李莉 李根 梁华 张丹

[摘要] 目的 比較低剂量顺铂（DDP）联合5-氟尿嘧啶（5-Fu）方案与经典DDP单药方案用于中晚期宫颈癌同期放化疗中的效果及毒副作用。 方法 收集2008年2月～2012年12月于成都市妇女儿童中心医院就诊的中晚期宫颈癌患者64例，所有患者均采用同步放化疗治疗，放疗方法均为体外全盆腔照射和盆腔内放疗。根据化疗方案不同将其分为两组，低剂量DDP联合5-Fu组（A组，n=34）：DDP 15 mg/（m2·d），5-Fu 600 mg/（m2·d），静脉滴注，连续5 d，放疗前、中、后各化疗1个疗程，共3次；DDP单药方案组（B组，n=30）给予DDP 40 mg/（m2·d），每周1次，共6次。记录并比较两组疗效和毒副作用，治疗结束后每3个月复查1次，检查并统计疾病进展情况。 结果 A组和B组的治疗有效率分别为94.1%和96.7%，差异无统计学意义（P > 0.05）；2年无进展生存率分别为85.2%和76.7%，差异无统计学意义（P > 0.05）；A组Ⅲ、Ⅳ级急性化疗不良反应（血液系统不良反应、消化系统不良反应、皮炎和肝肾功能损害）发生率明显高于B组（P < 0.05），而Ⅲ、Ⅳ级非血液系统慢性毒副作用发生率明显低于B组（P < 0.05）。 结论 低剂量DDP联合5-Fu方案同步放化疗治疗宫颈癌与DDP单药方案同步放化疗效果相似，但前者急性毒副作用发生率低，慢性毒副作用发生率高，患者更易耐受。

[关键词] 中晚期宫颈癌；同期放化疗；顺铂；5-氟尿嘧啶

[中图分类号] R735.1 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0119-04

Comparative study of low dose Cisplatin combined with 5-Fluorouracil and Cisplatin single-agent in the treatment of advanced cervical cancer

LI Li LI Gen▲ LIANG Hua ZHANG Dan

Department of Pharmaceutical， Chengdu Women and Children's Center Hospital， Sichuan Province， Chengdu 610091， China

[Abstract] Objective To compare the clinic efficacy and toxicity of low dose Cisplatin （DDP） combined with 5-Fluorouracil （5-Fu） regimen and DDP single-agent in the treatment of advanced cervical cancer. Methods 64 patients with advanced cervical carcinoma from February 2008 to December 2012 in Chengdu Women and Children's Center Hospital were selected， all of the patients were given radiation and chemo-therapy， the radiation methods were whole pelvic radiotherapy and pelvic radiotherapy. They were divided into two groups according to different chemotherapy regimens， the low dose DDP combined with 5-Fu treatment group （group A， n = 34）： DDP 15 mg/（m2·d）， 5-Fu 600 mg/（m2·d）， intravenous drip， 5 days for one treatment course. Three times of treatment were respectively implemented in the period of before， during and after radiotherapy. The DDP treatment group （group B， n = 34）： DDP 40 mg/（m2·d）， one time a week， continually 3 weeks. The curative effect and adverse reaction in both groups were recorded and compared， patients were reviewed every 3 months after treatment， and the progress of disease was record. Results The effective rates of group A and group B were 94.1% and 96.7% respectively， the difference was not statistically significant （P > 0.05）； 2-year progression-free survival rates of group A and group B were 85.2% and 76.7% respectively， the difference was not statistically significant （P > 0.05）. The incidence of acute chemotherapy adverse reaction of grade Ⅲ， Ⅳ （adverse reaction of blood system and digestive system， dermatitis， liver and kidney impairment） in group A was significantly higher than that of group B （P < 0.05）， while the incidence of chronic side effects in non-blood system of group A was significantly lower than that of group B （P < 0.05）. Conclusion Low dose DDP combined with 5-Fu has same chemotherapy effect as the DDP single-agent in the treatment of cervical cancer， but incidence of acute toxic side reaction of the former is low， and chronic side effects is high， therefore patients were more easily tolerated.

[Key words] Medium-term and advanced cervical cancer； Concurrent chemotherapy； Cisplatin； 5-Fluorouracil

宫颈癌好发于中年女性，是一种常见的女性肿瘤，其发病率仅次于乳腺癌，据统计，全球每年有49万例新发病例，27万例死亡病例[1-2]。早期宫颈癌主要通过手术治疗，其生存率得到了显著提高。中、晚期患者主要采取放射治疗，但由于放射剂量受限，致使单纯放疗效果较差，5年存活率不超过40%，复发者的存活率更是低于30%[3-4]，因此传统单纯放疗已逐渐被同步放化疗所取代。临床试验表明，与单纯放疗比较，以顺铂为基础的同步放化疗能够明显改善患者的生存率[5-8]，但该药物毒副作用较大，所以寻找新的同期放化疗方案替代经典的顺铂（DDP）方案成为研究重点。本研究比……