A comparative clinical study of postoperative intensity-modulated radiotherapy combined with concurrent and sequential chemotherapy for high-risk early-stage cervical cancer
Nie Fangfang, Wang Li-hua, Teng Yin-cheng, Wang Yu-dong, Fu Jie
Department of Radiation Oncology,Shanghai Jiaotong University Affliated Sixth People′s Hospital,Shanghai 200233,China
Abstract：Objective To evaluate the efficacy and acute toxicities of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent (C-IMRCT) or sequential chemotherapy (S-IMRCT) in the treatment of high-risk early-stage cervical cancer. Methods A retrospective study was performed on the clinical data of 105 patients with high-risk early-stage (ⅠB1-ⅡA2) cervical cancer from 2009 to 2017. Those patients were divided into C-IMRCT group (n=73) and S-IMRCT group (n=32). The 5-year disease-free survival (DFS) and overall survival (OS) rates, recurrence rate, metastasis rate, and acute toxicities were compared between the two groups. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate prognostic analysis was performed by the log-rank test. Recurrence, metastasis, and adverse reactions were compared using continuous correction chi-square test. Results The median follow-up time was 20 and 23 months in the C-IMRCT group and the S-IMRCT group, respectively (P=0.813). There were no significant differences in the 5-year DFS and OS rates between the two groups (72.6% vs. 72.5%, P=0.918;82.8% vs. 78.5%, P=0.504). There were no significant differences in the recurrence and metastasis rates between the two groups (P=0.598;P=1.000). The univariate prognostic analysis showed that no pathological factor affected prognosis. There were no significant differences in the incidence rates of grade 1-2 hematological toxicity, diarrhea, and urinary tract infection between the two groups (46.6% vs. 41.9%, P=0.884;P=0.854;P=0.271). Conclusions Further clinical studies are needed in terms of the survival rate in patients with high-risk early-stage cervical cancer receiving C-IMRCT.
Nie Fangfang,Wang Li-hua,Teng Yin-cheng et al. A comparative clinical study of postoperative intensity-modulated radiotherapy combined with concurrent and sequential chemotherapy for high-risk early-stage cervical cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(5): 473-477.
[1]Torre LA,Bray F,Siegel RL,et al. Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.DOI:10.3322/caac.21262. [2]Landoni F,Colombo A.Randomized study between radical surgery and radiotherapy for the treatment of stage ⅠB-ⅡA cervical cancer:20-year update[J].2017,28(3):e34.DOI:10.3802/jgo.2017.28.e34. [3]Delgado G,Bundy B,Zaino R,et al. Prospective surgical-pathological study of disease-free interval in patients with stage ⅠB squamous cell carcinoma of the cervix:a Gynecologic Oncology Group study[J].Gynecol Oncol,1990,38(3):352-357. [4]Kinney WK,Alvarez RD,Reid GC,et al. Value of adjuvant whole-pelvis irradiation after Wertheim hysterectomy for early-stage squamous carcinoma of the cervix with pelvic nodal metastasis:a matched-control study[J].Gynecol Oncol,1989,34(3):258-262. [5]Peters WA,3rd,Liu PY,Barrett RJ,2nd,et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix[J].J Clin Oncol,2000,18(8):1606-1613.DOI:10. 1200/jco. 2000.18.8.1606. [6]戚世芳,刘华,田晓予.早期高危宫颈癌术后同步放化疗的临床研究[J].中国实用医药,2010(34):5-6. Qi SF,Liu H,Tian XY. Clinical Reseach Of Concurrent Chemoradiotherapy For The Early Stage Postoperative Cervical Cancer With High-risk Factors[J]. China Prac Med,2010(34):5-6. [7]Sehouli J,Runnebaum IB,Fotopoulou C,et al. A randomized phase Ⅲ adjuvant study in high-risk cervical cancer:simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R):a NOGGO-AGO Intergroup Study[J].Ann Oncol,2012,23(9):2259-2264.DOI:10.1093/annonc/mdr628. [8]Mabuchi S,Isohashi F,Yokoi T,et al. A phase Ⅱ study of postoperative concurrent carboplatin and paclitaxel combined with intensity-modulated pelvic radiotherapy followed by consolidation chemotherapy in surgically treated cervical cancer patients with positive pelvic lymph nodes[J].Gynecol Oncol,2016,141(2):240-246.DOI:10.1016/j.ygyno.2016.02.011. [9]Zhao H,Li L,Su H,et al. Concurrent paclitaxel/cisplatin chemoradiotherapy with or without consolidation chemotherapy in high-risk early-stage cervical cancer patients following radical hysterectomy:preliminary results of a phase Ⅲ randomized study[J].Oncotarget,2016,7(43):70969-70978.DOI:10.18632/oncotarget.10450. [10]Takekuma M,Kasamatsu Y,Kado N,et al. Adjuvant chemotherapy versus concurrent chemoradiotherapy for high-risk cervical cancer after radical hysterectomy and systematic lymphadenectomy[J].Int J Clin Oncol,2016,21(4):741-747.DOI:10.1007/s10147-016-0955-3. [11]Rose PG,Bundy BN,Watkins EB,et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer[J].N Engl J Med,1999,340(15):1144-1153. [12]郑建清,黄碧芬.宫颈癌术后紫杉醇联合顺铂同步放化疗的临床研究[J].中国实用医药,2015(01):11-13.DOI:10.14163/j.cnki.11-5547/r.2015.01.005. Zheng JQ,Huang BF. The clinical study of concurrent radiotherapy and paclitaxel combined with cisplatin in patients with cervical carcinoma[J]. China Prac Med,2015(01):11-13.DOI:10.14163/j.cnki.11-5547/r.2015.01.005. [13]Kim SW,Chun M,Ryu HS,et al. Long-term results of early adjuvant concurrent chemoradiotherapy for high-risk,early stage uterine cervical cancer patients after radical hysterectomy[J].BMCCancer,2017,17(1):297.DOI:10.1186/s12885-017-3299-0. [14]Lee TS,Kang SB,Kim YT,et al. Chemoradiation with paclitaxel and carboplatin in high-risk cervical cancer patients after radical hysterectomy:a Korean Gynecologic Oncology Group study[J].Int J Radiat Oncol Biol Phys,2013,86(2):304-310.DOI:10.1016/j.ijrobp.2013.01.035. [15]Mell LK,Kochanski JD,Roeske JC,et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy[J].Int J Radiat Oncol Biol Phys,2006,66(5):1356-1365.DOI:10.1016/j.ijrobp.2006.03.018. [16]Albuquerque K,Giangreco D,Morrison C,et al. Radiation-related predictors of hematologic toxicity after concurrent chemoradiation for cervical cancer and implications for bone marrow-sparing pelvic IMRT[J].Int J Radiat Oncol Biol Phys, 2011,79(4):1043-1047. DOI:10.1016/j.ijrobp.2009.12.025. [17]Erpolat OP,Alco G,Caglar HB,et al. Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervical cancer patients after concurrent chemoradiotherapy:a national multi-center study[J].Eur J Gynaecol Oncol,2014,35(1):62-66. [18]聂芳芳,陈小琴,付杰.早期高危宫颈癌术后同期放化疗研究进展[J].中华放射肿瘤学杂志,2017(12):1470-1474.DOI:10.3760/cma.j.issn.1004-4221.2017.12.025. Nie FF,Chen XQ,Fu J. Research advances in postoperative concurrent chemoradiotherapy for high-risk early stage cervical cancer[J].Chin J Radiat Oncol,2017(12):1470-1474.DOI:10.3760/cma.j.issn.1004-4221.2017.12.025.
2018, Vol. 27 
