Clinical study on simultaneous modulated accelerated radiotherapy for advanced cervical cancer

doi:10.3760/cma.j.issn.1673-422X.2018.09.007

Abstract

Abstract: ObjectiveTo study the clinical efficiency and adverse reactions of simultaneous modulated accelerated radiotherapy (SMART) and intensitymodulated radiation therapy (IMRT) in advanced cervical cancer. MethodsSixty patients with advanced cervical cancer were collected from April 2011 to April 2017 in our hospital. The 60 patients were randomly divided into experimental group (30 cases) and control group (30 cases) by using stratified randomization method. The two groups were given intracavitary irradiation and concurrent chemotherapy. The patients in experimental group were treated with SMART and the patients in control group were treated with IMRT. 95% planned target volume was 50.4 Gy/28 F in the two groups and the dose for IMRT with simultaneous integrated boost was 64.4 Gy/28 F to the planning target volume. Disease progression, survival time and adverse reactions of the two groups were compared. ResultsAt the end of radiotherapy, the experimental group had 23 patients with complete response (CR), 4 patients with partial response (PR), 2 patients with unaltered stable disease (SD), 1 patient with progressive disease (PD), and the control group had 22 patients with CR, 3 patients with PR, 3 patients with SD, 2 patients with PD. The overall efficiency of the experimental group was slightly higher than that of the control group (90.0% vs. 83.3%), but the difference was not statistically significant (χ2=0.144, P=0.704). After 3 months of radiotherapy, the experimental group had 28 patients with CR, 1 patient with PR, 1 patient with PD, and the control group had 22 patients with CR, 2 patients with PR, 3 patients with SD, 3 patients with PD. The overall efficiency of the experimental group (96.7%) was higher than that of the control group (96.7% vs. 80.0%), but the difference was not statistically significant (χ2=2.588, P=0.108). The median overall survival time of the experimental group and control group were 43 months and 38 months, and the difference was statistically significant (χ2=7.087, P=0.008). The 1year survival rates of the two groups were 96.6% and 85.7%, and the 3year survival rates were 86.2% and 60.7%, respectively. There were no significant differences in the incidences of gastrointestinal reaction (66.7% vs. 63.3%, χ2=0.073, P=0.787), urinary system reaction (33.3% vs. 30.0%, χ2=0.077, P=0.781) and bone marrow suppression (83.3% vs. 86.7%, χ2=0.000, P=1.000) between the two groups. ConclusionThe efficiency of advanced cervical cancer patient treated with SMART is better than IMRT, and the adverse reactions are tolerable, which is worthy of clinical promotion.

Key words: Uterine cervical neoplasms, Radiotherapy, intensitymodulated;, Simultaneous modulated accelerated radiotherapy, Adverse reaction

Yang Chunhua, Wang Xia, Zhang Longzhen, Chen Jie, Tang Tianyou, Liu Guihong. Clinical study on simultaneous modulated accelerated radiotherapy for advanced cervical cancer[J]. Journal of International Oncology, 2018, 45(8): 544-547.

References

1］俞青青, 唐荣军, 楼军, 等. 同步热放化疗治疗在中晚期宫颈癌的应用价值［J］. 中国妇幼健康研究, 2015, 26(4): 794796. DOI: 10.3969/j.issn.16735293.2015.04.047. ［2］ Zhang G, Fu C, Zhang Y, et al. Extendedfield intensitymodulated radiotherapy and concurrent cisplatinbased chemotherapy for postoperative cervical cancer with connnon iliac or paraaortic lymph node metastases: a retrospective review in a single institution［J］. Int J Gynecol Cancer, 2012, 22(7): 12201225. DOI: 10.1097/ IGC.0b013e3182643b7c. ［3］ Vandecasteele K, Makar A, Van den Broecke R, et al. Intensitymodulated arc therapy with cisplatin as neoadjuvant treatment for primary irresectable cervical cancer. Toxicity, tumor response and outcome［J］. Strahlenhter Onkol, 2012, 188(7): 576581. DOI: 10.1007/s0006601200970. ［4］ Li XL, Chen ZY, Cui YC, et al. Simultaneous modulated accelerated radiotherapy in cervical cancer with retroperitoneal lymph node metastasis after radical hysterectomy and pelvic lymphadenectomy［J］. Int J Gynecol Cancer, 2015, 5(5): 903909. DOI: 10.1097/IGC.0000000000000426. ［5］ Goodman KA, Regine WF, Dawson LA, et al. Radiation Therapy Oncology Group consensus panel guidelines for the delineation of the clinical target volume in the postoperative treatment of pancreatic head cancer［J］. Int J Radiat Oncol Biol Phys, 2012, 83(3): 901908. DOI: 10.1016/j.ijrobp.2012.01.022. ［6］ Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015［J］. CA Cancer J Clin, 2016, 66(2): 115132. DOI: 10.3322/caac.21338. ［7］赵宗兴. 局部晚期宫颈癌同步推量调强放疗与常规调强效放疗的计量学比较急早期临床观察［D］. 长春: 吉林大学, 2015．［8］叶玲. 中晚期宫颈癌调强放疗联合同步化疗与常规放疗联合同步化疗临床疗效及不良反应对比观察［J］. 临床和实验医学杂志, 2016, 15(1): 5154. DOI: 10.3969/j.issn.16714695.2016.01.018. ［9］ Tang JM, Ma XM, Hou YL, et al. Analysis of simultaneous modulated accelerated radiotherapy (SMART) for nasopharyngeal carcinomas［J］. J Radiat Res, 2014, 55(4): 794802. DOI: 10.1093/ jrr/ rru012. ［10］ Ippolito E, Cellini N, Diqesù C, et al. Postoperative intensitymodulated radiotherapy with simultaneous integrated boost in prostate cancer: a doseescalation trial［J］. Urol Oncol, 2013, 31(1): 8792. DOI: 10.1016/ j.urolonc.2010.10.005. ［11］ Boyle J, Craciunescu O, Steffey B, et al. Methods, safety, and early clinical outcomes of dose escalation using simultaneous integrated and sequential boosts in patients with locally advanced gynecologic malignancies［J］. Gynecol Oncol, 2014, 135(2): 239243. DOI: 10.1016/ j.Ygyno.2014.08.037.

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