Study of radiotherapy dose effect of neoadjuvant chemotherapy versus concurrent chemoradiotherapy in cervical cancer
Li Fenghu1,2, Mei Fan2, Du Yanjun1,2, Yin Shuishui2, Tian Xue1,2, Hu Lili1,2, Hong Wei1,2, Shan Lang2, Ban Hong2, Xu Congfeng2, Liu Wen2, Lu Bing1,2, Li Jiehui1,2
1Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; 2Department of Gynecological Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang 550004, China
Abstract：Objective To compare the effect of neoadjuvant chemotherapy vs. concurrent chemoradiotherapy on the target volume and organs at risk for locally advanced bulky (>4 cm) cervical cancer. Methods From March 1, 2019 to June 30, 2021, 146 patients pathologically diagnosed with cervical cancer were selected and randomly divided into two groups using random number table method: the neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) group (n=73) and CCRT group (n=73). Patients in the NACT+CCRT group received 2 cycles of paclitaxel combined with cisplatin NACT, followed by CCRT, the chemotherapy regimen was the same as NACT. In the CCRT group, CCRT was given. Statistical description of categorical data was expressed by rate. The measurement data between two groups were compared by Wilcoxon rank-sum test for comparison of two independent samples, and the rate or composition ratio of two groups was compared by χ2 test. Results Before radiotherapy, GTV in the NACT+CCRT group was (31.95±25.96) cm3, significantly lower than (71.54±33.59) cm3 in the CCRT group (P<0.01). Besides, CTV and PTV in the NACT+CCRT group were also significantly lower compared with those in the CCRT group (both P<0.05). In terms of target volume dosimetry, D100GTV, D95CTV, V100GTV, V100CTV and V95PTV in the NACT+CCRT group were significantly higher than those in the CCRT group (all P<0.05). The complete remision (CR) rates in the NACT+CCRT and CCRT groups were 86.3% and 67.6%, with statistical significance between two groups (P<0.01) . Regarding organs at risk, NACT+CCRT group significantly reduced the dose to the bladder, rectum, small intestine and urethra compared with CCRT group (all P<0.05). Conclusions NACT can reduce the volume of tumors in patients with large cervical masses, increase the radiation dose to tumors, reduce the dose to organs at risk, and make the three-dimensional brachytherapy easier. Therefore, NACT combined with CCRT may be a new choice for patients with locally advanced cervical cancer with large masses.
Li Fenghu,Mei Fan,Du Yanjun et al. Study of radiotherapy dose effect of neoadjuvant chemotherapy versus concurrent chemoradiotherapy in cervical cancer[J]. Chinese Journal of Radiation Oncology, 2023, 32(2): 131-137.
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