ABSTRACT
Objective:To evaluate the 3-year survival outcomes and late injury between the self-designed patent single-channel applicator, which was modified from the traditional tandem applicator and wrapped with a oval-shield alloy around the source channel and standard Fletcher-type applicator in the high-dose-rate brachytherapy for cervical cancer.Methods:Patients initially diagnosed with cervical cancer in the Affiliated Hospital of Southwest Medical University from December 2011 to April 2017 were enrolled and randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. The whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (Equivalent Dose in 2 Gy at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m 2 once weekly during EBRT. Clinical efficacy and safety were evaluated after corresponding treatment. Results:In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. Up to December 2020, all patients had been followed up for 3 years, and the median duration of follow-up was 61 months. In the Fletcher group, the 3-year overall survival, progression-free survival and locoregional failure-free survival was 76.3%, 78.1% and 75.4%, and 83.8%, 80.3% and 85.5% in the single-channel group, respectively. In the Fletcher group, the cumulative rate of grade 3-4 late rectal complications was 3.3% and 6.7% in the single-channel group ( P=0.122). The cumulative rate of grade 3-4 bladder complications was 1.3% in the Fletcher group and 0.7% in the single-channel group ( P=1.000). Conclusion:The self-designed patent single-channel intracavitary applicator yields equivalent long-term clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer.
ABSTRACT
Objective:To evaluate the effects of the nadirs of neutrophils and lymphocytes during concurrent chemoradiotherapy (CCRT) on clinical prognosis of patients with cervical cancer, aiming to provide reference data for clinicians.Methods:Clinical data of FIGO (2018)Ⅰ B1-Ⅳ A cervical cancer patients treated with radical CCRT in the University of Hong Kong-Shenzhen Hospital, from January 2015 to September 2019 were analyzed. Routine blood test was performed weekly. The overall survival (OS) was calculated by Kaplan- Meier method and analyzed by log-rank test. Univariate and Multivariate prognostic analysis were performed by Cox proportional hazards model. Results:A total of 87 patients were included. The cutoff values of absolute neutrophil count nadir (ANC n) and absolute lymphocyte count nadir (ALC n) for predicting OS were determined by receiver operating characteristic curve. Compared with the ANC n of ≤2.14×10 9/L ( n=76), patients with the ANC n of > 2.14×10 9/L ( n=11) had lower 2-year OS rate (54.5% vs. 88.9%, P=0.035). Compared with ALC n of > 0.2×10 9/L ( n=49), patients with ALC n of ≤0.2×10 9/L ( n=38) obtained lower 2-year OS rate (75.3% vs. 90.8%, P=0.008). Multivariate analysis showed that ANC n (>2.14×10 9/L vs. ≤2.14×10 9/L)( HR=4.487, 95% CI: 1.404-14.344, P=0.011), ALC n (≤0.2×10 9/L vs. >0.2×10 9/L)( HR=5.814, 95% CI: 1.822-18.554, P=0.003), concurrent chemotherapy cycle (5-6 cycles vs. 0-4 cycles)( HR=0.204, 95% CI: 0.060-0.696, P=0.011) and the mean body radiation dose ( HR=1.296, 95% CI: 1.125-1.493, P<0.001) were significantly associated with OS. Patients with the ANC of > 5.19×10 9/L before CCRT were more likely to have ANC n of > 2.14×10 9/L during CCRT and those with the ALC of < 2.05×10 9/L before CCRT was more likely to have ALC n of ≤0.2×10 9/L during CCRT. Conclusions:Peripheral ANC n and ALC n during CCRT have different prognostic effects and influencing factors. Clinical prognosis of cervical cancer patients may be improved by closely monitoring routine blood parameters and optimizing treatment modality during CCRT.
ABSTRACT
Objective:To investigate the value of serum miR-143 level combined with MRI in predicting the early response to concurrent chemoradiotherapy (CCRT) in cervical cancer.Methods:A total of 85 patients with pathologically confirmed cervical cancer underwent conventional MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The biopsy tissues and serum samples were collected. The differential expression of miRNA in the biopsy tissues was determined by microarray chip. The expression level of miR-143 in the serum samples was analyzed by qRT-PCR. All patients were divided into the non-residual and residual tumor groups according to post-treatment MRI. Pre-treatment clinical factors, MRI parameters and miR-143 between two groups were statistically analyzed by the univariate and multivariate analyses. The optimal thresholds and predictive performance for post-treatment incidence of residual tumors were estimated by drawing the ROC curve.Results:At one month after CCRT, there were 52 patients in the non-residual tumor group and 33 patients in the residual tumor group. In the residual tumor group, pre-treatment FIGO staging, apparent diffusion coefficient (ADC), D and V e were significantly higher (all P<0.05), whereas K trans value was significantly lower ( P<0.001) when compared to those in the non-residual tumor group. The miRNA array analysis showed that there were 16 miRNAs with differential expression levels between two groups (all P<0.05). Among them, the increase of miR-143 was the most significant in the residual tumor group. Compared with the residual tumor group, the expression level of serum miR-143 was significantly down-regulated in the non-residual tumor group ( P=0.002). Compared with the SiHa cells, the expression level of miR-143 in the SiHa-R cells was significantly up-regulated ( P<0.05). Multivariate analysis showed that only miR-143, D, K trans and V e were the independent prognostic factors. The combination of multi-parametric MRI and miR-143 exhibited the highest predictive performance (AUC=0.975), with a sensitivity of 84.8% and a specificity of 96.2%. Conclusion:The combination of multi-parametric MRI with miR-143 further improves the predictive performance for residual tumors after CCRT, which contributes to the personalized treatment of cervical cancer.