Kim D S, Moon H, Kim K T, Hwang Y Y, Cho S H, Kim S R
Department of Obstetrics and Gynecology, School of Medicine, Hanyang University, Seoul, Korea.
Gynecol Oncol. 1989 May;33(2):225-30. doi: 10.1016/0090-8258(89)90557-x.
The effect of preoperative adjuvant chemotherapy on the 2-year survival rate of patients with locally advanced cervical cancer (stages Ib and II with bulky tumour) was evaluated. The 54 patients first received initial chemotherapy of vinblastine, bleomycin, and cis-platinum in a combined regimen (VBP) and then radical hysterectomy. The overall histologic response rate to chemotherapy of the primary tumor confirmed in the surgical specimen was 81% including microscopic or no evidence of disease (41%, Grade III or IV). A lower than expected incidence of lymph node metastasis (20%) was found. All nodal metastasis was noted in patients with Grades I or II (P = 0.0034). Median follow-up was 36 months (range 26-60 months). Three recurrences (6%) appeared and those patients died of the disease within 24 months. Thus the 2-year tumour-free survival rate was 94%. The patients who had positive nodes more often experienced recurrence (27 vs 0%) and a lower 2-year survival rate (72 vs 100%) (P = 0.0067). All of these recurrences were found in patients with three or more positive nodes. This preliminary study suggest that preoperative adjuvant chemotherapy (VBP) is effective (1) in reducing tumour volume or the stage of the disease, (2) in curing the lymph node involvement, and (3) in improving the 2-year tumour-free survival rate. A prospective randomized study comparing radical surgery alone with preoperative adjuvant chemotherapy followed by radical surgery is in progress.
评估术前辅助化疗对局部晚期宫颈癌（Ib期和II期且肿瘤体积较大）患者2年生存率的影响。54例患者首先接受长春花碱、博来霉素和顺铂联合方案（VBP）的初始化疗，然后进行根治性子宫切除术。手术标本中证实的原发肿瘤对化疗的总体组织学缓解率为81%，包括显微镜下无疾病证据或无疾病（41%，III级或IV级）。发现淋巴结转移发生率低于预期（20%）。所有淋巴结转移均见于I级或II级患者（P = 0.0034）。中位随访时间为36个月（范围26 - 60个月）。出现3例复发（6%），这些患者在24个月内死于该疾病。因此，2年无瘤生存率为94%。有阳性淋巴结的患者更常出现复发（27%对0%），2年生存率较低（72%对100%）（P = 0.0067）。所有这些复发均见于有3个或更多阳性淋巴结的患者。这项初步研究表明，术前辅助化疗（VBP）有效：（1）可缩小肿瘤体积或降低疾病分期；（2）可治愈淋巴结受累；（3）可提高2年无瘤生存率。一项比较单纯根治性手术与术前辅助化疗后再行根治性手术的前瞻性随机研究正在进行中。
