Prognostic Analysis Of Radical Radiotherapy For Cervical Cancer

Background and Objective:In recent decades intensity modulated radiotherapy(IMRT)has been integrated into many fields of radiation oncology.Its application in gynecologic oncology has gradually increased in recent ten years[1].This paper mainly analyzes the prognosis of radical radiotherapy for cervical cancer,including factors affecting survival rate and disease free survival rate,the prognosis of IMRT in radical radiotherapy of cervical cancer,including the difference in survival rate,recurrence rate,recurrence pattern and acute and chronic side effects compared with conventional radiotherapy(CRT),and also include the effect of prognosis using preventive extended field intensity modulated radiation therapy for cervical cancer..Methods:The study retrospectively analyzed the clinical data,tumor related information and follow-up results of 256 cases of FIGO treated with radical radiotherapy for ⅠB-ⅢB cervical cancer from January 2010 to January 2013.Results:Among the 256 patients,91 were treated with IMRT and 165 were treated with CRT.There was no significant difference in BMI,FIGO staging,degree of differentiation and pathological type among the two groups.The age in group CRT was higher than that in group IMRT(P<0.05).The SCC value and the proportion of lymph node metastasis before treatment,the total dose of A point and the dosage plus dose were significantly higher than those of CRT group(P<0.05).In the single factor analysis of OS influencing factors,only tumor stage was significantly correlated with OS(P<0.05).Multivariate analysis showed that tumor stage and pathological type were independent factors affecting overall survival in five years.The risk of death in patients with stage IIIB within five years is 5.587 times that of patients with stage IIB(P<0.05).The risk of death in patients with adenocarcinoma within five years is 8.558 times that of patients with squamous cell carcinoma(p<0.05).In the single factor analysis of DFS factors,the method of radiotherapy,tumor stage,SCC before treatment,and lymph node metastasis after radiotherapy were significantly correlated with DFS(P<0.05).The results of multifactor analysis showed that the tumor stage,pathological type and lymph node metastasis after radiotherapy were the independent factors that affected the five year disease free survival.The risk of recurrence or death in patients with stage ⅢB within five years is 4.219 times higher than that in patients with stage IIB(p<0.05).The risk of recurrence or death in patients with adenocarcinoma within five years is 7.469 times that of patients with squamous cell carcinoma(p<0.05).The risk of recurrence or death within five years after radiotherapy in group of which patients who still have lymph nodes within three months after radiotherapy is 2.609 times as high as that in group which without lymph nodes(p<0.05).The independent factors affecting OS and DFS were balanced.Subgroup analysis showed that the acceptance of synchronous chemotherapy in patients with IIB squamous cell carcinoma was an independent factor affecting five years’ total survival.The risk of death within five years without chemotherapy is 5.278 times that of patients receiving chemotherapy(p<0.05).In patients with stage ⅢB squamous cell carcinoma,pre-treatment lymph node metastasis is an independent factor affecting the disease-free survival in five years.The recurrence or death risk at the group of lymph node diameter 0cm before treatment was 3.364 times higher than that in group 0-lcm(p<0.05).The risk of recurrence or death in group 1-2cm was 4.277 times higher than that in group 0-lcm(p<0.05).After balanced the independent factors affecting OS and DFS,there was no significant difference in OS and DFS between CRT group and IMRT group in five years.The rates of local recurrence and distant metastasis in group CRT and IMRT were 3.7%and 0%,respectively(P>0.05),the local recurrence rates were 4.9%and 6.6%respectively(P>0.05),the distant metastasis rates were 10.4%and 22%respectively(P<0.05).There was no significant difference between the two groups in the acute phase of grade 3 or higher(P>0.05).The incidence of long-term urinary side effects in group CRT and group IMRT was 1%and 0%respectively(P>0.05).The incidence of long-term urinary side effects was greater than grade 3.The incidence of long-term gastrointestinal reactions of grade 3 or higher was 2%and 5%respectively(P>0.05).For patients with negative pelvic lymph nodes,patients with tumor volume>4cm were 0%and 8%(P>0.05)for prophylactic extended intensity modulated radiation therapy and non preventive irradiation.Conclusions:The results of this study showed that tumor stage and pathological type were independent factors affecting overall survival in five years.Tumor stage,pathological type and lymph nodes exist within three months after radiotherapy are independent factors that affect the disease-free survival in five years.The subgroup analysis showed whether receiving synchronous chemotherapy was an independent factor affecting five years total survival,and the pre-treatment lymph node metastasis was an independent factor affecting the five year disease-free survival.CRT group and IMRT group had relatively good prognosis.There was no significant difference in OS and DFS between the two groups in five years.The positive lymph node area in group IMRT had better clinical outcome with dose addition than CRT group.There was no significant difference in acute and chronic side effects between the two groups.The recurrent modes of IMRT and CRT two groups were mainly distant metastasis.The difference of local recurrence rate between the two groups was not statistically significant.The distant metastasis rate of group IMRT was higher than that of the group CRT and was statistically significant.It may be associated with the lymph node metastasis rate and the level of SCC in group IMRT before treatment,which was significantly higher than that of the CRT group.There is no significant difference in the distant metastasis rate and survival rate of patients without pelvic lymph node metastases with positive pelvic lymph nodes or large tumor size without pelvic lymph node metastases.