Prognostic Analysis On Early Stage Cervical Cancer In Postoperative IMRT And Radiation Toxicity Observed

Objective:1、A retrospective analysis of early cervical cancer(FIGO stage IB1-IIA) has a poor prognosis surgery patients prognosis in intensity modulated radiation therapy;2.Abserve the toxicity of organs at risk;3.Analyze the impact of different radiotherapy techniques for quality of life of patients and radiotherapy toxicity of the reaction occurrence,by the EORTC QLQ-C30 and the EORTC QLQ-CX24 questionnaires,So as to explore if IMRT can improve the treatment of early stage cervical cancer patients gain ratio.Methods: Cervical cancer patients 148 case(FIGO stage IB1-IIA) with Radiotherapy.was retrospective analyzed from July 2007 to February 2014 in the First Affiliated Hospital of Fu Jian Medical University. Follow-up of 148 cases, no one was lost, the follow-up to the December 2014 deadline.Age 29-82 years old. IMRT 100 cases, 2 cases of recurrence and 5 deaths;3D-CRT 48 cases,2 cases of recurrence, 4 deaths; FIGO stage: IB1 of 23 cases, IB2 of 49 cases, IIA of 76 cases; Pathological:122 cases of squamous cell carcinoma, adenocarcinoma in 18 cases,8 cases of other type(including seven cases of adenosquamous carcinoma, small cell neuroendocrine carcinoma);Histological grade: 89 cases of poorly differentiated;54 cases of Intermediate differentiated,5 cases of well-differentiated;Lymph node metastasis: 123 cases without lymph node metastasis,18 cases with lymph node metastasis, lymph node metastasis ≥2 one of 7 cases; Cervical stromal invasion: invasive deep myometrial 127 cases, 21 cases of invasive superficial muscle layer;Lymphatic stromal invasion: within vascular thrombosis associated with 29 cases, 119 cases within no vascular invasion;Tumor diameter: 13 cases ≥4cm diameter,135 cases <4cm. 54 cases with adjuvant chemotherapy, adjuvant chemotherapy in 94 cases did not fit. They are used in chemotherapy(paclitaxel 135 mg / m2, ivgtt, d1 + cisplatin 40 mg, ivgtt, d1-3)chemotherapy, ranging from 2-3 cycles. According to the Radiation Therapy Oncology Organization(Radiation Therapy Oncology Group, RTOG) grading standards, evaluate organ-threatening toxicity. Using the EORTC QLQ-C30, the quality of life core(European cancer research and treatment organizations prepared Scale Chinese version, the four dimensions(including: to evaluate the quality of life and physical function, social function, role, mental health); EORTC QLQ-CX24 the quality of life of cancer meter module Chinese version), for the treatment of cervical cancer cases, from three dimensions(including: evaluation of self-image and values, symptoms, quality of life) were evaluated. A total of 82 patients were involved in the survey, in which 55 patients IMRT,3D-CRT group of27 patients.Results:Results: Early postoperative cervical cancer with poor prognostic factors, using two different methods of radiotherapy: the IMRT and 3D-CRT radiotherapy. Two total average survival time was 83.0 months, 95% CI confidence interval(79.8,86.2). The mean time to recurrence was 80.7months, 95% CI confidence interval(79.9,84.4). The IMRT group were superior to survival time 3D-CRT group(P = 0.01). 3D-CRT group of 24-month relapse-free survival was 93.75 percent, 32-month relapse-free survival rate was 89.5%; IMRT group of 24-month relapse-free survival rate was 96%,32-month relapse-free survival rate was 94.1%. IMRT group in relapse-free survival was better than 3 years 3D-CRT group. While other possible factors prognostic factors were analyzed, the results showed: cervical swelling larger the diameter, the more the number of pelvic lymph node metastasis, may shorten survival time; different pathological types and different pathological grade, recurrence-free time on different, low level, squamous easy to relapse. From radiation therapy to the rectum,bladder, small intestine, pelvis, femoral head angle and so threatening organ toxicity caused by the analysis, the results showed: 1-3 hematologic toxicity, IMRT group of 86 cases(86.0%), 3D-CRT group of 31 cases(64.8%),compared with 3D-CRT group was significantly(P = 0.01); but there was no significant difference(P> 0.05) in acute and chronic enteritis,bladder, lower limb edema aspects. Cause no more than two 4 hematologic toxicity, toxicity than three digestive system and urinary system. From the perspective of dosimetry, threatening organ DVH parameters were compared. IMRT group in the small intestine V15, V30 and V15 pelvis higher volume illuminated by the 3D-CRT group(P <0.05), bladder and rectum V40 illuminated by volume were lower than 3D-CRT group(P <0.05). Therefore,compared with IMRT radiotherapy-threatening organ toxicity was no significant increase. By EORCT QLQ-30 quality of life questionnaire and EORCT QLQ-CX24 cervical module survey results showed that: two in vaginal dryness, vaginal shorter tighten vagina, pain during intercourse, the side effects were no significant differences(P on > 0.05); the degree of sexual pleasure IMRT group(54.2%), 3D-CRT group(30.0%).Conclusion:Early stage cervical cancer patients have adverse factors assist IMRT compared to 3D-CRT radiotherapy: prolonged survival time;with dosimetric advantage, for better protection of the bladder and rectum;improving the quality of life of the population.