摘要
同步放化疗是局部晚期子宫颈癌的首选治疗方案,但受医疗资源和放疗副反应的限制,新辅助化疗后行根治性子宫切除术在很多国家及地区作为替代方案。多项临床研究证明了顺铂或卡铂联合紫杉醇新辅助化疗的可行性和安全性。与直接手术相比,新辅助化疗可提高手术切除率、减少术后并发症和术后辅助放疗,但长期生存获益仍有争议;与同步放化疗相比,无进展生存期较短,但两者的总体生存期无显著差异,毒副反应的靶器官各有不同。可见,新辅助化疗在局部晚期子宫颈癌的治疗中有其优势和局限性,实施前需充分考虑其利弊,进行个体化决策。此外,化疗方案优化和化疗反应预测的研究有望改善新辅助化疗反应率,使更多局部晚期子宫颈癌患者获益。
Concurrent chemoradiation is the first choice of treatment for locally advanced cervical cancer.However,in a radiation resource-limited setting or as a part of efforts to avoid radiation-induced adverse effects,neoadjuvant chemotherapy followed by radical hysterectomy has been used as an alternative in many countries and regions.Multiple clinical trials have confirmed the feasibility and safety of neoadjuvant chemotherapy with cisplatin or carboplatin plus paclitaxel.Compared with primary radical surgery,preoperative neoadjuvant chemotherapy can improve resection rate,reduce postoperative complications,and decrease the demand for adjuvant radiotherapy,while the long-term survival benefits are still controversial.Compared with concurrent chemoradiation,neoadjuvant chemotherapy followed by radical surgery is associated with a shorter progression-free survival,but it does not compromise the overall survival,and the spectrum of toxic effects varies between these two treatment strategies.In conclusion,neoadjuvant chemotherapy has strengths and limitations in treatment for locally advanced cervical cancer,and it is necessary to balance its advantages and disadvantages and make personalized decisions.Hopefully,efforts to optimize chemotherapy regimens and predict responsiveness to chemotherapy are able to improve the chemotherapy response rate in the near future,conferring more benefits for cervical cancer patients.
作者
张菁霓
蔡晶
王泽华
ZHANG Jing-ni;CAI Jing;WANG Ze-hua(Union Hospital,Tongji Medical College,Huazhong University of Sciencee and Technology,Wuhan 430022,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2023年第7期677-683,共7页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家自然科学基金(81974413)。
关键词
子宫颈肿瘤
新辅助化疗
同步放化疗
手术
化疗方案
cervical neoplasm
neoadjuvant chemotherapy
concurrent chemoradiation
surgery
chemotherapy regimen
