Intracavitary Brachytherapy For Locally Advanced Cervical Cancer:retrospective Analysis Of Therapeutic Effect And Prognostic Factors

Objective:To analyze the efficacy and toxic side effects of intracavitary brachytherapy in the treatment of locally advanced cervical cancer,to analyze the prognostic factors of the treatment for patients with locally advanced cervical cancer（LACC）,and to explore the clinic value of intracavitary brachytherapy in LACC treatment.Patients and methods:A retrospective analysis was performed within 83 patients with LACC who received external radiotherapy + intracavitary brachytherapy in the Second Hospital of Jilin University from May2013 to November 2018.Clinical staging（FIGO,2018）included 6 patients in stage IB,10 in Stage IIA,28 in Stage IIB and 7 in Stage IIIA,10 in Stage IIIB,22 in Stage IIIC,.Among them,5patients appeared hydronephrosis after radiotherapy.The efficacy of intracavitary brachytherapy after 3 months was evaluated by RECIST criteria,acute toxicity was evaluated by the national Cancer Institute combined toxicity criteria,and late toxicity was evaluated by the RTOG radiation damage criteria.SPSS 22.0 for Windows statistical software was used for statistical analysis（P <0.05 was statistically significant）.Continuity variables are described in terms of median（range）.Kaplan-meier method was used to evaluate the later curative effect by calculating the overall survival,progression-free survival and local control time.Log-rank method was used to determine the prognostic factors: patient’s age,FIGO stage before treatment,pathological type,longest initial tumor diameter,tumor diameter after external irradiation,synchronous chemotherapy,parametrial extension,lymph node metastasis at diagnosis,KPS score,hemoglobin level before treatment,hydronephrosis.And multivariate prognostic factors were analyzed by Cox regression model.ResultsThe median follow-up time was 60 months（range: 5~93 months）and efficacy evaluation was conducted 3 months later after the end of brachytherapy.There were 48 cases（57.83%）of CR,33 cases（39.76%）of PR,and 2 cases（2.41%）of SD.RR（RR=CR+PR/ total number of cases）was 97.59%.CBR（CBR=CR+PR+SD/ total number of cases）was 100%.At the last follow-up,26 patients were dead,57 patients survived,with a median survival time of 59 months（5~93 months）.The 1-year OS,PFS and LC of patients after intracavitary brachytherapy were97.6%,86.7% and 95.2%,respectively.The 3-year OS,PFS and LC were 71.6%,68.9% and83.8%,respectively.The 5-year OS,PFS and LC were 68.3%,68.9% and 82.0% respectively.As for toxic side effects,no patient had acute rectal toxicity and acute bladder toxicity of grade4.Three（3.6%）patients developed acute rectal toxicity of grade 3 and three（3.6%）patients developed acute bladder toxicity of grade 3.All of them were improved by appropriate symptomatic management.Univariate prognostic factor analysis by log-rank method showed that the longest initial tumor diameter,tumor diameter after external irradiation,lymph node metastasis,KPS score and hydronephrosis had statistical significance on OS.Pathological type,initial tumor longest diameter,tumor diameter after external irradiation,KPS score and hydronephrosis had statistical significance for PFS.The longest initial tumor diameter,tumor diameter after external irradiation,KPS score and hydronephrosis had statistical significance for LC.Multivariate analysis of COX model showed that the longest initial tumor diameter and hydronephrosis were independent prognostic factors for OS.KPS score before treatment was an independent prognostic factor for PFS.Hydronephrosis is an independent prognostic factor for LC.Conclusion:（1）The effect of brachytherapy is very significant in the clinical treatment of LACC.It can effectively prolong the survival period of patients and improve the quality of life.In this study,our department could leads to excellent 1、3、5-year OS（97.6%/71.6%/68.3%）and LC（95.2%/83.8%/82.0%）.（2）In this study,the incidence of acute lower gastrointestinal toxicity and acute bladder toxicity was 3.6% after intracavitary brachytherapy.The incidence of late toxicity in lower digestive tract and bladder was 28.9% and 26.5% respectively.（3）In this study,the longest initial tumor diameter and hydronephrosis after radiotherapy were independent prognostic factors of OS.KPS score before treatment was an independent prognostic factor of PFS.Hydronephrosis is an independent prognostic factor of LC after radiotherapy.