Sugiyama T, Nishida T, Hasuo Y, Fujiyoshi K, Yakushiji M
Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan.
Gynecol Oncol. 1998 May;69(2):130-6. doi: 10.1006/gyno.1998.4976.
We assessed neoadjuvant intraarterial chemotherapy (NAC) followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer.
Over 5 years, 48 consecutive women with International Federation of Gynecology and Obstetrics stage IIb-IVa cervical cancer were enrolled. Treatment consisted of bilateral internal iliac artery infusion of cisplatin (100 mg/m2, day 1) or carboplatin (400 mg/m2, day 1) and peplomycin (20 mg/m2, day 1) for two courses separated by 3 weeks. Doxorubicin (30 mg/m2, day 1) was added for patients with adenocarcinoma. Stage III patients who responded to NAC and Stage IIb patients underwent radical hysterectomy with pelvic lymphadenectomy. Stage III patients not responding to NAC and all stage IVa patients were treated with pelvic radiotherapy.
Complete response was achieved in 5 (10.4%) of 48 patients, while a partial response was noted in 32 (66. 7%) and stable disease in 11 (22.9%). Of 25 patients with stage IIIb disease, 16 (64.0%) were able to undergo surgery. The 4-year disease-free survival (DFS) was 80.0% in patients with stage IIb and 62.3% in patients with stage III. In stage IIIb, the 4-year DFS in patients receiving surgery (75.2%) was higher than the DFS for those receiving radiotherapy (44.4%) (P < 0.05). Grade 3 or 4 leukopenia developed in 17 (35.4%) patients. Nausea and vomiting of grade 2 or higher occurred in 34 (70.8%). Creatinine clearance transiently decreased (>/= grade 2) in 16.6%. Patients negative for serum squamous cell carcinoma-associated antigen (SCC) responded better to NAC than to SCC-positive cases, and SCC-negative survival was significantly better than SCC-positive survival (P < 0.05).
Neoadjuvant intraarterial chemotherapy with platinum was safely performed, and a survival benefit followed radical surgery with or without radiotherapy after response to NAC.
我们评估了新辅助动脉内化疗（NAC）联合根治性子宫切除术和/或放疗用于局部晚期宫颈癌患者的疗效。
在5年多的时间里，连续纳入了48例国际妇产科联盟（FIGO）分期为IIb-IVa期的宫颈癌女性患者。治疗方案为双侧髂内动脉灌注顺铂（100mg/m²，第1天）或卡铂（400mg/m²，第1天）以及培普利霉素（20mg/m²，第1天），共两个疗程，疗程间隔3周。腺癌患者加用阿霉素（30mg/m²，第1天）。对NAC有反应的III期患者和IIb期患者行根治性子宫切除术及盆腔淋巴结清扫术。对NAC无反应的III期患者和所有IVa期患者行盆腔放疗。
48例患者中5例（10.4%）达到完全缓解，32例（66.7%）部分缓解，11例（22.9%）病情稳定。在25例IIIb期患者中，16例（64.0%）能够接受手术。IIb期患者的4年无病生存率（DFS）为80.0%，III期患者为62.3%。在IIIb期，接受手术患者的4年DFS（75.2%）高于接受放疗患者的DFS（44.4%）（P<0.05）。17例（35.4%）患者发生3级或4级白细胞减少。34例（70.8%）患者出现2级或更高等级的恶心和呕吐。16.6%的患者肌酐清除率短暂下降（≥2级）。血清鳞状细胞癌相关抗原（SCC）阴性的患者对NAC的反应优于SCC阳性患者，且SCC阴性患者的生存率显著高于SCC阳性患者（P<0.05）。
铂类新辅助动脉内化疗安全可行，对NAC有反应后，无论是否进行放疗，根治性手术后均有生存获益。
