Cervical cancer is one of the three most common malignant tumors in female reproductive system, which seriously affects the quality of life and the life of women [1]. Currently radiotherapy and surgery is the main treatment of cervical cancer, although radiotherapy and surgical treatment technology has been improved, but the 5 year survival rate of patients with advanced cervical cancer has not been significantly improved [2, 3]. In recent years, preoperative interventional chemotherapy has been paid more attention, it can effectively control the tiny metastasis and improve the resection rate. It has become a new and effective method of adjuvant chemotherapy [4]. This study retrospectively analyzed the clinical data of our hospital 97 patients with locally advanced artery cervical cancer patients in to in treatment of locally advanced cervical artery clinical effect difference compared with traditional chemotherapy and interventional arterial chemotherapy in two ways, report as follows now.
1, data and methods
1.1, research object
January 2011 to 2013 in 97 cases of our hospital of locally advanced (I-Ia~IIIb) cervical cancer patients and age (between 30 and 59 years old, average age (36.62 + 7.12) years old. According to the treatment methods are divided into routine group (conventional chemotherapy) (55 cases) and intervention group (interventional arterial chemotherapy) 42 cases, all were the main clinical performance of irregular vaginal bleeding and liquid flow, according to the criteria of FI-GO 2009 International Federation of gynecology and obstetrics diagnosis. There were no significant differences in clinical data between the two groups (all P>0.05), see table 1.
Table 1 Comparison of clinical data between two groups before treatment
1.2, treatment method
Conventional group was given conventional radiotherapy and chemotherapy: using in vitro pelvic radiotherapy, brachytherapy radiotherapy and cisplatin sensitizing chemotherapy method. According to the 180~200cGy/ time in vitro pelvic radiotherapy, 5 times per week, reaching 2500~3000cGy then of pelvic cavity brachytherapy, 500~700cGy/. Once a week, to 3000~4000cGy, radiotherapy and given the concentration of cisplatin 40 mg / m2, weekly 1 times. Percutaneous coronary interventional artery chemotherapy group: using Seldinger s technique of unilateral femoral artery puncture, the abdominal aortic bifurcation at 2 cm placed 5.0F pigtail type catheter, according to the speed of 10 ml / s injection 30ml iopromide significantly, 136.1 kPa pressure delay 1 second DSA angiography showed tumor location and tumor feeding arteries, based on the images of DSA manifestations of selected RH, 4.0~5.0FRS or cobra catheter, super selection inserted into the internal iliac artery stem or uterine artery. According to the principle of the artery chemotherapy choice: nedaplatin 80 ~ 100 mg / m2 or carboplatin 300 mg / m2 or cisplatin 60 to 90 mg / m2, diluted with physiological saline. Total amount of liquid 150~100 ml. For all patients after chemotherapy infusion (time 20 min, total liquid 2/3) will contain anti-cancer drugs (liquid total amount of 2/3) of gelatin sponge particles embolism uterine artery or double iliac artery.
1.3, observation index
Conventional treatment observation group and intervention group, the clinical features and complications, measuring tumor size, clinical staging change were analyzed, in accordance with the WHO evaluation criteria and evaluation of curative effect: complete remission (CR) refers to the complete disappearance of the tumor and maintain more than 4 weeks), partial remission (PR) refers to the tumors to shrink by more than 50% and maintained for more than 4 weeks, stable (SD) refers to the tumors to shrink or increase no more than 25%, and no new lesions appear, progress (PD) refers to the tumor increased more than 25%, the emergence of new lesions. At the same time, the quality of life index scale (QL-Index) [5] all patients daily life, exercise, health, support, and general situation of evaluation, each score of 0, 1 and 2, respectively, each add up to total score higher health status is normal.
1.4, statistical analysis
Excel database was established by using the results of the study, by double entry double input and calibration data, using statistical software SPSS 17. 0 for statistical analysis, measurement data using t-test, count data using chi square test, ranked data by rank sum test, inspection standard alpha = 0.05.
2, the results
Two, 2.1 groups of patients after treatment of clinical features
Treatment after interventional group, tumor diameter was significantly lower than that in normal group, the difference has statistical significance (P < 0.05); also in the intervention group rate of radical operation was higher than that of the normal group, the difference has statistical significance (P < 0.05); and two groups of clinical downstaging ratio had no significant difference, the difference was not statistically significance (P > 0.05), see Table 2.
