| Objective: A number of studies show that the postoperative pathology of thecervical cancer suggest the patients with positive parametrial tissue, positive lymphgland and/or positive surgical cutting edge should receive cisplatin-basedchemotherapy. However, whether the patients with the postoperative pathological hintsvascular cancer embolus could benefit from the postoperative synchronizationchemo-radio therapy hasn’t been testified by the large-scale clinical trials and remainsto be further studied and discussed. This study mainly observes the curative efficacyand the safety of the vascular cancer embolus（+）patients who have the postoperativeradiotherapy of the cervical cancer.Methods: This study applies the method of studying the retrospective cases whichincludes a total of118cases of the postoperative pathologic vascular cancer emboluspatients who are treated by the department of radiation oncology of the SecondAffiliated Hospital of Dalian Medical University from January I,2005to December312009. Those cases can be classified into two groups: the first one is that of theconcurrent chemo-radio therapy group. In this group, there are57patients who receivepostoperative adjunctive therapy. The synchronous chemotherapy regimens should beDDP weekly therapy, during the time of pelvic external irradiation. Specifically, it isDDP30-40mg/㎡which should be given at the1st,8th,15th,22th，29thand36thdays andsymptomatic and supportive treatment should be made to cure chemotherapy-related side effects.. If the patients suffer the positive parametrial tissue、positive lymph nodeand/or poor prognosis pathological factors of the positive surgical cutting edge,192lrintracavitary radiotherapy should be added. The second one is radiotherapy groupwhich includes61cases. And the scheme in this group is just the same as the first one.The patients from two groups are provided with the fellow-up medical care, assessedand comparatively analyzed. The comparative analysis mainly includes3-yeardisease-free survival,3-year overall survival,1-year,2-year and3-year pelvicrecurrence rate and treat mentrelated side effects. The assessment of the side effects canbe divided into two parts, namely: the early side effects and the late side effects, whosecontention is the rectum side effects, bladder side effects, gastrointestinal side effectsand myelosuppression.Results: Compared with the radiotherapy, postoperative chemotherapy combineswith radiotherapy reduces one-year pelvic recurrence rate (radiochemicalsynchronization group7.32%versus radiotherapy group23.21%, P=0.037) andtwo-year pelvic recurrence rate (synchronization group12.20%versus radiotherapygroup30.36%, P=0.035) of the patients. And the three-year pelvic recurrence ratebetween them are similar (synchronous group21.95%versus the radiotherapy group32.14%, P=0.269). In aspect of the survival analysis, the3-year disease-free survivalrate and the3-year overall survival of the two groups are very close to each other andthe difference between them was not statistically significant and the result should befuther studied. The early side effects of the radiochemical synchronization group areworse than that of the radiotherapy group. The side effect of the first one ismyelosuppression and gastrointestinal reactions within the tolerable range. Furthermore,the actively symptomatic and supportive treatments do not affect the follow-up therapy.The two groups of patients have no difference in the late complications.Conclusion: The resynchronization therapy cuts down the partial recurrence rate ofvascular cancer embolus in patient who has received the radical hysterectomy, but itmakes no significant improvement in3-year progression-free survival and overallsurvival. It ought to be studied and analyzed to make clear whether the resynchronization therapy have advantage in the survival aspect. As to thetreatment-related side effects, the resynchronization therapy’s increase slightly but causeno late complications of the patients. |
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