Efficacy And Adverse Effects Of Simultaneous Radiotherapy Combined With Surgery For Locally Advanced Cervical Cancer

Objective:To compare the clinical efficacy and safety of different treatment modalities of simultaneous radiotherapy followed by combined surgery and radical radiotherapy,and to provide more treatment modalities for patients with locally advanced cervical cancer,especially those with underlying bowel and bladder diseases that cannot tolerate high-dose radiotherapy and seriously resist interpolation.Methods:Retrospective analysis of 53 patients with cervical cancer,aged 29-67 years with a median age of 50 years,who visited our hospital from April 2019 to November 2021.They were divided into three groups according to treatment modality: synchronous radiotherapy followed by surgery group(n=13): external pelvic irradiation synchronous platinum-based monotherapy combined with minimal radical surgery for cervical cancer;radical radiotherapy group(n=20): synchronous radiotherapy +brachytherapy;radical surgery for cervical cancer group: extensive hysterectomy +pelvic lymph node dissection with postoperative adjuvant therapy decided according to postoperative pathological risk factors.To observe the clinical efficacy(tumor regression,recent efficacy,disease recurrence,metastasis,2-year OS,and 2-year PFS),early and late adverse effects(bladder adverse effects,lower gastrointestinal adverse effects)and bone marrow suppression in the radical radiotherapy group and the surgery group after simultaneous radiotherapy.The postoperative side effects(operation time,intraoperative bleeding,indwelling catheter time,postoperative venting time,postoperative hospital days,whether intraoperative blood transfusion,etc.)and postoperative pathology were observed in the radical surgery group and the surgery group after simultaneous radiotherapy with different treatment modes.SPSS25 statistical software was applied for data analysis.Results:1.Comparison of efficacy and adverse reactions between concurrent chemoradiotherapy + operation group and radical chemoradiotherapy group⑴Clinical data: there was no statistical difference in clinical data between the radical chemoradiotherapy group and the operation group after concurrent chemoradiotherapy.(2)Clinical efficacy:(1)Tumor regression after the end of external irradiation: 5patients(38.5%)had CR,6 patients(46.2%)had PR,2 patients(15.4%)had SD,and no patients with PD after simultaneous radiotherapy combined with surgery group,and the total effective ORR was 84.6%.In the radical radiotherapy group,after external pelvic irradiation,8 patients(40%)had CR,10 patients(50%)had PR,2patients(10%)had SD,and no patients with PD,with an overall effective ORR of90%.There was no significant difference in tumor regression between the two groups.(2)Comparison of recent efficacy(after 3 months of treatment): 9 patients(69.2%)had CR,3 patients(23.1%)had PR,1 patient(7.7%)had SD,and no patients with PD after 3 months of treatment in the synchronous radiotherapy combined with surgery group,with an overall effective ORR of 92.3%.After radical radiotherapy 15(75%)patients had CR,3(15%)patients had PR,2(10%)patients with PD and no patients with SD,with an overall effective rate(CR+PR)of 90%.There was no statistically significant difference in the recent efficacy between the two groups of patients.(iii)Comparison of long-term outcomes: 1 patient(7.7%)died,1 patient(7.7%)had pelvic recurrence,and 1 patient(7.7%)had distant metastasis in the synchronous radiotherapy combined with surgery group,with 2-year PFS of 76.9% and 2-year OS of 92.3%;3 patients(15%)died,1 patient(5%)had pelvic recurrence,and 2 patients(10%)had distant metastasis in the radical radiotherapy group.The 2-year PFS was80% and the 2-year OS was 90%.There was no significant difference in death,pelvic recurrence,distant metastasis and 2-year OS and 2-year PFS between the two groups.(3)Adverse effects: The synchronous radiotherapy combined with surgery group was better than the radical radiotherapy group in chronic lower gastrointestinal reactions,but there was no significant difference between the two groups in acute lower gastrointestinal reactions,acute and chronic bladder reactions,and bone marrow suppression.The incidence of patients in the synchronous radiotherapy combined with surgery group was lower than that in radical radiotherapy in grade 2 or higher acute lower gastrointestinal reaction,grade 2 or higher acute bladder reaction,grade 2 or higher acute lower gastrointestinal reaction,grade 2 or higher chronic lower gastrointestinal reaction,and grade 2 or higher bone marrow suppression,but all P >0.05 and there was no statistical difference.2.Comparison of postoperative pathology and adverse effects between concurrent chemoradiotherapy + operation group and radical surgery group⑴ Clinical data: The staging of the combined operation group with concurrent chemoradiotherapy was later than that of the radical operation group,and there was no significant difference in age and pathological types.(2)Postoperative pathology: the simultaneous radiotherapy combined with surgery group was significantly better than the radical surgery group in terms of deep interstitial cervical infiltration and microscopic complete remission rate;there was no significant difference between the two groups in terms of parametrial infiltration and choroidal infiltration;there were no residual cancer foci and positive surgical margins in both groups.(3)Adverse effects: The synchronous radiotherapy-chemotherapy combined surgery group had significantly less operating time,intraoperative bleeding,duration of indwelling urinary catheter,and postoperative hospitalization days than the radical surgery group.There was no significant difference in postoperative exhaustion time between the two groups;intraoperative blood transfusion accounted for 100% of all transfusions in the radical surgery group,and there was no intraoperative blood transfusion in the simultaneous radiotherapy combined surgery group,but P>0.05,no statistical difference.No incisional infection occurred in both groups,and no serious adverse events such as intraoperative vascular,ureteral,intestinal and nerve injuries occurred in both groups.Conclusions:For patients with locally advanced cervical cancer who are too responsive to radiotherapy to adhere to subsequent brachytherapy or who are severely resistant to Interstitial brachytherapy,simultaneous radiotherapy followed by minimal radical hysterectomy can be a salvage treatment modality with comparable efficacy to radical radiotherapy without increasing the incidence of associated adverse effects.Minimal radical hysterectomy for cervical cancer in this study has significantly lower surgical risk than standard radical hysterectomy for cervical cancer,providing surgeons with a new surgical option.The results of the study still need to be clinically validated in a large sample.