| Objective: To compare the efficacy,side effects and prognosis of the patients treated with three-dimensional intracavitary brachytherapy(3D-ICBT)VS conventional intracavitary brachytherapy(CICBT)for cervical stump cancer.Methods : We retrospectively analyzed the clinical data of 62 patients with cervical stump cancer in Sichuan Cancer Hospital from January 2009 to March 2014,24 patients were treated with conventional intracavitary brachytherapy(CICBT)before January 2012 and 38 patients were treated with three dimensional intracavitary brachytherapy(3D-ICBT)after January 2012.All patients were followed up to March 2019,the efficacy,side effects and prognosis were compared between groups.Survival rates were calculated by Kaplan-Meier method and Log-rank analysis was used to test survival differences between subgroups,COX regression analysis was used for multivariate analysis of prognosis factors.Results: To March 2019,there are 34 patients survival,25 patients were died,3 patients were lost in follow up.In 3D-ICBT group,10 patients achieved complete remission(CR),24 patients achieved partial remission(PR),4 patients achieved stable disease(SD),the total effective rate was 89.47%,in CICBT group,9 patients achieved complete remission(CR),11 patients achieved partial remission(PR),4 patients achieved stable disease(SD),the total effective rate was 83.33%(P=0.423).In CICBT group,19 patients(79.17%)developed hematological toxicities(Including 6 cases of grade2 myelosuppression,11 cases of grade3 myelosuppression,2 cases of grade4 myelosuppression),28 patients(73.68%)developed hematological toxicities in 3D-ICBT group(including 9 cases of grade2 myelosuppression,18 cases of grade3 myelosuppression,1 case of grade 4 myelosuppression)(p = 0.729).In 3D-ICBT group,only 6 patients(15.79%)developed nonhematological toxicities(including 1 cases of grade1 acute bladder reaction,2 cases of grade2 acute bladder reaction,1case of grade2 acute rectum reaction,1 case of grade2 late rectum reaction,1case of grade2 late bladder reaction),in CICBT group,9 patients(37.50%)developed nonhematological toxicities(including 2 cases of grade1 acute bladder reaction,1 case of grade2 acute bladder reaction,2 cases of grade2 acute rectum reaction,1case of grade2 late rectum reaction,1 case of grade2 late bladder reaction,1case of grade4 late bladder reaction)(P=0.026).To March 2019,in 3D-ICBT group,13 patients were died(including 1 case of lung metastasis,1 case of lymphatic metastasis,11 cases of tumor recurrence in pelvic cavity),23 patients were survival,2 patients were lost in follow up.In CICBT group,12 patients were died(Including 1 case of lung metastasis,1 case of bone metastasis,8 cases of tumor recurrence in pelvic cavity,1 case of heart disease,1 case of vesicovaginal fistula),11 patients were survival,1 patient were lost in follow up.Univariate analysis showed that the 5-year survival rate was higher in patients with squamous carcinoma than patients with adenocarcinoma(70.00% VS 28.6%)(P= 0.008),patients with highly differentiated carcinoma than patients with moderately and poorly differentiated carcinoma(81.70% VS 56.30% VS 33.30%)(P = 0.019).Multivaliable analysis showed that pathological type,degree of tumor differentiation and lymph node metastasis were the independent factors to influence the overall survival rate of patients with cervical stump cancer.Conclusion(1)3D-ICBT combined with external-beam radiotherapy in the treatment of cervical stump cancer is feasible and safe,which achieved lower rate of toxicity compared with CICBT and should be implemented in clinical treatment of cervical stump cancer;(2)High dose intracavitary radiotherapy is feasible for patients treated with three dimensional intracavitary brachytherapy for cervical stump cancer;(3)The prognosis for squamous carcinoma is better than adenocarcinoma,the patients with better differentiated cancer have better prognosis,the patients without lymph node metastasis have better prognosis than patients with lymph node metastasis. |
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