Choi C H, Kim T-J, Lee S-J, Lee J-W, Kim B-G, Lee J-H, Bae D-S
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Int J Gynecol Cancer. 2006 May-Jun;16(3):1157-64. doi: 10.1111/j.1525-1438.2006.00549.x.
The aim of this study was to assess the efficacy and toxicities of a combination of paclitaxel, ifosfamide, and cisplatin (TIP) for recurrent carcinoma of the uterine cervix. Fifty-three patients with recurrent cervical carcinoma were treated with ifosfamide 1500 mg/m(2) intravenously over 3 h on days 1-3, paclitaxel 135 mg/m(2) as a 3-h intravenous infusion, and cisplatin 50 mg/m(2) intravenously over 30 min on day 1. The chemotherapy was repeated every 3 weeks until there was disease progression or unacceptable toxicity. Forty-five patients received at least three courses of treatment and were evaluable for their response. Twenty-one patients (46.7%) showed objective responses, including 4.4% complete responses and 42.2% partial responses. The median time to progression and the overall survival for all the patients were 8.0 months (95% confidence interval [CI], 7.1-8.9 months) and 19.0 months (95% CI, 11.9-26.1 months), respectively. The median duration of response was 9.0 months. Patients who had previously been treated with another chemotherapy after tumor recurrence showed a moderate response rate (29.4%) but a shorter time to progression (6 vs 8 months, P= 0.0421) and a shorter survival (11 vs 39 months, P= 0.0018). Patients with good performance status showed a higher response rate (63.6% vs 30.4%, P= 0.026) and a longer time to progression (9 vs 7 months, P= 0.0049). Patients with recurrent disease only outside the previous radiotherapy (RT) field exhibited a slightly higher response without statistical significance (60.0% vs 36.0%, P= 0.109). Grade 3 or 4 toxicities included neutropenia in 13% of patients and neurotoxicity in 5%. Three deaths during treatment were observed, but two of them were due to disease progression. We conclude that the combination chemotherapy with TIP yields a high response rate with acceptable toxicity for patients with recurrent cervical carcinoma, including those patients who have failed to respond to prior platinum-based chemotherapy.
本研究的目的是评估紫杉醇、异环磷酰胺和顺铂联合方案（TIP）治疗复发性子宫颈癌的疗效和毒性。53例复发性子宫颈癌患者接受如下治疗：第1 - 3天，异环磷酰胺1500mg/m²静脉滴注3小时；紫杉醇135mg/m²静脉滴注3小时；第1天，顺铂50mg/m²静脉滴注30分钟。每3周重复化疗，直至疾病进展或出现不可接受的毒性。45例患者接受了至少3个疗程的治疗，并可评估其反应。21例患者（46.7%）显示出客观反应，包括4.4%的完全缓解和42.2%的部分缓解。所有患者的中位疾病进展时间和总生存期分别为8.0个月（95%置信区间[CI]，7.1 - 8.9个月）和19.0个月（95%CI，11.9 - 26.1个月）。中位缓解持续时间为9.0个月。肿瘤复发后曾接受过其他化疗的患者显示出中度反应率（29.4%），但疾病进展时间较短（6个月对8个月，P = 0.0421），生存期较短（11个月对39个月，P = 0.0018）。体能状态良好的患者显示出较高的反应率（63.6%对30.4%，P = 0.026）和较长的疾病进展时间（9个月对7个月，P = 0.0049）。仅在先前放疗（RT）野之外出现复发性疾病的患者显示出略高的反应率，但无统计学意义（60.0%对36.0%，P = 0.109）。3级或4级毒性包括13%的患者出现中性粒细胞减少和5%的患者出现神经毒性。治疗期间观察到3例死亡，但其中2例是由于疾病进展。我们得出结论，对于复发性子宫颈癌患者，包括那些对先前铂类化疗无反应的患者，TIP联合化疗产生了较高的反应率且毒性可接受。
