Analysis Of Therapeutic Effect Of Cervical Stump Cancer

Background and purpose:Cervical stump cancer is a malignant tumor with low incidence rate in gynecological tumors.After subtotal hysterectomy,the cervical stump may develop a tight adherence to peripheral tissues and fibrosis occur,thus increasing the difficulty of a second surgery.Surgical treatment is only suitable for early stage patients,while radiotherapy plays a key role in all stages of cervical stump cancer as a radical treatment.Besides,the uterine tandem cannot be implanted or fixed satisfying because of the absence or too short length of the cervical tube.Interstitial brachytherapy can cover the tumor in high dose rate both reduce the dose of surrounding normal tissue in this situation.In this study,the short-term and long-term effects,2-year overall survival rate,side effects and influence factors of the three treatment modes of surgical treatment,postoperative chemoradiotherapy and radical chemoradiotherapy for cervical stump cancer were further discussed,so as to provide more basis for the individualized treatment of patients.Materials and methods:A retrospective analysis was performed on 25 patients with cervical stump cancer who had completed surgical treatment,postoperative chemoradiotherapy or radical chemoradiotherapy at China-Japan Union Hospital of Jilin University from 2011 to 2020.Based on the 2009 FIGO stage,15 cases were confirmed as stage I(6 stage IA,9 stage IB),7 as stage II(1 stage IIA and 6 stage IIB),3 as stage III.Surgery was performed in 19 cases,8 of the 19 patients underwent chemoradiotherapy.6 patients received radical chemoradiotherapy.The surgical methods were radical trachelectomy with bilateral adnexectomy and pelvic lymphadenectomy.External irradiation plus brachytherapy were utilized.The dose of external irradiation was 45-50 Gy,1.8-2Gy/f,1f/day,5 times per week.The prescription dose of brachytherapy was 5-7Gy/f,once a week,divided into 2-6 times.The prescription dose of CTV D90 was 12.5-59.5Gy EQD2 and the total equivalent dose was 57.5-91.35 Gy EQD2.The chemoradiotherapy group was given concurrent or adjuvant TP/TD regimens for 1-6 cycles.The tumor response was assessed according to the Response Evaluation Criteria in Solid Tumors,and late toxicity was graded according to the Radiation Therapy Oncology Group late radiation morbidity scoring scheme.Kaplan-meier method was used to analyze OS,PFS and LC,and the survival curve was drawn and compared with log-rank test in SPSS 18.0 software,and p<0.05 was considered statistically significant.Results:The median follow time of all patients was 24.6 months(5.2~118 months).The 2-year OS,PFS,LC rate were 80%,76%,91.3%.In the surgery group,1 patient was lost to follow-up,2 died,and 1 underwent tumor progression.The 2-year OS,PFS and LC rate were 72.7%,63.6% and 81.8%,respectively.The 2-year OS,PFS and LC in the postoperative chemoradiotherapy group were 75%,75%,87.5% Among the 8 patients received postoperative radiotherapy,1 patient died and 1 patient was lost to follow-up.All patients in the radical radiotherapy group achieved complete remisson without death or local recurrence.The 2-year OS,PFS and LC in the radical radiotherapy group were 100%,100% and 100%,respectively.Compared with the operation group and the postoperative chemoradiotherapy group,the radical radiotherapy group had a significant advantage in the prognostic survival index.During the treatment,1 patient receiving radical radiotherapy had grade 2 vaginal mucosal reaction.1 patient who received postoperative chemoradiotherapy developed grade 1 acute liver function injury and grade 3 bone marrow suppression.One patient had her defecation habit changed and another had postoperative intestinal obstruction.Among the patients who received radiotherapy,2 had grade 2 long-term bladder reaction and 1 had grade 2 long-term reaction.All the patients received radiotherapy had no late side effects above level 3.Univariate analysis showed that interval between the treatment and STH had statistical difference for OS.The time interval and pathological type were correlated with 2-year PFS.The clinical stage and pathological type were related to the 2-year local control rate.Conclusion:Suffered from cervical stump cancer with early stage,patients with postoperative high risk factors or a number of medium-risk factors are recommended to be treated with adjuvant chemoradiotherapy combined with vaginal brachytherapy,which can significantly improve the tumor control.For locally advanced cervical stump cancer,radical chemoradiotherapy is the most effective treatment with mild side effects,which can improve the local control rate and patients' quality of life.However,further large data validation is needed.