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新辅助化疗和手术在宫颈癌中的作用。

The role of neoadjuvant chemotherapy and surgery in cervical cancer.

机构信息

Department of Obstetrics and Gynecology, Second Medical Faculty, Charles University, Prague, Czech Republic.

出版信息

Int J Gynecol Cancer. 2010 Oct;20(11 Suppl 2):S42-6. doi: 10.1111/igc.0b013e3181f60d73.

Abstract

The role of neoadjuvant chemotherapy (NAC) in "bulky" and locally advanced cervical cancer has been of interest for the last 25 years, and in many countries, NAC has become the standard of care. In the present paper, we review our 10 years' experience with high-dose-density NAC in cervical cancer management in 141 women (CervNAC I protocol). High-dose-density neoadjuvant chemotherapy and radical surgery has resulted in high clinical response rates and seems to be feasible in the management of stage IB bulky cervical cancer. Neoadjuvant chemotherapy reduces tumor volume and positivity of lymph nodes and thus minimizes the need for postoperative radiotherapy or chemoradiotherapy. Tumor size reduction and node negativity allows less radical surgical procedures such as modified radical hysterectomy or nerve-sparing radical hysterectomy. Early and especially late toxicity of our high-dose density chemotherapy is acceptable. Neoadjuvant chemotherapy followed by surgery represents a valid alternative to primary chemoradiotherapy in young and sexually active patients. Five-year survival in patients who underwent surgery in our study was 80.6%. Currently, 3 papers with 3 approaches have been published on NAC before fertility-sparing surgery. One of the limitations of fertility-preserving surgery is deep stromal invasion and tumors larger than 2 cm. The idea underlying NAC is to reduce the size of the cervical tumor to preserve fertility. In the present paper, we also review our experience with high-dose-density NAC in fertility-sparing surgery in 15 women (LAP3-NAC protocol).

摘要

新辅助化疗(NAC)在“大肿块”和局部晚期宫颈癌中的作用已经引起了 25 年的关注,在许多国家,NAC 已成为标准治疗方法。在本文中,我们回顾了我们在 141 名妇女(CervNAC I 方案)中使用高剂量密度 NAC 治疗宫颈癌的 10 年经验。高剂量密度新辅助化疗和根治性手术导致了高临床反应率,似乎在治疗 IB 期大肿块宫颈癌方面是可行的。新辅助化疗可缩小肿瘤体积并降低淋巴结阳性率,从而最大限度地减少术后放疗或放化疗的需求。肿瘤大小缩小和淋巴结阴性允许进行更保守的手术,如改良根治性子宫切除术或保留神经的根治性子宫切除术。我们高剂量密度化疗的早期和特别是晚期毒性是可以接受的。新辅助化疗后手术是年轻和有性生活的患者替代原发放化疗的有效选择。在我们的研究中,接受手术的患者 5 年生存率为 80.6%。目前,已有 3 篇关于生育保留手术前 NAC 的论文发表,采用了 3 种不同的方法。生育保留手术的一个局限性是深层间质浸润和肿瘤大于 2cm。NAC 的理念是缩小宫颈肿瘤的大小,以保留生育能力。在本文中,我们还回顾了我们在 15 名妇女(LAP3-NAC 方案)中进行高剂量密度 NAC 生育保留手术的经验。

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