Kaku Shoji, Takahashi Kentaro, Murakami Yoshitaka, Wakinoue Shirou, Nakagawa Tetsuya, Shimizu Yoshihiko, Kita Nobuyuki, Noda Yoichi, Murakami Takashi
Departments of Obstetrics and Gynecology, and.
Exp Ther Med. 2010 Jul;1(4):651-655. doi: 10.3892/etm_00000102. Epub 2010 Jul 1.
Chemoradiotherapy is currently the main treatment for locally advanced cervical cancer, but neoadjuvant intraarterial chemotherapy (IA-NAC) has been reported to achieve favorable results. This study investigated the efficacy of several different IA-NAC regimens. The subjects were 55 patients with stage IIB-IIIB cervical cancer who received IA-NAC between January 1991 and April 2006. IA-NAC was administered for a total of 1-3 courses at 3-week intervals, with three different regimens being employed in chronological order. The response rate achieved with IA-NAC was 90.2% for squamous cell carcinoma, 60% for adenosquamous carcinoma and 42.9% for adenocarcinoma. Surgery was performed after IA-NAC in 36 patients, and radiotherapy alone was performed in 19 patients. The 5-year survival rate was 72.9% for patients with squamous cell carcinoma and 50% for those with adenocarcinoma or adenosquamous carcinoma. PAMF therapy (cisplatin, epirubicin, mitomycin-C and 5-fluorouracil) achieved a response rate of ≥90% for squamous cell carcinoma, as did CDDP + THP therapy (cisplatin plus pirarubicin), while PACF therapy (cisplatin, epirubicin, cyclophosphamide and 5-flurouracil) achieved a better response rate for adenosquamous carcinoma and adenocarcinoma. Grade 3 or 4 hematological toxicity was significantly more common with PAMF therapy. In conclusion, IA-NAC improved the survival of patients with squamous cell carcinoma. CDDP + THP therapy achieved a high response rate with little hematologic toxicity. PACF therapy achieved a significantly higher response rate in patients with adenosquamous carcinoma or adenocarcinoma. Therefore, IA-NAC may be a therapeutic option for locally advanced cervical cancer, particularly using the above-mentioned regimens.
目前，放化疗是局部晚期宫颈癌的主要治疗方法，但据报道新辅助动脉内化疗（IA-NAC）也取得了良好效果。本研究调查了几种不同IA-NAC方案的疗效。研究对象为1991年1月至2006年4月期间接受IA-NAC治疗的55例IIB-IIIB期宫颈癌患者。IA-NAC共进行1-3个疗程，间隔3周，按时间顺序采用了三种不同方案。IA-NAC对鳞状细胞癌的有效率为90.2%，腺鳞癌为60%，腺癌为42.9%。36例患者在IA-NAC后接受了手术，19例患者仅接受了放疗。鳞状细胞癌患者的5年生存率为72.9%，腺癌或腺鳞癌患者为50%。PAMF疗法（顺铂、表柔比星、丝裂霉素-C和5-氟尿嘧啶）对鳞状细胞癌的有效率≥90%，CDDP + THP疗法（顺铂加吡柔比星）也是如此，而PACF疗法（顺铂、表柔比星、环磷酰胺和5-氟尿嘧啶）对腺鳞癌和腺癌的有效率更高。PAMF疗法3级或4级血液学毒性明显更常见。总之，IA-NAC提高了鳞状细胞癌患者的生存率。CDDP + THP疗法有效率高且血液学毒性小。PACF疗法在腺鳞癌或腺癌患者中的有效率显著更高。因此，IA-NAC可能是局部晚期宫颈癌的一种治疗选择，特别是采用上述方案时。
