Shen Yi, Yang Lu, Wang Zehua
Department of Gynaecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
Oncol Lett. 2012 Mar;3(3):641-645. doi: 10.3892/ol.2011.529. Epub 2011 Dec 19.
The objective of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. A total of 19 patients who had bulky cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib2 to IIb2 (lesion diameter >4 cm) received NAC with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. The tumor diameter, the response rate, the resection rate and the lymph node metastasis rate after chemotherapy, as well as the toxicity were evaluated. All patients successfully received NAC, with the exception of 1 patient with FIGO Stage Ib2 and 7 cm tumor diameter, who rejected complete therapy. The tumor diameter was reduced from 4.93±0.81cm before NAC to 2.57±1.90 cm after treatment (P<0.01), and the overall response rate [complete remission (CR) + partial remission (PR)] was 78.9% (15/19). Two patients received radiotherapy after NAC, 1 patient was found to have cystic metastasis during the surgery and the operative rate was 83.3% (15/18). Pelvic lymph node metastasis was found in 2 of the 18 patients (11.1%) without parametrial and vaginal margin involvement. Hematological toxicity was the most common side effect and the 3-4 toxicity level was only 11.1% (2/18). In conclusion, NAC with paclitaxel, combined with carboplatin and cisplatin, followed by laparoscopic radical hysterectomy and pelvic lymphadenectomy was found to be effective and safe. Thus, NAC is the ideal treatment for patients with early bulky cervical cancer.
本研究的目的是评估在腹腔镜根治性子宫切除术和盆腔淋巴结清扫术前，紫杉醇联合卡铂和顺铂新辅助化疗（NAC）的疗效和安全性。共有19例国际妇产科联盟（FIGO）分期为Ib2至IIb2期（病灶直径>4 cm）的巨块型宫颈癌患者在腹腔镜根治性子宫切除术和盆腔淋巴结清扫术前接受了紫杉醇联合卡铂和顺铂的NAC。评估了化疗后的肿瘤直径、缓解率、切除率和淋巴结转移率以及毒性。所有患者均成功接受了NAC，但有1例FIGO Ib2期、肿瘤直径7 cm的患者拒绝了完整治疗。肿瘤直径从NAC前的4.93±0.81 cm缩小至治疗后的2.57±1.90 cm（P<0.01），总缓解率[完全缓解（CR）+部分缓解（PR）]为78.9%（15/19）。2例患者在NAC后接受了放疗，1例患者在手术中发现有囊性转移，手术切除率为83.3%（15/18）。18例无宫旁和阴道切缘受累的患者中有2例（11.1%）发现盆腔淋巴结转移。血液学毒性是最常见的副作用，3-4级毒性水平仅为11.1%（2/18）。总之，紫杉醇联合卡铂和顺铂的NAC，随后进行腹腔镜根治性子宫切除术和盆腔淋巴结清扫术被发现是有效且安全的。因此，NAC是早期巨块型宫颈癌患者的理想治疗方法。
