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目的为一例确诊的ⅡA2巨块型宫颈癌患者制定循证治疗方案。方法 针对IIA2期巨块型宫颈癌的治疗问题,提出问题,检索证据,对所获证据进行质量评价,并结合医生的经验和患者的愿望制定治疗方案。结果共纳入296篇文献,31篇系统综述/Meta分析和2篇临床指南。证据结果显示:有高危因素的早期宫颈癌及局部进展期宫颈癌同期放化疗能降低死亡风险,降低肿瘤的局部复发和远处转移,延长患者的无进展生存期及总的生存期,以顺铂为基础的化疗方案优于其他方案。对新辅助化疗的应用尚存在争议,没有有力的证据,综合指南推荐、文献报道、临床经验及患者的具体情况,对该名患者的治疗方案采用全量放疗加顺铂单药同期周化疗。结论对于早期巨块型宫颈癌的最佳根治方案及化疗的选择,目前并无强有力的证据支持,需要遵循循证医学的原则,综合各方面因素考虑。
The purpose is to develop an evidence-based treatment regimen for a confirmed case of IIA2 giant-type cervical cancer. Methods Aiming at the treatment of IIA2 massive cervical cancer, the author put forward the questions, retrieved the evidence, and evaluated the quality of the evidence obtained. Based on the experience of the doctor and the wishes of the patients, the treatment plan was formulated. Results A total of 296 articles, 31 systematic reviews / meta-analyzes and 2 clinical guidelines were included. Evidence results show that: with high risk factors of early cervical cancer and locally advanced cervical cancer concurrent chemoradiotherapy can reduce the risk of death, reduce local recurrence and distant metastasis of the tumor, prolong the patient’s progression-free survival and overall survival to Shun Platinum-based chemotherapy is superior to other options. The use of neoadjuvant chemotherapy is still controversial, there is no strong evidence, comprehensive guidelines recommend, literature reports, clinical experience and the specific circumstances of patients, the patient’s treatment with full dose of radiotherapy plus cisplatin single-week chemotherapy. Conclusion There is no strong evidence support for the best radical regimen and chemotherapy for early giant cervical cancer. The evidence-based medicine needs to follow the principle of comprehensive consideration of various factors.