划完成治疗,同期化放疗的中位放疗剂量50 Gy(46～52 Gy,每次2 Gy)和人均化疗次数4次(3～5次)与序贯放疗相似(P=0.60和P=0.34)。在中位随访20个月(8～43个月)期间发现,同期化放疗较序贯放疗能减少局部复发率(0/15 vs 9/39,P=0.04),而两组无进展生存期(log-rank,P=0.26)和总生存期(log-rank,P=0.51)相似。同期化放疗患者出现3～4级血液学不良反应比例高于序贯放疗(4/15 vs 1/39,P=0.03),而3级胃肠道急性不良反应相似(4/15 vs 5/39,P=0.22),随访期间两组患者未发现3～4级晚期不良反应。结论紫杉醇联和卡铂的同期化放疗能减少有高危因素的早期宫颈癌术后患者局部复发,并有较好耐受性。
Objective To evaluate the efficacy and toxicity of paclitaxel combined with carboplatin concurrent radiotherapy (CCRT) in the treatment of early stage cervical cancer with high risk factors. Methods From July 1, 2008 to June 30, 2011, 54 patients with high risk factors for ⅠB1 ~ ⅡB cervical squamous cell carcinoma underwent radical resection. Among them, 15 patients underwent concurrent chemoradiotherapy and 39 patients underwent sequential radiotherapy. Concurrent chemotherapy was paclitaxel (135 mg / m 2) combined with carboplatin (AUC = 5) in the first week of radiotherapy for a course of treatment. Adjuvant chemotherapy with the same period of chemotherapy, at the end of radiotherapy, a course of treatment every 21 days. The recurrence rate, progression-free survival (PFS), overall survival (OS) and acute and late adverse events of concurrent and concurrent radiotherapy were compared. Results All 54 patients completed the treatment according to the schedule. The median radiation dose of 50 Gy (46 Gy, 52 Gy, 2 Gy each time) and 4 times (3 to 5 times) = 0.60 and P = 0.34). During a median follow-up of 20 months (range, 8 to 43 months), it was found that concurrent radiotherapy was associated with less local recurrence than with sequential radiotherapy (0/15 vs 9/39, P = 0.04), whereas progression-free survival (log-rank, P = 0.26) and overall survival (log-rank, P = 0.51). The proportion of grade 3 to 4 hematologic adverse reactions was significantly higher in patients with concurrent radiotherapy than in sequential radiotherapy (4/15 vs. 1/39, P = 0.03), while the grade 3 GI adverse effects were similar (4/15 vs 5 / 39, P = 0.22). No adverse reactions of grade 3 to 4 were found in the two groups during follow-up. Conclusions Concurrent chemoradiotherapy with paclitaxel and carboplatin can reduce the local recurrence of patients with early stage cervical cancer who have high risk factors and have better tolerability.