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Objective: To evaluate factors that affect recurrence ofⅠb-Ⅱa cervical cancer after surgery or radiation therapy, and to provide evidence for prevention and personalized treatment of cervical cancer recurrence. Methods: We retrospectively analyzed clini-cal and pathological data of 193 patients with stageⅠb-Ⅱa cervical cancer who were diagnosed and treated in Affiliated Cancer Hos-pital of Xinjiang Medical University from January 2010 to April 2015. The patients were assigned into the following two groups: postop-erative radiotherapy recurrence group (36 cases) and non-recurrence group (157 cases). Factors related to recurrence after postopera-tive radiotherapy were analyzed. Results: The incidence rates of squamous cell carcinoma, adenocarcinoma, and other cervical cancer types were 90.2% (174/193), 5.7% (11/193), and 4.1% (8/193), respectively. The recurrence rates of squamous cell carcinoma, adeno-carcinoma, and other cervical cancer types were 16.7% (29/174), 45.5% (5/11), and 25.0% (2/8), respectively. The difference was statis-tically significant (χ2=12.463, P<0.05). The proportion of patients with age≤40 years, adenocarcinoma, vaginal margin, vascular inva-sion, lymph node metastasis, and parametrial invasion was higher in the relapse group than in the non-relapse group; the difference was statistically significant between the two groups (P<0.05). The odds ratio (OR) values for positive vaginal margin, positive vascular invasion, and positive parametrial invasion were above 1 (P<0.05). Therefore, these three factors were independent risk factors for cer-vical cancer recurrence after radiotherapy. Conclusions: Among stage Ib-IIa cervical cancer cases, squamous cell carcinoma had the highest recurrent incidence. However, the rate of recurrence after surgery or radiation therapy was the highest for adenocarcinoma. Postoperative pathology suggests that patients with positive vaginal margins, positive vascular infiltration, and positive parametrial in-vasion have a high risk of recurrence after radiotherapy and should be followed-up carefully.
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Objective To compare the dosimetry and toxicities between postoperative fixed-field intensity-modulated radiotherapy (FF-IMRT) and image-guided radiation therapy/volumetric modulated arc therapy (IGRT-VMAT) for cervical cancer.Methods A total of seventy patients with stage I b-Ⅱa postoperative cervical cancer who had high risk factors,were divided into FF-IMRT (FF-IMRT group,n =35)and IGRT-VMAT (IGRT-VMAT group,n =35),to compare the difference of target dose and adverse reaction between the two groups.Results In the IGRT-VMAT group,the interfractional setup errors in the x,y,and z axes were (0.25±0.14) cm,(0.26±0.16) cm,and (0.24±0.18) cm,respectively;the intrafractional setup errors in the x,y,and z axes were (0.1±0.09) cm,(0.12±0.09) cm,and (0.11±0.09) cm,respectively;the margins in the x,y,and z axes were 0.75 cm,0.84 cm,and 0.78 cm,respectively.Under the same dosimetric conditions,the IGRT-VMAT group was superior to the FF-IMRT group in terms of conformity index,treatment time,and number of monitor units (P=0.000).The Dmean and volume receiving high-dose irradiation for the bladder,rectum,and small intestine were significantly lower in the IGRT-VMAT group than in the FF-IMRT group (P=0.000).Compared with the FF-IMRT group,the IGRT-VMAT group had a significantly reduced incidence of acute and chronic gastrointestinal,urinary,and hematologic toxicities (P＜ 0.05).Conclusions IGRT-VMAT can correct setup error online,shorten the treatment time,reduce the dose to organs at risk,and alleviate acute and chronic toxicities,and is especially suitable for patients with postoperative small bowel position changes.
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Objective:To explore the factors affecting the postoperative prognosis of early cervical squamous cell carcinoma and inves-tigate the different radiotherapy techniques. Methods:A total of 100 postoperative patients of early cervical squamous cell carcinoma treated in Affiliated Tumor Hospital of Xinjiang Medical University and Affiliated Tumor Hospital of Sun Yat-sen University from March to September 2013 were enrolled in our study. The prognostic factors for these patients were analyzed. After being subjected to differ-ent postoperative radiotherapy techniques, the efficacy and complications of the techniques were assessed for patients, including 50 cases of conventional radiotherapy (CRT) and 50 cases of image-guided radiotherapy (IGRT). Results:The 3-year overall survival rate was 89%, and the 3-year disease-free survival rate was 78%. The 3-year overall survival rates of the CRT and IGRT groups were 78.57%and 89.06%, respectively. The difference between these rates was statistically significant (P=0.034). The 3-year survival rates of the CRT and IGRT groups were 66.67%and 87.36%, respectively. The difference was statistically significant (P=0.042). The incidence of ear-ly and late complications in the CRT group was higher than that in IGRT group, and the difference of P<0.05 was statistically significant. Multivariate analysis showed that postoperative radiotherapy, parametrial invasion, lymph node metastasis, lymphovascular space in-vasion, perineural invasion, and deep stromal invasion were the independent risk factors for the prognosis of patients with early stage cervical squamous cell carcinoma. Conclusion:Early prognosis of cervical squamous cell carcinoma results from the interaction of mul-tiple factors. The 3-year survival rate of the IGRT group was significantly better than that of the CRT group in the early stage of cervical squamous cell carcinoma. IGRT alleviates acute and chronic toxicities and helps improve the quality of life of patients.