Table 2 Comparison of clinical features of two groups of patients after treatment
Two, 2.2 groups of patients after the treatment of the near future curative effect comparison
There was no significant difference (P>0.05) between the conventional group and the intervention group in the short term curative effect after treatment, see table 3.
Table 3 Comparison of short term effects after treatment in two groups (n,%)
Two, 2.3 groups of patients after treatment quality of life index
After treatment, the patients in the intervention group were significantly higher than the normal group, the difference was statistically significant (P<0.05), and the difference was statistically significant ().
Table 4 Comparison of the quality of life of the two groups after treatment
Two, 2.4 groups of patients with complications after treatment
After treatment, the intervention group patients of bladder injury occurred in 3 cases, rectal injury occurred in 2 cases, 1 case ureteral injury, and the conventional group all occurred in patients with secondary type amenorrhea, 10 cases occurred radiation proctitis, 6 cases occurred radiation cystitis, 6 cases secondary intestinal infection, 3 cases occurred local radioactive skin and soft tissue injury.
3, discussion
Cervical cancer exist around the world is one of the human body is the most common malignant tumor, not only occupies the first place in the female reproductive organs in cancer, and is all female malignant tumor is the most common cancer [6]. Many patients due to various reasons do not have a strong sense of self health care and economic level is low, cause not timely diagnosis of cervical cancer, and in patients with advanced disease [J]. At this time the traditional put chemotherapy in the treatment and the efficacy of surgical treatment is usually not ideal, because the majority of patients with parametrial and regional lymph node metastasis, and larger lesions, the radiotherapy sensitivity is not high, resulting in difficult operation or inoperable [8-10]. In recent years, with the medical technology development and various auxiliary treatment of the cervical cancer by prior to surgery and radiotherapy chemotherapy supplemented by postoperative treatment means development [11 to the preoperative treatment, 12], especially preoperative interventional vein chemotherapy greatly valued, currently involved in the uterine artery embolization combined with surgery, radiotherapy treatment has become the treatment of the patients with cervical cancer effective method [13, 14]. This study retrospectively analyzed the clinical data of 97 patients with locally advanced cervical cancer, and compared the clinical effects of traditional chemotherapy and interventional arterial chemotherapy in the treatment of two patients with locally advanced cervical cancer.
The results of this study showed that the recent curative effect and the clinical stage of the patients in the conventional group and the intervention group were higher, and the difference was not statistically significant. In the intervention group, the tumor diameter was significantly smaller than that of the conventional group, and the radical operation rate was significantly higher than that of the conventional group, the difference was statistically significant. Interventional artery chemotherapy is through the catheter directly in the arteries that supply blood to the tumor injection chemotherapy drugs, make with less drug dose make cancer first obtain the highest impact concentration, drug plasma protein binding was reduced, drug utilization index was increased by a big margin [15], also did not destroy the lesion of all the vessels, lymphatic [16], also perilesional tissue, micro vascular and regional lymph node also has higher drug concentration, so as to achieve efficient killing effect, helping to narrow the primary lesions and reduce the clinical stages [17, 18]. Interventional artery chemotherapy and help to surgical resection, control lymphatic, intravascular transfer, reduce intraoperative and postoperative metastasis, to reduce the complications of surgery, also let operation can't be performed who get the chance of operation, and improve the tumor cells to radiation sensitivity [19, 20]. The study results show traditional radiotherapy and chemotherapy group, the incidence of complications in patients with large, easy to make the patients occurred following the hair amenorrhoea, radiation proctitis, cystitis, local radiation skin and soft tissue injury and secondary enteric infection, and the intervention group, the incidence of complications in patients with less. At the same time after treatment, the intervention group patients with daily life, health, the overall situation and the total score were significantly higher than those in the normal group and the differences were significant statistically significant and the conventional group quality of life index is low may and chemoradiation therapy in patients with after a variety of complications have a certain relationship.
To sum up, the traditional chemotherapy and interventional arterial chemotherapy in the treatment of locally advanced cervical artery patients have better short-term effect, but to get involved in arterial chemotherapy can more effectively reduce the tumor size, with higher radical operation rate and quality of life, and relatively few complications.