Ki Kyung-Do, Song Dong-Hwa, Tong Seo-Yun, Lim Myong-Cheol, Lee Jong-Min, Lee Seon-Kyung
Department of Obstetrics and Gynecology, East-West Neo Medical Center, Kyung Hee University, Seoul, Republic of Korea.
Int J Gynecol Cancer. 2009 Jan;19(1):50-3. doi: 10.1111/IGJ.0b013e318197f8be.
We retrospectively analyzed 51 consecutive patients with bulky International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer who were treated with vincristine (1 mg/m), bleomycin (25 mg/m; days 1-3), and cisplatin (50 mg/m) every 10 days between 1995 and 2005 to assess the efficacy and the safety of a quick course of neoadjuvant chemotherapy. A clinical response occurred in 37 patients (72.5%), including 7 patients (13.7%) with a complete response and 30 patients (58.8%) with a partial response; 13 patients (25.5%) had a stable disease, and 1 patient (2.0%) had a progressive disease. Among the 50 patients who were surgically explored, 42 patients had a radical hysterectomy with pelvic and para-aortic lymphadenectomy; radical surgery was aborted in 8 patients because of paracervical and para-aortic lymph node involvement. Hematologic toxicity was the most common adverse event with anemia occurring most frequently, followed by leukopenia. Importantly, pulmonary toxicity occurred in 7 patients, 2 of whom died of complications from pulmonary fibrosis 1 and 3 months after radical surgery. With a median follow-up of 53 months (range, 2-129 months), the estimated 2- and 5-year survival rates were 74.9% and 61.3%, respectively. In conclusion, the survival benefit of a quick course of neoadjuvant chemotherapy consisting of vincristine, bleomycin, and cisplatin may be uncertain despite the significant clinical response in bulky International Federation of Gynecology and Obstetrics stage IB2-IIA cervical cancer. Special care is required to monitor bleomycin-induced pulmonary toxicity.
我们回顾性分析了1995年至2005年间连续收治的51例患有巨大国际妇产科联盟（FIGO）分期为IB-IIA期宫颈癌的患者，这些患者接受了长春新碱（1 mg/m²）、博来霉素（25 mg/m²；第1 - 3天）和顺铂（50 mg/m²）每10天一次的治疗，以评估短疗程新辅助化疗的疗效和安全性。37例患者（72.5%）出现临床缓解，其中7例（13.7%）完全缓解，30例（58.8%）部分缓解；13例患者（25.5%）病情稳定，1例患者（2.0%）病情进展。在接受手术探查的50例患者中，42例行根治性子宫切除术及盆腔和腹主动脉旁淋巴结清扫术；8例患者因宫颈旁和腹主动脉旁淋巴结受累而中止根治性手术。血液学毒性是最常见的不良事件，贫血最为频繁，其次是白细胞减少。重要的是，7例患者出现肺部毒性，其中2例在根治性手术后1个月和3个月死于肺纤维化并发症。中位随访时间为53个月（范围2 - 129个月），估计2年和5年生存率分别为74.9%和61.3%。总之，尽管在巨大的FIGO分期为IB2-IIA期宫颈癌中短疗程由长春新碱、博来霉素和顺铂组成的新辅助化疗有显著临床缓解，但生存获益可能不确定。需要特别注意监测博来霉素引起的肺部毒性。
