术前辅助放化疗加根治性子宫切除术治疗ⅠB2~ⅡA期宫颈癌50例临床分析
Clinical analysis of 50 cases of stage ⅠB2-ⅡA cervical carcinoma with radical hysterectomy after neoadjuvant chemo-irradiation
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摘要:目的 分析术前辅助放化疗后行根治性子宫切除术加盆腔淋巴切除术治疗FIGOⅠB2~ⅡA期宫颈癌患者, 探讨宫颈癌的个体化治疗。方法 回顾2006年6月至2010年6月期间在天津市中心妇产科医院治疗的所有术前辅助放化疗后行根治性子宫切除术的宫颈癌FIGOⅠB2~ⅡA期患者资料。结果 共50例FIGOⅠB2~ⅡA期患者术前行新辅助化疗以及阴道盒消瘤治疗后行根治性子宫切除术加盆腔淋巴切除术。50例患者手术顺利, 手术时间平均195 min(110~285 min), 平均失血量583 mL(200~1 400 mL)。28%(14/50)患者出血量超过800 mL, 需要输血治疗。术后尿储留4例, 血栓性静脉炎2例, 3例术后复发率6%。12例患者盆腔淋巴结转移, 其中2例患者同时有宫旁转移, 1例患者阴道残端有肿瘤细胞。23例患者具有2种以上高危因素(包括宫颈间质深层浸润、淋巴血管内瘤栓、肿瘤大小≥4 cm)。共26例患者需要术后辅助治疗。远期并发症3~4度骨髓抑制为4%(2/50), 放射性直肠炎和放射性膀胱炎2%(1/50)和输尿管肾盂积水2%(1/50), 淋巴水肿6%(3/50), 阴道狭窄发生率4%(2/50)。中位随访时间43个月, 3年生存率90%, 3年无瘤生存率90%。结论 术前辅助放化疗加根治性子宫切除的治疗宫颈癌ⅠB2~ⅡA期患者安全有效, 能够获得理想的生存率, 并发症发生率较低。Abstract:Objective This study aims to analyze the results of pre-operative brachytherapy and neoadjuvant chemotherapy followed by radical hysterectomy in cases of International Federation of Gynecology and Obstetrics(FIGO) stage ⅠB2-ⅡA cervical carcinoma and to investigate the effect of individualized treatment on cervical cancer.Methods Cervical cancer cases treated with brachytherapy and chemotherapy before surgery in Tianjin Central Hospital for Obstetrics and Gynecology between June 2006 and June 2010 were reviewed.Results Fifty patients received brachytherapy, pretoperative chemotherapy followed by redical hysterectomy and pelvic lymph node dissection.The median operating time was 195 min(range 110 min to 285 min) and the median blood loss was 583 mL(range 200 mL to 1400 mL).Among the 50 patients, 14(28%) experienced an estimated blood loss of more than 800 mL during surgery and required blood transfusion, 4 experienced urinary retention, and 2 manifested thrombophlebitis.The postoperative febrile morbidity rate(> 38℃ for 2 days) was 6%(3/50) and the median time of recovery was 7 days(range 4 days to 18 days).Twelve patients(24%) exhibited positive lymph nodes, with parametrial invasion in 2 patients(4%) and positive incisal margin of the vagina in 1 patient(2%).Up to 23 patients had more than two intermediate risk factors.A total of 26(52%) patients needed adjuvant therapy after surgery.Approximately 2 patients(4%) experienced long-term complications, such as G3 to G4 myelosuppression, 1 patient(2%) had proctitis and cystitis, and 2 patients(4%) had symptomatic vaginal stenosis.The morbidities of ureterohydronephrosis and lymphedema were 2%(1/50) and 6%(3/50), respectively.The median follow-up time was 43 months(range 24 months to 72 months).The three-year overall survival and disease-free survival rates were 90% CI(range 61.70 to 71.05) and 90% CI(range 61.61 to 71.10), respectively.Conclusion Pre-operative brachytherapy and neoadjuvant chemotherapy are safe for the treatment of FIGO stage IB2-IIA cervical carcinoma and can achieve optimal survival rate and low complications.
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