早期高危宫颈癌术后同步放化疗和序贯放化疗的对比研究

目的：对早期高危宫颈癌术后同步放化疗与序贯放化疗的疗效和毒副作用进行比较。方法：６８例早期高危宫颈癌术后患者随机分成同步放化疗组（３５例）及序贯放化疗组（３３例）。同步放化疗组放疗同时予以顺铂（ＤＤＰ）＋亚叶酸钙（ＣＦ）＋氟尿嘧啶（５ ＦＵ）化疗，放疗结束后再行辅助化疗；而序贯放化疗组先仅行放疗，结束后再行辅助化疗。治疗结束后定期复查，评估疗效和毒副作用，并进行对比。结果：同步组和序贯组中位生存时间分别为７０.３个月和６４.６个月（Ｐ＝０.０４７）。两组３年和５年局部无进展生存率分别为９３.８％、８７.５％和９２.１％、８０.９％；３年和５年总生存率分别为９６.８％、９０.６％和９６.１％、８５.０％（Ｐ＝０.０４９）。两组主要毒副反应为放射性直肠炎和骨髓抑制，但患者经治疗后均可耐受。结论：同步放化疗治疗早期高危宫颈癌术后患者，疗效优于序贯放化疗，且安全性较好。

Compare the effect of concurrent chemoradiotherapy with sequential treatment on early stage postoperative cervical carcinoma with high-risk factors

Objective：To compare the effect and adverse effect of concurrent chemoradiotherapy with sequential treatment on early stage postoperative cervical carcinoma with high-risk factors. Methods： Sixty-eight patients of early stage postoperative cervical carcinoma with high-risk factors were randomly divided into two groups：concurrent chemoradiotherapy group and sequential radiotherapy and chemotherapy group. Each patient of the concurrent group was given eisplatin at the dose of 25mg/m2 d1-d3 , calcium folinate, 200mg/m2 and 5-fluorouracil,500mg/m2 d1-d5 when irradiated, repeat every 28 days, total 3 cycles; Each patient of the sequential group received radiotherapy with the same dose and same method first only. All patients of both groups received chemotherapy with cisplatin at the dose of 40mg/m2 d1-d3, calcium folinate,200mg/m2 and 5-fluorouracil,750mg/m2 d1 -d5 four weeks after radiation, repeat every 28 days, total 3 cycles. Results ：The median survival of the concurrent group and sequential group were 70. 3 and 64. 6 months respectively;the 3-, 5-year local progress-free survival rate of both groups were 93.8% , 87.5% and 92. 1% , 80. 9% respectively, showing a significant difference （ P = 0. 047 ）. The overall survival rate were 96. 8% , 90. 6% and 96. 1% , 85.0% respectively （ P = 0.049 ）. The adverse effects of the concurrent group including bone marrow inhibition and reaction of digestive tract were a little roore serious than that of sequential which could be alleviated. Conclusion ： The effect of concurrent ehemoradiotherapy on early stage postop- erative cervical carcinoma with high-risk factors could increase the LPFS and OS of the patients compared with sequential. Toxicity of two groups was no significant difference, but the patients could tolerate.