Clinical Study And Acute HT Analysis Of Postoperative Intensity-modulated Radiotherapy Combined With Concurrent Chemotherapy For High-risk Early-stage Cervical Cancer

Objectives1.To evaluate the efficacy and acute toxicity of postoperative intensity-modulated radiotherapy combined with concurrent(C-IMRCT)or sequential(S-IMRCT)chemotherapy in high-risk early-stage cervical cancer.2.To investigate the influence factors of acute hematological toxicity in patients with high-risk early-stage cervical cancer receiving postoperative C-IMRCT.Methods1.Collect clinic data of postoperative cervical cancer patients(2009.5.1-2017.4.30)with high-risk early stage(IB1-IIA2).Patients were divided into two groups:concurrent intensity-modulated radiotherapy combined with concurrent chemotherapy.(C-IMRCT)or sequential intensity-modulated radiotherapy combined with concurrent chemotherapy.(S-IMRCT).The 5-year disease free survival(DFS),5-year overall survival(OS),recurrence rate,metastasis rate and acute toxicity were compared between the two groups.The survival rate was calculated by Kaplan-Meier method and was tested by the Logrank.Single factor prognostic analysis was carried out by Logrank.Recurrence,metastasis,adverse reaction were compared by continuous correctionχ2 test.2.Collect clinic data of postoperative cervical cancer patients(2013.5-2017.5)with high-risk early stage(IB1-IIA2).All patients received postoperative intensity-modulated radiotherapy combined with concurrent chemotherapy.(C-IMRCT).The basic white blood cells,hemoglobin,platelet and neutrophil cells counts were recorded.The lowest values of each blood count in the process of C-IMRCT were also recorded and graded.The degree of acute hematologic toxicity was evaluated by RTOG grading standard.Influence factors may cause acute hematological toxicity(leukopenia,hemoglobin reduction,thrombocytopenia,and neutrophil reduction)included age,pathologic type,FIGO stage,total dose of radiotherapy,duration of radiotherapy(day),total dose of chemotherapy,number of chemotherapy and pelvic bone marrow dose-volume).The pelvic bone marrow dose-Volume calculation method is:to draw the pelvis bone marrow in the patient’s original CT image.There are 4 sections:Whole pelvic bone marrow(WP-BM),Ilium bone marrow(IL-BM),Low pelvis bone marrow(LP-BM),Lumbosacral bone marrow(LS-BM).The dose-volume histogram(DVH)was generated to obtain the 10Gy,20Gy,30Gy,40Gy,45Gy and 50Gy for each part of the bone marrow.Results1.105 patients were included in and were divided into two groups:73 patients received intensity-modulated radiotherapy combined with concurrent chemotherapy.(C-IMRCT)and 32 patients received intensity-modulated radiotherapy combined with sequential chemotherapy(S-IMRCT).There was no significant difference between the two groups in age,FIGO stage,pathological type and pathological conditions(P>0.05).The 5-year DFS was similar in two group(72.6%&72.5%,respectively(P=0.918);The 5-year OS was higher in the C-IMRCT than in the S-IMRCT(82.8%&78.5%,respectively),but there was no statistically difference.(P=0.504).The recurrence and metastasis rate in the two groups had no statistically difference(P values were 0.598&1.000,respectively).Single factor prognostic analysis showed that no pathological factors affected patients’prognosis.The main acute toxicity was hematological toxicity(1-2 grade),The total incidence of hematological toxicity was higher in the C-IMRCT than in the S-IMRCT(46.6%&40.6%,respectively),but there was no statistically difference(P=0.784).Other toxicities included diarrhea(P=0.854)and urinary tract infection(P=0.271),there was no statistically difference.2.52 patients were included in and all patients recieved intensity-modulated radiotherapy combined with concurrent chemotherapy.(C-IMRCT).The average age was 47.6±1.24 year.The median count of basic leukocyte count,hemoglobin count,platelet count and neutrophil were 5.8x10~9/L,121g/L,259.5x10~9/L and 3.1x10~9/L,respectively.The average nadir count of leukocyte,hemoglobin,platelet and neutrophils was 2.82x10~9/L,109.65g/L,138.17x10~9/L and 1.87x10~9/L respectively.The rates of 2 grade and above leukopenia,hemoglobin reduction,thrombocytopenia and neutropenia were 57.7%,1.9%,1.9%and 21.1%respectively.Leukopenia was associated with LS-V20(r=-0.293)and duration of radiotherapy(day)(r=-0.392;P=0.035);Haemoglobin reduction was associated with WP-V30,WP-V40,WP-V45,WP-V50,IL-V20,IL-V40,IL-V45,IL-V50,LP-V30,LP-V40,LP-V45 and LP-V50(P<0.05);Thrombocytopenia was associated with duration of radiotherapy(day)(r=-0.373,P=0.006);Neutropenia was associated with duration of radiotherapy(day)(r=-0.388,P=0.004).Multivariate regression analysis showed that hemoglobin was negatively correlated with WP-V30,IL-V40 and LP-V40(P<0.05).Conclusions1.Futher clinical studies are needed in terms of the survival rate in patients with cervical cancer receiving postoperative C-IMRCT.2.The acute hematological toxicity of the high-risk early-stage cervical cancer receiving postoperative C-IMRCT is related to the duration of radiotherapy(day)and the low dose or high dose to the pelvic bone marrow.