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Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-Ⅱ A cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy.Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion,depth of stromal invasion or tumor size ＞ 4 cm were retrospectively analyzed.The impact of observing (NT),chemotherapy (CT),radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared.The Kaplan-Meier method was used to survival analysis,and log-rank test difference,Cox model was used to prognostic factor analysis.Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0％ and 84.8％.Univariate and multivariate analyses demonstrated that TS＞ 4 cm and therapeutic method were the independent prognostic factors of PFS.The number of risk factors and therapeutic method were the independent prognostic factors of OS.In the whole group,both RT and CCRT could improve the prognosis of patients with no statistical significance (P＞0.05).In the subgroup analysis,for patients with a single intermediate risk factor (low risk group),CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692).Compared with NT and CT,RT and CCRT could improve the PFS and OS,whereas no statistical significance was noted between the RT and CCRT (both P＞0.05).For those with ≥2 risk factors (high risk group),CCRT could significantly prolong the PFS compared with CT (84.9％ vs.70％;P=0.006),but did not improve the OS (P=0.107).Compared with RT,CCRT could significantly improve the PFS and OS (both P＜0.05).Conclusion For patients with only one risk factor,RT can enhance the clinical prognosis.CCRT can improve the clinical prognosis of stage Ⅰ-Ⅱ A cervical cancer patients with ≥ 2 risk factors.
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Objective To evaluate the efficacy and acute toxieities of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent (C-IMRCT) or sequential chemotherapy (S-IMRCT) in the treatment of high-risk early-stage cervical cancer.Methods A retrospective study was performed on the clinical data of 105 patients with high-risk early-stage (Ⅰ B1-Ⅱ A2) cervical cancer from 2009 to 2017.Those patients were divided into C-IMRCT group (n=73) and S-IMRCT group (n=32).The 5-year disease-free survival (DFS) and overall survival (OS) rates,recurrence rate,metastasis rate,and acute toxicities were compared between the two groups.The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test.Univariate prognostic analysis was performed by the log-rank test.Recurrence,metastasis,and adverse reactions were compared using continuous correction chi-square test.Results The median follow-up time was 20 and 23 months in the C-IMRCT group and the S-IMRCT group,respectively (P=0.813).There were no significant differences in the 5-year DFS and OS rates between the two groups (72.6％ vs.72.5％,P=0.918;82.8％ vs.78.5％,P=0.504).There were no significant differences in the recurrence and metastasis rates between the two groups (P=0.598;P=1.000).The univariate prognostic analysis showed that no pathological factor affected prognosis.There were no significant differences in the incidence rates of grade 1-2 hematological toxicity,diarrhea,and urinary tract infection between the two groups (46.6％ vs.41.9％,P=0.884;P=0.854;P=0.271).Conclusions Further clinical studies are needed in terms of the survival rate in patients with high-risk early-stage cervical cancer receiving C-IMRCT.
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Objective To analyze the clinical outcome and prognostic factors of concurrent radiochemotherapy (CRCT) or radiotherapy (RT) alone followed by radical hysterectomy in cervical cancer.MethodsBetween April 2006 and June 2011,182 patients with FIGO ⅠB2-ⅢB cervical carcinoma were treated with preoperative CRCT ( 123 patients) or RT alone ( 59 patients) followed by radical surgery.Weekly cisplatin (40 mg/m2)were administered during radiotherapy for patients treated with CRCT.Preoperative RT doses were 40-50 Gy in 20-25 fractions.Total hysterosalpingo-oophorectomy and pelvic lymph node dissection was performed 2-3 weeks after neoadjuvant therapy.The prognostic factors were analyzed by Cox-regression method.ResultsSixty-nine patients were followed up for 3 years.For patients with tumor ≥4.5 cm,there were no significant differences in the 3-year progression-free survival (PFS) and overall survival (OS) rates between CRCT and RT alone ( x2 =1.84 and 1.56,P =0.176 and 0.221 ).For patients with tumor ＜ 4.5 cm,CRCT group had higher PFS and OS rates than RT alone ( x2 =5.22 and 4.81,P=0.022 and 0.018).The 3-year PFS and OS rates were 92.0％ and 93.8％.By multivariate analysis,tumor diameter ( ≥6 cm vs.＜ 6 cm) was significant prognostic factor for PFS and OS (x2 =2.56,P =0.011 ;x2 =4.06,P =0.007 ),age ( ＜ 48 vs.≥ 48 years) was significant prognostic factor for OS (x2=4.86,P =0.046),and postoperative lymph node status (positive vs.negative) was significant prognostic factor for PFS ( x2 =1.04,P =0.010).ConclusionsTreatment with CRCT or RT followed by radical surgery has achieved good OS and PFS for patients with FIGOⅠB2-ⅢB cervical cancer.Tumor diameter,age and postoperative lymph node status are important prognostic factors for survival.
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Objective To study if local implant of sustained-release 5-fluorouracil (5-Fu) and cisplatin (DDP) combined with radiotherapy can improve the treatment result of advanced and recurrent cervical cancer. Methods Forty-two patients with advanced (26 with stage Ⅲ) or recurrent (16) cervical cancer received local implant of sustained-release 5-Fu and DDP combined with radiotherapy ( group A), and 40 ( including 29 with stage Ⅲ and Ⅱ with recurrent cervical cancer) received radiotherapy alone during the same period as the control (group B). In group A, the pelvic external radiation was 45-55 Gy (including 25-30 Gy to the whole pelvis) over 6-7 weeks using 6-10 MV X-beams; 192Ir intracavity brachytherapy was 24-36 Gy in 4-6 fractions to the point "A", while the patients with Ⅲ A disease received 24-32 Gy in 3-4 fractions to 0.5 cm depth from the surface of vaginal mucosa; Sustained-release 5-Fu (200-400 rag) and DDP (40-80 mg) were implanted by puncture before and during the course of radiotherapy. In group B, the external beam radiation was as same as in group A, except that there was 8-12 Gy boosting to the local tumor in group B; The brachytherapy was 30-42 Gy to point "A", and those with ⅢA disease received 40-48 Gy to 0.5 cm depth from the surface of vaginal mucosa. Treatment efficacy and complications were compared be tween the two groups. Results In group A and B, the complete response rate (CR) was 69% and 30% (X2=12.50,P<0.01 ), respectively. The 3-year tumor-free survival rate was 62% and 25 % (X2=11.33,P<0.01), respectively. The time between the treatment and tumor response was shorter in group A then in group B. The toxicities of the bone marrow, the rectum and the bladder were similar between the two groups. Conclusions Local implant of sustained-release 5-Fu and DDP combined with radiotherapy could improve the results of patients with advanced or recurrent cervical cancer, without increasing the treatment toxicities.