Clinical Study Of Extended-field Chemoradiotherapy For ⅢB Cervical Squamous Cell Carcinoma

PART1 OUTCOMES FOR ⅢB CERVICAL SQUAMOUS CELL CARCINOMA WITH PARAAORTIC LYMPH NODE METASTASIS TREATED WITH EXTENDED-FIELD CHEMORADIOTHERAPY.Objective:To investigate the efficacy and toxicity of stage IIIB cervical squamous carcinoma patients with para-aortic lymph node metastasis when treated with extended-filed chemoradiotherapy.Methods:Patients diagnosed from 2011 to 2013 with CT-avid pelvic lymph nodes treated with extended field chemoradiotherapy were analysed,including overall survival(OS),progression free survival(PFS)and toxicity.Results:A total of 12 patients were analysed.Median follow-up time was 18 months(3-36 months).12 months and 18 months OS、PFS were 91.7%and 83.3%、75%and 58.3%.Seven cases(58.3%)experienced acute grade 1/2 gastrointestinal toxicity and one case(8.3%)experienced acute grade 3 gastrointestinal toxicity.Eight cases experienced acute grade 1/2 hematological toxicity,and four cases(33.3%)experienced acute grade 3 hematological toxicity,Grade 1/2 late genitourinary and gastrointestinal toxicity were 16.7%and 16.7%.No 3 or higher-grade late toxicity.Conclusions:Extended-field chemoradiotherapy for ⅢB vervical squamous cell carcinoma with para-ortic lymph node metastasis is effective and safe.PART 2 EXTENDED-FIELD CHEMORADIOTHERAPY VERSUS WHOLE PELVIS CHEMORADIOTHERAPY FOR IIIB CERVICAL SQUAMOUS CELL CARCINOMA PATIENTS WITH PELVIC LYMPH NODE METASTASIS.Objective:Toevaluate the sense of preventive extended-field chemoradiotherapy for ⅢB cvervical squamous cell carcinoma with pelvic lymph node metastasis.Methods:Patients diagnosed from 2011 to 2013 with CT-avid pelvic lymph nodes were analysed.22 cases treated with extended field chemoradiotherapy(extended field group),and 25 cases of pelvic chemoradiotherapy(pelvic group).The overall survival(OS),progression free survival(PFS),and toxicity were compared between the two treatment groups.Results:1-year and 2-years OS of extended field group and pelvic group were 65.6%and 76.0%、65.6%and 52.6%respectively.1-year and 2-years PFS of the two grops were 86.4%and 76.0%、67.0%and 61.1%.There was no significant difference in PFS、OS between the the two groups((P>0.05).Acute toxcity and late toxcity were seen in grade Ⅰ-Ⅱ,no significant difference between two groups of(P>0.05).Figure DVH:Small intestine and spinal cord irradiated volume is greater in extended field group than the pelvic group(1865.6 ±573.9cm3 vs 1101.6±317.1 cm3,P=0.017,22.15±7.22cm3 vs 13.30±2.96cm3,P=0.017),Small intestinal V20,V30 and V40 V40,V40,rectum,bladder and femoral head V33 and the maximum dosage of various organs accepted and the average dose were no statistically significant difference in two groups(P>0.05).Conclusions:Extended-field chemoradiotherapy has no obvious advantages in patients of IIIB vervical squamous cell carcinoma with pelvic lymph node than whole pelvic radiotherapy,while toxicity was not significantly increased.PART 3 EXTENDED-FIELD CHEMORADIOTHERAPY VERSUS WHOLE PELVIS CHEMORADIOTHERAPY FOR IIIB CERVICAL SQUAMOUS CELL CARCINOMA PATIENTS WITH OUT LYMPH NODE METASTASIS.Objective:To evaluate the sense of preventive extended-field chemoradiotherapy for IIIB cvervical squamous cell carcinoma without lymph node metastasis.Methods:Patients diagnosed as IIIB cvervical squamous cell carcinoma from 2011 to 2013 were analysed.14 cases treated with extended field chemoradiotherapy(extended field grop),and 34 cases of pelvic chemoradiotherapy(pelvic grop).The overall survival(OS),progression free survival(PFS),and toxicity were compared between the two treatment groups.Results:1-year and 3-years OS of extended field grop and pelvic grop were 92.9%and 97.1%、83.6%and 83.6%respectively.1-year and 3-years PFS of the two grops were 92.9%and 94.1%、83.6%and 60.2%.There was no significant difference in PFS、OS between the the two grops(P>0.05).Acute toxcity and late toxcity were seen in grade 1-2,no significant difference between two groups of(P>0.05).Conclusions:Preventive extended-field chemoradiotherapy has no obvious advantages in patients of ⅢB vervical squamous cell carcinoma when compared to pelvic radiotherapy,while toxicity was not significantly increased.