Panetta A, Angelelli B, Martoni A
Division of Medical Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy.
Anticancer Res. 1999 Jan-Feb;19(1B):765-8.
Induction chemotherapy, consisting of 3 courses of cisplatin (30 mg/m2/i.v. 1st and 2nd day), epirubicin (30 mg/m2/i.v. 1st and 2nd day), etoposide (75 mg/m2/i.v. 1st and 2nd day) and bleomycin (15 mg/i.v. 1st and 2nd day), prior to radical hysterectomy and lymph nodes resection, was used in the primary treatment of 34 consecutive patients (pts) with cervical carcinoma: 8 stage Ib < 4 cm, 11 stage Ib > 4 cm, 13 stage IIa, 2 stage IIb. Median age was 55 years (range 32-75) and median Karnofsky performance status was 90% (range 70-100%).
Among the 34 evaluable patients (pts), the overall clinical response rate was 53%, which included a complete response in 9 pts (26.5%) and a partial response in 9 subjects (26.5%). Fifteen stable diseases and one progression were also observed. All the pts were operated on and no invasive residual tumor was found in the surgical specimens obtained from 6/9 clinical complete responders. Lymph-node metastases were found after chemotherapy in 16% (5/32) of the pts with stable disease. Eight pts presented disease recurrence, four had isolated pelvic recurrences, two had pelvic and distant failure, and two had isolated distant metastases. Until now, 9 pts have died. The most frequent toxic effects were: alopecia 100%, nausea-vomiting 73% (25/34), leukopenia 65% (22/34).
The results suggest that the administration of induction chemotherapy prior to surgery is effective in reducing the tumor volume and results in tolerable toxicity. However, the impact on survival is questionable and randomized trials for conventional treatment are needed.
在34例连续的宫颈癌患者的初始治疗中，于根治性子宫切除术和淋巴结切除术前采用诱导化疗，化疗方案为3个疗程的顺铂（第1天和第2天，30 mg/m²，静脉注射）、表柔比星（第1天和第2天，30 mg/m²，静脉注射）、依托泊苷（第1天和第2天，75 mg/m²，静脉注射）和博来霉素（第1天和第2天，15 mg，静脉注射）：8例Ib期＜4 cm，11例Ib期＞4 cm，13例IIa期，2例IIb期。中位年龄为55岁（范围32 - 75岁），中位卡诺夫斯基体能状态为90%（范围70 - 100%）。
在34例可评估患者中，总体临床缓解率为53%，其中9例（26.5%）完全缓解，9例（26.5%）部分缓解。还观察到15例病情稳定和1例进展。所有患者均接受了手术，在9例临床完全缓解者的手术标本中未发现侵袭性残留肿瘤。病情稳定的患者中有16%（5/32）在化疗后发现有淋巴结转移。8例患者出现疾病复发，4例为孤立性盆腔复发，2例为盆腔和远处转移失败，2例为孤立性远处转移。截至目前，9例患者死亡。最常见的毒性反应为：脱发100%，恶心呕吐73%（25/34），白细胞减少65%（22/34）。
结果表明，术前给予诱导化疗在缩小肿瘤体积方面有效，且毒性可耐受。然而，对生存的影响尚不确定，需要进行传统治疗的随机试验。
