中晚期宫颈癌多西他赛联合顺铂化疗同步放疗临床观察

目的探讨多西他赛联合顺铂化疗同步放疗治疗中晚期宫颈癌的临床疗效及不良反应。方法内蒙古医科大学附属人民医院2005-04-15-2009-04-15收治96例ⅡB-ⅢB期宫颈癌患者,其中放化疗50例（给予多西他赛联合顺铂化疗同步放疗）,接受单纯放疗46例。单纯放疗组应用盆腔外照射联合腔内近距离照射放疗方案,外照射采用6 MV X直线加速器,利用三维适形技术,盆腔四野盒式照射,剂量达（24-30）Gy/（12-15）次,腔内近距离照射A点剂量为7Gy/次,共6-7次。放化疗组化疗应用TP方案,3周为1个周期,连续治疗2-3个周期。具体用药为多西他赛75mg/m2,静脉滴入,d1;顺铂75mg/m2,静脉滴入,d1-d3。化疗当天开始行放射治疗,放疗方案与单纯放疗组相同。按照WHO实体瘤疗效判定标准,比较两组患者的近期临床疗效及远期临床效果,并比较不良反应。结果 96例患者均完成了放疗和化疗。放化疗组治疗后,完全缓解率为20.0%,显著高于单纯放疗组的6.5%;总体有效率为62.0%,显著高于单纯放疗组的34.8%,χ2=3.972,P=0.031。放化疗组1年生存率为98.0%,与单纯放疗组的93.5%相比,差异无统计学意义,χ2=7.793,P=0.281;放化疗组2年生存率为86.0%,优于单纯放疗组的63.0%,χ2=10.472,P=0.026;放化疗组局部复发率为8.0%,优于单纯放疗组的30.4%,χ2=13.851,P=0.008;放化疗组远处转移率为10.0%,优于单纯放疗组的36.9%,χ2=11.635,P=0.031。放化疗组胃肠道反应、骨髓抑制、放射性直肠炎和放射性膀胱炎的发生率分别为98.0%、96.0%、52.0%和50.0%,显著高于放疗组的71.7%、76.1%、30.4%和28.3%,但经对症处理后均得以缓解,患者可以耐受,不影响治疗的进程。结论顺铂联合多西他赛同步放疗治疗中晚期宫颈癌,可显著增强治疗效果,能明显提高患者的生存率。

Efficacy observation of advanced cervical cancer treatment with concurrent radiotherapy combined with docetaxel and cisplatin

OBJECTIVE To investigate the clinical efficacy of advanced cervical cancer treatment with concurrent radiotherapy combined with docetaxel and cisplatin.METHODS Ninety-six patients ofⅡB-ⅢB cervical cancer were collected from 2005 to 2009in our hospital,and they were randomly assigned into two groups.Fifty patients were given concurrent radiotherapy combined with docetaxel and cisplain,and 46 patients were treated with radiotherapy only.Treatment：simple radiotherapy patients with pelvic external beam radiotherapy plan joint cavity close exposure,external exposure the 6 MV X linear accelerator,using three dimensional conformal technology,pelvic fields cassette illuminate,dose of（24-30）Gy/（12-15）f,point A cavity close exposure dose for 7Gy/times,total of 6-7times.TP chemotherapy application solutions,3weeks for a cycle,continuous treatment of 3cycles;Specific medication：Docetaxel 75mg/m2 surface area,d1,Cisplatin 75mg/m2 surface area,d1 to d3.The clinical efficacy,long-term clinical results and the incidence of complications in two groups were compared and analyzed.RESULTS The complete remission rate and overall response rate were 20.0% and 62.0% in group treated with concurrent radiotherapy combined with docetaxel and cisplain,which was significantly higher than 6.5%,34.8% of the radiotherapy group.One-year survival rate was 98.0%in chemoradiotherapy group,compared to 93.5% of the radiotherapy group,with no statistical difference（P〉0.05）.Two-year survival rate was 86.0%in chemoradiotherapy group,compared to 63.0% of the radiotherapy group,with statistical difference（P〈0.05）.Local recurrence rates was 8.0%in chemoradiotherapy group,and 30.4%in radiotherapy alone group（P〈0.05）.Distant metastasis rates were 10.0%in chemorasiotherapy group,and 36.9%in radiotherapy alone group（P〈0.05）.The adverse effects of chemoradiotherapy group were significantly higher than that of radiotherapy group,but the symptoms of patients were relieved after treatment and that could not affect the proces