Scarabelli C, Zarrelli A, Gallo A, Visentin M C
Department of Gynecologic Oncology, Centro di Riferimento Oncologico di Aviano, Italy.
Cancer. 1995 Sep 15;76(6):1019-26. doi: 10.1002/1097-0142(19950915)76:6<1019::aid-cncr2820760616>3.0.co;2-4.
The purpose of this study was to determine the role of neoadjuvant intraarterial chemotherapy (NIC) in patients with advanced cervical cancer.
From June 1989 to December 1993, 36 consecutive patients with International Federation of Gynecology and Obstetrics Stage IIIB-IVA cervical cancer were admitted to the study. Treatment consisted of a bilateral infusion in the internal iliac artery of bleomycin (2.5 mg), doxorubicin (10 mg), and cisplatin (20 mg) for five courses after a 4-day rest period.
Twenty-nine (80.5%) patients received 100% of the programmed chemotherapeutic dose. The major toxic effects, according to World Health Organization criteria, were hematologic (19.4%, Grade 3 or 4), renal (2.8%, Grade 2), and gastrointestinal (61.1%, Grade 1 or 2). Only four patients (11.1%) had scanty bleeding around the site of catheter insertion. Neoadjuvant intraarterial chemotherapy induced responses in 33 of the 36 patients (5 complete, 28 partial; overall response rate, 91.7%), thus permitting radical surgery in all of these cases. Pretreatment characteristics were analyzed for response to NIC. None of the clinical parameters studied were related to chemoresponsiveness. A lower than expected incidence of lymph node metastases was detected (33.3%). Ten (30.3%) of the 33 patients who underwent surgery had disease recurrence. Lymph node status and pathologic parametrial involvement were significant prognostic factors for recurrence. The 5-year estimated survival for patients with a complete response, partial response, and stable disease was 100%, 36.2%, and 0%, respectively (P < 0.001). Clinical stage (P = 0.003) and response to NIC (P < 0.001) were significant prognostic factors in the overall estimated survival. The 5-year actuarial survival for patients with Stage IIIB and IVA disease was 66.7% and 0%, respectively.
These results suggest that NIC should be considered as a means of achieving prompt local control before surgery and/or radiotherapy.
本研究的目的是确定新辅助动脉内化疗（NIC）在晚期宫颈癌患者中的作用。
从1989年6月至1993年12月，连续36例国际妇产科联盟（FIGO）分期为IIIB-IVA期的宫颈癌患者纳入本研究。治疗方法为在双侧髂内动脉输注博来霉素（2.5mg）、阿霉素（10mg）和顺铂（20mg），每5个疗程后休息4天。
29例（80.5%）患者接受了100%的计划化疗剂量。根据世界卫生组织标准，主要毒副作用为血液学毒性（19.4%，3级或4级）、肾脏毒性（2.8%，2级）和胃肠道毒性（61.1%，1级或2级）。仅4例患者（11.1%）在导管插入部位周围有少量出血。新辅助动脉内化疗使36例患者中的33例产生反应（5例完全缓解，28例部分缓解；总缓解率为91.7%），从而使所有这些病例都能进行根治性手术。分析了治疗前特征对NIC的反应。所研究的临床参数均与化疗反应性无关。检测到淋巴结转移发生率低于预期（33.）。33例接受手术的患者中有10例（30.3%）疾病复发。淋巴结状态和病理参数受累是复发的重要预后因素。完全缓解、部分缓解和病情稳定患者的5年估计生存率分别为100%、36.2%和0%（P<0.001）。临床分期（P=0.003）和对NIC的反应（P<0.001）是总体估计生存率的重要预后因素。IIIB期和IVA期疾病患者的5年精算生存率分别为66.7%和0%。
这些结果表明，NIC应被视为在手术和/或放疗前实现快速局部控制的一种手段。
