ABSTRACT
Objective:To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage Ⅳ B hematogenous metastatic cervical squamous cell carcinoma. Methods:Clinical data of 80 patients with Ⅳ B stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan- Meier method. Prognostic factors were analyzed by Cox models. Results:The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis ( HR=2.23, 95% CI: 1.01-4.91, P=0.048) and ECOG performance status score of 3-4( HR=2.01, 95% CI: 1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS ( HR=0.39, 95% CI: 0.18-0.84, P=0.016). Compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS ( HR=0.32, 95% CI: 0.15-0.68, P=0.003). Conclusions:Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with Ⅳ B stage hematogenous metastatic cervical squamous cell carcinoma.
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Objective To study the difference between intensity-modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy (3D-CRT) for pelvic radiation of post-operative treatment with gynecologic malignant tumor. Methods A prospective investigation study was conducted on 183 patients of post-operative patients with whole pelvic radiation therapy of cervical cancer or endometrial cancer in Zhejiang Cancer Hospital [IMRT group (n=85) and 3D-CRT group (n=98)] from Oct. 2015 to Oct. 2016. The two groups received same dose (45 Gy in 25 fractions). Comparison of two groups with radiation dosimetry:the score according to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading standards before and after radiotherapy reaction, the score from functional assessment of cancer therapy scale-cervix (FACT-Cx) scale and expanded prostate cancer index composite for clinical practice (EPIC-CP) scale were also analyzed. Results (1) There were no significant effect with age, culture level, family economic condition and ratio of radiochemotherapy between two groups (all P>0.05). (2) Dosimetric comparison for IMRT vs 3D-CRT:the average dose of planning target volume (PTV) decreased(46.1 ± 0.4) vs(46.4 ± 0.5)Gy, V45 dose percentage increased(95.2 ± 1.0)%vs (93.3 ± 2.0)%, intestinal bag dose of V40 decreased(24.4 ± 6.8)%vs (36.5 ± 15.9)%, rectal V40 dose percentage decreased(73.9 ± 12.3)%vs (85.4 ± 8.4)%, and lower rectal V45 dose percentage(32.8 ± 13.4)%vs (71.5 ± 13.7)%, bladder V40 dose percentage decreased(55.5 ± 13.0)% vs (84.4 ± 13.0)%. Bone marrow V20 lower:(67.9 ± 5.4)% vs (79.5 ± 6.6)%, V10 lower:(82.1 ± 6.0)% vs (86.3 ± 6.6)%; there were significant differences (all P0.05). (3) Acute radiation injury classification for IMRT vs 3D-CRT:big or small intestine:Ⅱ-Ⅲreaction [13%(11/85) vs 24% (24/98); χ2=3.925, P=0.048], there was significant difference. Bladder: Ⅲ reaction [19% (16/85) vs 26% (25/98); χ2=1.171, P=0.279], there was no significant difference. Radiochemotherapy of bone marrow suppression:Ⅲ-Ⅳreaction (14/20), the incidence rate [26%(14/54) vs 31%(20/65);χ2=0.339, P=0.562], the difference was not statistically significant. (4) Quality of life scale by FACT-Cx scale in IMRT vs 3D-CRT:there were no significant difference before radiotherapy (82 ± 16 vs 85 ± 16;t=1.279, P=0.203), while there was significant difference after radiotherapy (76 ± 14 vs 71 ± 18;t=-2.160, P=0.032). EPIC-CP scale score:before radiotherapy they were (16±7 vs 15±6;t=-0.174, P=0.862) ,but after radiotherapy (18±7 vs 22± 7; t=3.158, P=0.002), there was significant difference between them. Before and after radiotherapy, the increased EPIC-CP scale of the IMRT group vs 3D-CRT group were 3 ± 4 and 6 ± 4, the 3D-CRT group was significantly higher, the difference was statistically significant (t=5.500, P=0.000). Conclusion IMRT has shown that there are a significant benefit for the post-operative patients with cervical cancer and endometrial cancer compared to 3D-CRT.
ABSTRACT
Haemorrhagic cystitis (HC) is a potentially severe complication,caused by high-dose chemotherapeutic drugs or radiation therapy (RT).It is thought that a defect caused by chemotherapeutic drugs in the glycosaminoglycan (GAG) layer may be the first step in HC development.The pathogenesis of RT-induced cystitis originates as a progressive obliteration of the small blood vessels of the bladder wall.Mesna,hyperhydration and continuous bladder irrigation have been shown effective in preventing HC.However,these preventive protocols do not always satisfactorily protect the patient from bladder injury.In recent years,GAG-replenishment therapy and hyperbaric oxygen therapy have gained some evidence exists.Currently,there is a lack of consensus about the best treatment for patients with chemotherapy and radiatherapy induced HC.Therefore,the prevention and treatment of this complication is still the focus at present.
ABSTRACT
Background and purpose:It is rare that gastric and colorectal cancer metastasize to the uterine cervix.The study aimed to explore the treatment,prognosis,and the clinical features of metastatases of uterine cervix from gastric and colorectal cancer.Methods:22 patients with metastatic carcinoma to the uterine cervix from gastric and colorectal cancer were treated from 1994 to 2007 in Cancer Hospital of Zhejiang Province.The clinical pathologic parameters and prognosis were analyzed retrospectively.Results:The ages of patients ranged from 29 to 74 years old with mean of 46.7 years.The main symptom of patients was vaginal bleeding(54.5%).The primary tumor was gastric cancer in 10 cases and colorectal cancer in 12 cases.6 cases received operation alone,3 cases received radiotherapy alone,1 case received chemotherapy alone,9 cases were treated by the combination of chemotherapy,operation or radiotherapy,3 cases were not treated.According to clinical pathologic parameters,if the primary tumor was gastric cancer,it metastasesed to endometrium of uterine body;if the primary tumor was colorectal cancer,the serosa and myometrial of uterine body were invaded.In 22 cases,3 cases were still under treatment,with one lost follow-up,and the others died,the mean overall survival was 14.6 months.The mean overall survival were 11.2 months for gastric cancer and 17.9 months for colorectal cancer respectively.The mean overall survival of signet-ring cell carcinoma,mucinous adenocarcinoma and adenocarcinoma(G1-G3)were 10 months,13 months,and 18.1 months respectively.The mean overall survival for the patients treated by either radiotherapy,operation or the combination were 10.7 months,13.2 months and 17.7 months respectively.The mean overall survival for 4 patients treated by radical operation and 5 patients treated by tumor cell reduction-extinction technique were 22.3 months and 7.8 months respectively.Conclusion:The mean overall survival for the patients with metastases of uterine cervix from gastric cancer was worse than that from colorectal cancer.The patients with signet-ring cell carcinoma had the shortest mean overall survival,followed by mucinous adenocarcinoma.The primary lesion of tumor,histological types and treatment modality may be the main factors that affect the prognosis.The strategy of the treatment for the disease should be multidisciplinary therapy including surgery,radiotherapy and chemotherapy.