Moioli M, Papadia A, Mammoliti S, Pacella E, Menoni S, Menada M V, Ragni N
Department of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
Minerva Ginecol. 2012 Apr;64(2):95-107.
Neoadjuvant chemotherapy represents a promising alternative to concomitant chemo-radiation therapy in locally advanced cervical cancer patients. The aim of this study was the evaluation of pathologic response rates, toxicity and predictors of response in locally advanced cervical cancer patients treated with neoadjuvant cisplatin and paclitaxel followed by radical surgery.
Fourteen patients with stage IB2 to IIB cervical cancer received three cycles of cisplatin 75 mg/m2 and paclitaxel 175 mg/m2 intravenously every three weeks followed by radical hysterectomy and bilateral pelvic lymphadenectomy. Toxicity, pathologic response and predictors of response were evaluated.
Chemotherapy related toxicities we-re as follows: alopecia 100%, asthenia 35.7%; nausea and vomiting 14.3%; paclitaxel hypersensitivity 7.1%, neutropenia 7.1%. Optimal, partial and no pathologic response was achieved in 21.4%, 64.3% and 14.2% of the patients, respectively. Based on lack of pathologic risk factors, 43% of the patients did not receive any adjuvant radiotherapy. Better response rates were obtained in patients with stage IIB, tumor diameter <5 cm, Hb >12 g/dL and SCC antigen <1.5 mg/dL. None of these variables reached statistical significance.
Neoadjuvant chemotherapy with cisplatin and paclitaxel in locally advanced cervical cancer appeared to be well-tolerated. Even though the TIP regimen has been shown to be more effective than the TP regimen in randomized controlled prospective trial, the TP regimen remains a reasonable alternative in those patients in whom the TIP regimen is considered or shown to be too toxic.
新辅助化疗是局部晚期宫颈癌患者同步放化疗的一种有前景的替代方案。本研究旨在评估新辅助顺铂和紫杉醇治疗后行根治性手术的局部晚期宫颈癌患者的病理缓解率、毒性及缓解预测因素。
14例IB2至IIB期宫颈癌患者每三周静脉接受三个周期的顺铂75mg/m²和紫杉醇175mg/m²治疗，随后行根治性子宫切除术和双侧盆腔淋巴结清扫术。评估毒性、病理缓解情况及缓解预测因素。
化疗相关毒性如下：脱发100%，乏力35.7%；恶心呕吐14.3%；紫杉醇过敏7.1%，中性粒细胞减少7.1%。分别有21.4%、64.3%和14.2%的患者达到最佳、部分和无病理缓解。基于无病理危险因素，43%的患者未接受任何辅助放疗。IIB期、肿瘤直径<5cm、血红蛋白>12g/dL和鳞状细胞癌抗原<1.5mg/dL的患者缓解率更高。这些变量均未达到统计学意义。
局部晚期宫颈癌患者采用顺铂和紫杉醇新辅助化疗耐受性良好。尽管在随机对照前瞻性试验中TIP方案已被证明比TP方案更有效，但对于那些认为或显示TIP方案毒性过大的患者，TP方案仍是一种合理的选择。
