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宫颈癌术后中危患者放疗与同步放化疗的疗效分析
潘闻燕, 马建萍, 何剑莉, 孟颖, 陆青, 冯阳阳, 拜周兰
宁夏医科大学总医院肿瘤医院放疗科,银川 750004
Analysis of clinical efficacy of radiotherapy alone and concurrent chemoradiotherapy in cervical cancer patients with intermediate risk factors after surgery
Pan Wenyan, Ma Jianping, He Jianli, Meng Ying, Lu Qing, Feng Yangyang, Bai Zhoulan
Department of Radiation Oncology, Tumor Hospital and General Hospital of Ningxia Medical University, Yinchuan 750004, China
Abstract:Objective To retrospectively analyze the differences of survival, recurrence, acute side effects and prognostic factors between early stage (stage ⅠB‐ⅡA) cervical cancer patients with intermediate risk factors receiving postoperative concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone. Methods Clinical data of 211 patients with intermediate risk factors after early stage cervical cancer surgery admitted to Department of Radiation Oncology of General Hospital of Ningxia Medical University from January 2016 to December 2018, were retrospectively analyzed. Among them, 91 cases were assigned in the RT group and 120 cases in CCRT group. The 3‐ and 5‐year overall survival (OS), progression‐free survival (PFS), recurrence and acute side effects were compared between two groups by Chi‐square test. Univariate analysis of OS and PFS was performed by Kaplan‐Meier method and log‐rank test was performed. Multivariate prognostic analysis was conducted by using Cox model. Results The 3‐ and 5‐year OS of 211 patients were 95.0% and 93.8%, respectively. The 3‐ and 5‐year PFS were 86.8% and 83.2%, respectively. The OS of CCRT and RT group were 93.9%, 96.5% (3‐year), 91.8%, 96.5% (5‐year) respectively (χ2=1.763, P=0.184), and the PFS were 84.4%, 89.9% (3‐year), 79.3%, 88.3% (5‐year) (χ2=2.619,P=0.106), with no difference between the two groups. The total recurrence rate was 15.64%, and there was no significant difference in the recurrence rate and recurrence area between two groups (χ2=2.623,P=0.105; χ2=6.745,P=0.080). Locoregional recurrence and lung metastasis were the main patterns of failure. Multivariate prognostic analysis showed that pathological type might significantly affect the OS (χ2=3.849, P=0.05), and depth of invasion significantly affected the PFS (χ2=4.095, P=0.043). The incidence of acute gastrointestinal side effect and bone marrow suppression in the CCRT group was significantly higher than that in the RT group (χ2=56.425, 27.833; both P<0.001). Conclusions Patients with intermediate risk factors after early cervical cancer surgery obtain high efficacy after radiotherapy. The main patterns of failure are locoregional recurrence and lung metastasis. The pathological type may be an independent prognostic factor of OS and the depth of invasion is an independent prognostic factor of PFS. Compared with RT, CCRT increases the risk of acute gastrointestinal side effects and myelosuppression, which can be tolerated. There is no significant difference in the clinical efficacy between RT and CCRT, which remains to be validated by large sample size studies.
Pan Wenyan,Ma Jianping,He Jianli et al. Analysis of clinical efficacy of radiotherapy alone and concurrent chemoradiotherapy in cervical cancer patients with intermediate risk factors after surgery[J]. Chinese Journal of Radiation Oncology, 2022, 31(12): 1115-1120.
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