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目的探讨紫杉醇联合卡铂同期放疗对高危险早期宫颈癌患者术后的临床疗效及安全性。方法行宫颈鳞癌根治术、分期为ⅠB1~ⅡB且有高危危险因素的患者60例,其中21例放疗1周内行同期放化疗患者作为A组,39例结束放疗后1周开始进行化疗患者作为B组。两组患者均采用紫杉醇联合卡铂进行化疗。比较两组患者的复发率、无进展生存期(PFS)、总生存期(OS)和不良反应发生率。结果两组患者均完成放疗和同期放化疗。随访过程中,A组患者复发率(0)明显低于B组(25.64%)(P<0.05);A组患者5例(23.81%)出现远处转移,4例(19.05%)患者死亡;B组患者10例(25.64%)出现远处转移,8例(20.51%)患者死亡。两组患者PFS、OS比较差异均无统计学意义(P>0.05)。同期放化疗常见的不良反应包括消化道系统和血液系统反应,其中A组患者1~2级血液学不良反应发生率为71.43%(15/21),3级消化道不良反应发生率为28.57%(6/21);B组患者1~2级血液学不良反应发生率为5.13%(2/39),3级消化道不良反应发生率为23.08%(9/39)。A组患者血液学不良反应发生率明显高于B组(P<0.05),其余不良反应发生率两组比较差异均无统计学意义(P>0.05)。A组患者放疗后辅助化疗68周期,B组患者163周期。在放疗后辅助化疗过程中,两组患者多见1~2级血液学和胃肠道不良反应,少见1~2级泌尿生殖系统不良反应。结论紫杉醇联合卡铂同期放疗可有效降低高危险早期宫颈癌患者术后局部复发率,同时患者具有良好的耐受性,值得临床推广应用。
Objective To investigate the clinical efficacy and safety of concurrent paclitaxel and carboplatin in the treatment of high-risk early cervical cancer patients. Methods Sixty patients with stage ⅠB1 ~ ⅡB risk factors for cervical squamous cell carcinoma were divided into two groups. Among them, 21 patients underwent radiotherapy and chemotherapy during the first trimester, and 39 patients underwent radiotherapy one week after radiotherapy. Group B. Both groups were treated with paclitaxel plus carboplatin for chemotherapy. The recurrence rate, progression-free survival (PFS), overall survival (OS) and incidence of adverse reactions were compared between the two groups. Results Both groups completed radiotherapy and concurrent chemoradiotherapy. During the follow-up, the recurrence rate (0) in group A was significantly lower than that in group B (25.64%) (P <0.05); in group A, 5 cases (23.81%) had distant metastasis and 4 cases (19.05% In group B, 10 patients (25.64%) had distant metastasis and 8 patients (20.51%) died. There was no significant difference in PFS and OS between the two groups (P> 0.05). Common side effects of concurrent chemoradiotherapy include gastrointestinal system and hematological reactions, including group A patients with grade 1 to 2 hematological adverse reactions was 71.43% (15/21), grade 3 gastrointestinal adverse reactions was 28.57% (6/21). The incidence of adverse reactions of grade 1 to 2 in group B was 5.13% (2/39), and the incidence of grade 3 gastrointestinal adverse reactions was 23.08% (9/39). The incidence of adverse reactions in group A was significantly higher than that in group B (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Patients in group A received 68 cycles of adjuvant chemotherapy after radiotherapy, and patients in group B had 163 cycles. In the adjuvant chemotherapy after radiotherapy, two groups of patients more common 1 to 2 hematology and gastrointestinal adverse reactions, rare genitourinary system 1 to 2 adverse reactions. Conclusions Paclitaxel combined with carboplatin in the same period of radiotherapy can effectively reduce the local recurrence rate of high-risk early cervical cancer patients, meanwhile, patients have good tolerance and worthy of clinical application.