| [Backgroud] Radiotherapy and operation treatment are the main treatment methods for cervical cancer.Concurrent chemoradiotherapy is the main treatment of advanced cervical cancer, existing data show that chemoradiotherapy can improve cervical cancer treatment,the radiation dose is directly related to the prognosis of cervical cancer, only achieve radical radiotherapy dose can wipe out the cancer. The normal tissues have certain limitations to tolerance of rays, conventional radiotherapy for advanced cancer patients, is unable to reach the cure dose. In recent years, the emerging of three-dimensional conformal radiotherapy (3-dimensional conforml radiotherapy,3D-CRT) can make the distribution of high doses of radiation agree with tumor morphology in the three-dimensional direction, so that the radiation can mainly concentrate in the tumor region. However,IMRT (intensity-modulated radiotherapy,IMRT) is based on the 3D-CRT, and can adjust the output dose in according with the clinical requirements, make the amount of the surrounding normal tissues or organs be controlled within an acceptable level, can better protect the surrounding normal tissue and improve the treatment effect. Lymph node metastasis is an important factor of affecting the survival rate of cervical cancer. The therapeutic effect of IMRT and 3D-CRT for advanced cervical cancer patients who were treated in our hospital (Linyi Tumour Hospital) with pelvic lymph node metastasis and (or) paraaortic lymph node metastasis were retrospectively analyzed, and provide further reference with IMRT technology for advanced cervical cancer.[Objective] To observe the curative effect, prognosis and adverse reactions, of 3D-CRT(three dimensional conformal radiotherapy) and IMRT (intensity-modulated radiotherapy) combined with concurrent chemotherapy foradvanced cervical cancer with pelvic lymph node metastasis and (or) para-aortic lymph node metastasis, analyse the clinical application of IMRT, explore the individualized treatment plan for advanced cervical cancer with lymph node metastasis.[Methods] The clinical data of 68 cases with advanced cervical cancer between 2008.01 and 2012.03 were retrospectively studied, all patients were treated in our hospital for the first time, the age ranged from 26 to 73, median age was 49 including 45 cases of squamous cell carcinoma,16 cases of adenocarcinoma,7 cases of adenosquamous carcinoma,9 cases of stage ⅡB,17 cases of stage Ⅲ A, 42 cases of stage ⅢB,35 cases with pelvic lymph node metastasis,13 cases of para-aortic lymph node metastasis,20 cases with pelvic lymph node metastasis and para-aortic lymph node metastasis,32 cases in the control group (treated with 3D-CRT) received the external pelvic radiotherapy, brachytherapy,3D-CRT and cisplatin chemotherapy,36 cases in the study group (treated with IMRT) received the external pelvic radiotherapy, brachytherapy, IMRT and cisplatin chemotherapy, the recent efficiency, recent adverse reactions, the 1,2,3-year survival rate, survival analysis and long-term complications of two groups were observed,correlation analysis of data and results in the two groups were analysed with SPSS20.0 software.[Results] The short-term efficacy was evalued 4 weeks after the end of the Treatment,the complete remission rate was 68.8% (22/32),partial remission rate was 21.9% (7/32),the stable rate was 6.3% (2/32),the progressed rate was 3.1% (1/32), the efficiency was 90.6% (29/32)in the control group; the complete remission rate was 72.2%(26/36),partial remission rate was 22.2% (8/36),the stable rate was 2.8% (1/36),the progressed rate was 2.8%(1/36), the efficiency was 94.4% (34/36) in the control group;significant difference did not exist between the two groups in recent curative effect (X2=0.363, P=0.660) K-M (Kaplan-Meier)method was used to estimate the survival rates,the 1,2,3-year survival rate was 81.20%(26/32),62.5% (20/32),46.90%(15/32) in 3D-CRT group, the 1,2,3-year survival rate was 94.4%(34/36),83.3%(30/36),66.7%(24/36) in IMRT group,there was no statistical difference between the two groups in survival rate (X2=0.259, P=0.878).Clinical stage, pathological type, lymph node metastasis, cervical tumor volume associated with prognosis. There was no statistical difference between the two groups in blood system toxicity(P>0.05), however, statistically significant difference existed in acute upper digestive tract reaction, acute lower gastrointestinal reaction,acute genitourinary system responses (Z=2.59,P=0.01; Z=2.906,P=0.004; Z=3.479,P=0.001), significant difference also existed in delayed adverse reactions of small intestine, large intestine and urinary bladder between the two groups (Z=2.483,P=0.013; Z=2.973,P=0.03; Z=2.287,P=0.022)(Conclusion]1. There was no significant difference in the recent curative effect between the two groups,suggesting that 3D-CRT and IMRT can well control the extended lymph node,and improve the short-term curative effects.2. There was no significant differences in the 1,2,3-year survival rate and survival curve of survival rate between the two groups,suggesting that curative effect was similar between the two groups.3. The acute adverse reaction and late radiation injury in IMRT group were generally lower than that in 3D-CRTgroup, IMRT can well protect organs at risk, reduce side reactions.4. Clinical stage, pathological type, lymph node metastasis,cervical tumor volume are independent factors assosiated with prognosis. |
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