Analysis Of The Efficacy Of Different Adjuvant Therapies For Radical Postoperative Cervical Cancer

Background and Objective:Cervical cancer is the fourth most common cancer in women around the world, it is alsothe fourth leading cause of cancer deaths in women worldwide. Early stage of cervical cancer(ⅠA~ⅡA period) advocates surgery, advanced stage of cervical cancer (ⅡB~Ⅳperiod)advocates radiotherapy. Pathological has a important significance to assess prognosis andguide postoperative treatment. Studies have shown that reasonable and effective treatmentplays an important role for the patients with risk factors for postoperative to reduce the localrecurrence and distant metastasis rate.The purpose of the present study was to investigate the clinical efficacy and thetoxicities of concurrent chemoradiotherapy and sequential chemoradiotherapy andchemotherapy alone and radiotherapy alone of the patients with FIGO ⅠB1～ⅡB cervicalcancer after operation with risk factors for recurrence.Methods:We retrospectively analyzed of218cases of ⅠB1～ⅡB patients with risk factors forrecurrence of cervical cancer after surgery in First Hospita1of Jilin University, according tothe postoperative adjuvant therapy, dividedintoconcurrent chemoradiotherapy group of62cases (group A), sequential chemoradiotherapy group of70cases (group B), chemotherapyalone group of38cases (group C) and radiotherapy alone group of48cases (group D).Compared each group’s5-year overall survival rate,5-year disease-free survival rate, sideeffets and the rates of local recurrence and distant metastases.Concurrent chemoradiotherapygroup included cisplatin combined with radiotherapy and paclitaxel plus cisplatin combined with radiotherapy, Compared the two group’s5-year overall survival rate and5-yeardisease-free survival rate and the rates of local recurrence and distant metastases.Results:The5-year disease-free survival rate of the grope of A, B, C and D were83.9%,73.6%,47.4%,56.9%, respectively. The overall difference between the groups was statisticallysignificant(χ2=21.798, P<0.001). The disease-free survival rate of group A was higher thaneach other group, the differences were statistically significant(P<0.05); There had statisticallysignificants between the grope of B and the two groups of radiotherapy alone orchemotherapy alone(P<0.05). There had no statistically significant between the grope ofradiotherapy alone and chemotherapy alone. The5-year overall survival rate of the grope of A,B, C and D were93.1%,82.5%,57.9%and71.9%, respectively. The overall differencebetween the groups was statistically significant (χ2=21.791,P<0.001). The overall survivalrate of grope A compared with grope B, C and D, the differences were statistically significant(P<0.05); There had no significant difference between groups B and D (χ2=0.116, P=0.734),but there had statistically significants between the two groups with D (P<0.05). In the gropeof concurrent chemoradiotherapy, the effect of cisplatin combined with radiotherapy andpaclitaxel plus cisplatin combined with radiotherapy was equal. Early major toxicities of eachgroup included bone marrow inhibition, gastrointestinal reactions, group A and B had nodifference about this, but compared with group C and D, the incidence of toxicities werehigher. Late complications included radiation proctitis, radiation cystitis, there were nosignificant differences among group A、B and C. In the follow-up period, the rates of localrecurrence and distant metastases of grope A, B, C, D were16.13%,25.71%,57.89%,43%,respectively. There had no significant difference between groups A and B (P=0.205). Therehad no significant difference between group C and D(P=0.285), but there had statisticallysignificants between the grope of chemotherapy combained with radiotherapy and the twogroups of radiotherapy alone or chemotherapy alone.The distant metastasis rate of grope C(39.47%) was higher than other groups, the local recurrence rate of grope D (31.25%) washigher than other groups. Conclusion:1. The gropes of chemotherapy combained with radiotherapy improves theefficacycompared with the two groups of radiotherapy alone or chemotherapy alone.2. The concurrent chemoradiotherapy improves the efficacy combained withsequentialchemoradiotherapy group.3. In the grope of concurrent chemoradiotherapy, the effect of cisplatin combined withradiotherapy and paclitaxel plus cisplatin combined with radiotherapy is equal.4. About bone marrow inhibition, gastrointestinal reactions, the incidence of the grope ofchemotherapy combained with radiotherapy is higher, but it can be tolerated.5. Concurrent chemoradiotherapy can improve the local control rate, reduce distantmetastasis and improve survival rate for the patients with FIGO ⅠB1～ⅡB cervical cancerafter operation with risk factors for recurrence,it is a preferred treatment regimen.