| Objective: In order to explore the application value of interstitial brachytherapy in the treatment of recurrent cervical cancer,the efficacy,toxicity and prognostic factors of interstitial brachytherapy and conventional brachytherapy in the treatment of recurrent cervical cancer were compared and analyzed,to provide theoretical basis for the formulation of treatment plan for recurrent cervical cancer.Methods: The clinical data of 72 patients with recurrent cervical cancer in the fourth hospital of Hebei Medical University from September 2015 to April 2020 were analyzed retrospectively.According to different methods of brachytherapy,they were divided into conventional brachytherapy group and interstitial brachytherapy group,with 36 cases in each group.Inclusion criteria:1)brachytherapy for recurrence;2)diagnosis of recurrence with pathological results or recurrence indicated by case history,increasing continually tumor markers(SCCA)combined with magnetic resonance imaging((MRI)),computed tomography(CT)and positron emission tomography(PET/CT);and3)no radiotherapy contraindications and severe medical diseases,no distant metastasis.4)all stages were based on 2018 FIGO stage;5)KPS ≥ 70 after treatment,regular outpatient examination or telephone follow-up was conducted to evaluate the curative effect,related side effects and prognostic factors.Results:1.Comparison of short-term efficacy: the clinical effective rate of interstitial brachytherapy group was 91.6%,and that of conventional brachytherapy group was 72.2%.There was significant difference between the two groups(P < 0.05).2.Comparison of LC,OS and PFS: The 1-year LC and 2-year LC of the interstitial brachytherapy group were 94% and 90.6% respectively,while the1-year LC and 2-year LC of the conventional brachytherapy group were74.5% and 67.8% respectively.There was significant difference in the local control rate between the two groups(P < 0.05).In the interstitial brachytherapy group,the median OS was 18 months,6 patients died,30 patients survived,8 patients had distant metastasis and 3 patients had pelvic recurrence.The 1-year OS and 2-year OS were 88.5% and 76.4% respectively;in the conventional brachytherapy group,the median OS was 44 months,18 cases died,18 cases survived,5 cases had distant metastasis,and 11 cases had pelvic recurrence.The 1-year OS and 2-year OS were 77.8% and 66% respectively.There was no significant difference in OS between the two groups(P > 0.05).The median PFS of interstitial brachytherapy group was 25 months,1-year PFS and 2-year PFS were 74.4% and 55.1% respectively,while that of conventional brachytherapy group was 30 months,1-year PFS and 2-year PFS were 66.7% and 57.9%,respectively.There was no significant difference in PFS between the two groups(P > 0.05).3.Comparison of efficacy of different sites of recurrence: The clinical effective rate of central recurrence was 77.8% in interstitial brachytherapy group and 69.4% in conventional brachytherapy group.There was no significant difference between the two groups(P > 0.05).The clinical effective rate of peripheral recurrence was 13.9% in the interstitial brachytherapy group and 2.7% in the conventional brachytherapy group.There was significant difference between the two groups(P < 0.05).4.Early side effects: The incidence of bladder grade 2 and above side effects in the interstitial brachytherapy group was 13.8%,and that in the conventional brachytherapy group was 22.2%.There was no significant difference between the two groups(P > 0.05).The incidence of rectal grade 2and above side effects in the interstitial brachytherapy group was 25%,and that in the conventional brachytherapy group was 30.5%.There was no significant difference between the two groups(P > 0.05).The incidence of toxicity and side effects of bone marrow grade 2 and above in the interstitial brachytherapy group was 63.8%,and that in the conventional brachytherapy group was 75%.There was no significant difference between the two groups(P > 0.05).5.Late side effects: the incidence of bladder toxicity grade 2 and above in the interstitial brachytherapy group was 16.7%,and that in the conventional brachytherapy group was 38.8%.There was significant difference between the two groups(P < 0.05).The incidence of rectal side effects grade 2 and above in the interstitial brachytherapy group was 11.1%,and that in the conventional brachytherapy group was 33.3%.There was significant difference between the two groups(P < 0.05).6.Prognostic factors: Log-rank univariate analyze of the relationship between prognosis and clinical stage,the maximum diameter of tumor,hemoglobin value,SCCA value,recurrence interval time,whether concurrent chemotherapy,recurrence site,mode of brachytherapy,the results showed that the location of recurrence,the maximum diameter of tumor and the value of hemoglobin were related to OS,the location of recurrence and the maximum diameter of tumor were related to PFS,and the mode of brachytherapy,the location of recurrence and the maximum diameter of tumor were related to LC.The results of multivariate analyze of COX regression model showed that only the maximum diameter of the tumor was the independent prognostic factors of OS and PFS,and the location of recurrence and mode of brachytherapy were the independent prognostic factors of LC.Conclusions:1.Patients with recurrent cervical cancer are treated with interstitial brachytherapy with good short-term efficacy and high local control rate.However,there was no significant difference in OS and PFS,between the two groups at 1-year and 2-year.The reason may be related to the short follow-up time in the interstitial brachytherapy group and the total smaller number of cases.2.Patients with recurrent cervical cancer,especially patients with peripheral type,should be treated with interstitial brachytherapy in order to improve the curative effect and prognosis.3.Compared with conventional brachytherapy,interstitial brachytherapy can reduce the incidence of late bladder and rectal side effects and improve the quality of life of patients by reducing the radiation dose of organ at risk.The early side effects of bladder,rectum and bone marrow were similar between the two groups,which may be related to more patients with recurrent cervical cancer undergoing concurrent chemotherapy,larger tumor and some patients with history of radiotherapy.4.The treatment of recurrent cervical cancer is mainly comprehensive treatment.Before formulating the plan,we should pay attention to the maximum diameter of the tumor,the site of recurrence,the mode of brachytherapy,improve the hemoglobin value of patients and improve the prognosis of patients. |
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