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[目的]观察同步放化疗不同化疗方案应用于宫颈癌术后伴有高危复发因素患者的疗效、并发症。[方法]回顾性分析2008年1月至2013年3月山东省肿瘤医院收治的经术后病理证实伴有1个或多个高危不良预后因素、接受单纯放疗或同步放化疗治疗且具备完整临床病理资料的早期宫颈癌患者327例,其中接受单纯放疗(调强放射放疗+腔内放疗)者53例,接受同步放化疗(调强放射治疗+腔内放疗+化疗)者274例,后者根据化疗方案不同分为FP方案(5-氟尿嘧啶+顺铂)+IMRT+腔内放疗组(96例)、TP方案(紫杉醇+顺铂)+IMRT+腔内放疗组(91例)、PEB方案(顺铂+依托泊甙+博来霉素)+IMRT+腔内放疗组(87例),比较4组患者的治疗效果和相关并发症发生情况。[结果]随访时间为39~99个月,中位随访时间46个月。单纯放疗组、FP方案+放疗组、TP方案+放疗组、PEB方案+放疗组3年无瘤生存率分别为66.0%、80.2%、84.6%、81.6%,差异有统计学意义(χ2=8.959,P=0.03);3年总生存率分别为71.7%、85.4%、87.9%、83.9%,单纯放疗组和同步放化疗组比较差异均有统计学意义(P<0.05),但同步放化疗3组间差异无统计学意义(P>0.05)。4组患者慢性放疗毒副反应发生率差异无统计学意义(P>0.05)。[结论 ]对于早期高危宫颈癌患者,术后采用同步化疗+IMRT+腔内放疗可取得理想的治疗效果,不同化疗方案之间疗效及相关并发症发生率相当,但三联方案并发症发生率稍高。
[Objective] To observe the curative effect and complications of different chemotherapeutic regimens of concurrent chemoradiotherapy in patients with high risk of recurrent cervical cancer after operation. [Methods] Retrospective analysis of one or more high-risk adverse prognostic factors in Shandong Tumor Hospital from January 2008 to March 2013 was retrospectively analyzed. The patients were treated with radiotherapy alone or concurrent chemoradiotherapy and had complete clinical Pathological data of 327 patients with early cervical cancer, of which 53 patients received simple radiotherapy (IMRI plus intracavitary radiotherapy), receiving concurrent chemoradiotherapy (IMRT plus intracavitary radiotherapy + chemotherapy) were 274 cases, the latter According to the different chemotherapy regimens, they were divided into FP regimen (fluorouracil + cisplatin) + IMRT + endovascular radiotherapy group (96 cases), TP regimen (paclitaxel + cisplatin) + IMRT + Platinum + etoposide + bleomycin) + IMRT + intracavitary radiotherapy group (87 cases). The therapeutic effect and the related complication of the four groups were compared. [Results] The follow-up time ranged from 39 to 99 months and the median follow-up time was 46 months. The 3-year disease-free survival rates were 66.0%, 80.2%, 84.6% and 81.6% in radiotherapy alone, FP + radiotherapy, TP plus radiotherapy and PEB plus radiotherapy, respectively , P = 0.03). The overall 3-year survival rates were 71.7%, 85.4%, 87.9% and 83.9% respectively. There was significant difference between the radiotherapy group and the concurrent chemoradiotherapy group (P <0.05) There was no significant difference among the three groups (P> 0.05). There was no significant difference in the incidence of side effects of chronic radiation among four groups (P> 0.05). [Conclusion] For patients with early stage high risk cervical cancer, the use of synchronous chemotherapy + IMRT + intracavitary radiotherapy after operation can achieve the ideal therapeutic effect. The curative effect and related complication rates among different chemotherapy regimens are quite similar, but the incidence of complications in triple therapy is slightly higher .