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Objective:To compare the dosimetry and efficacy of intracavitary brachytherapy (ICBT) and intracavitary/interstitial brachytherapy (IC+ ISBT) based on CT image guidance in the treatment of stage Ⅲ B cervical cancer. Methods:Clinical data of 93 patients with stage Ⅲ B cervical cancer treated in Department of Radiotherapy of Jilin Cancer Hospital from June 2014 to February 2017 were analyzed retrospectively. According to the results of Gynecological examination and pelvic MRI before brachytherapy, confirming the size of residual tumor and the degree of parauterine infiltration, all patients were divided into the ICBT and IC+ ISBT groups. The D 90%, D 100%, V 100% and D 2cm 3 of bladder and rectum were compared, and the short-term and long-term efficacy was observed between two groups. Results:The median follow-up time was 60 months. The 5-year local control rate, distant metastasis-free survival rate and overall survival rate of all patients were 83%, 71% and 68%, respectively. Compared with the ICBT group, HR-CTV D 90% in the IC+ ISBT group was all more than 85 Gy, while there was no significant difference between two groups ( P=0.188). The D 2cm 3 of bladder and rectum in the IC+ ISBT group was significantly decreased by 7 Gy and 8 Gy (both P<0.01), and the distant metastasis-free survival rate was significantly improved ( P=0.009). The 5-year local control rate in the HR-CTV volume>60 cm 3 in the IC+ ISBT group was significantly higher than that in the IC group ( P=0.029). Conclusion:For patients with Ⅲ B cervical cancer, IC+ ISBT can not only ensure target coverage, but also significantly reduce the incidence of distant metastasis and the dose of organs at risk, and significantly improve the local control rate of large tumors.
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The main treatment options for cervical cancer include surgery and/or radiotherapy combined with chemotherapy. Radiotherapy consists of external beam radiotherapy and brachytherapy (BT). BT contains high-dose-rate (HDR-BT) and low-dose-rate brachytherapy (LDR-BT). The prognosis of cervical cancer is relatively good. However, some patients experience substantial treatment failures, such as intra-pelvic and/or extra-pelvic recurrences. Recurrent cervical cancer (RCC) has poor prognosis due to lack of effective and safe approach. In 2002, Professor Wang Junjie introduced CT-guidance into the field of LDR-BT, and fully applied 3D printing technology in BT in 2015, which met the requirement of preoperative LDR-BT planning, and significantly improving the precision, quality and efficiency of BT. In 2018, Professor Wang Junjie proposed the concept of stereotactic ablation brachytherapy (SABT). Chinese experts have attempted to treat RCC with BT for nearly two decades and accumulated certain clinical experience. Based on the 3D-printing template (3D-PT) assisted CT-guidance, the standard and consensus of BT for RCC were established, including the indications, dosimetric requirements, technological procedures and radiation protection, etc. At present, there is still a lack of phage Ⅲ clinical and evidence-based medicine for the treatment of RCC with 3D-PT guidance, which requires prospective multi-center, randomized studies to improve the evidence-based level of BT.
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Objective@#To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer.@*Methods@#A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis.@*Results@#The 2-year overall survival (OS) and disease free survival (DFS) were 83.4% and 72.5%, respectively. During the follow-up periods, 46 patients (21.8%) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27%) had recurrence and metastasis, including 16 (28.1%) with local recurrence, 27 (47.4%) with distant metastasis, and 14 with local recurrence and distant metastasis(24.6%). Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2=7.123, 6.014, 8.398, P<0.05; DFS: χ2=11.832, 8.003, 7.731, P<0.05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis (χ2=9.286, P<0.05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS(HR=2.963, 2.473, 2.574, P<0.05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR =3.014, 1.988, 1.914, P<0.05).@*Conclusions@#By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
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Objective To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer. Methods A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis. Results The 2-year overall survival (OS) and disease free survival (DFS) were 83. 4％ and 72. 5％, respectively. During the follow-up periods, 46 patients (21. 8％) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27％) had recurrence and metastasis, including 16 (28. 1％) with local recurrence, 27 (47. 4％) with distant metastasis, and 14 with local recurrence and distant metastasis ( 24. 6％) . Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2 = 7. 123, 6. 014, 8. 398, P < 0. 05; DFS: χ2 = 11. 832, 8. 003, 7. 731, P < 0. 05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis ( χ2 =9. 286, P<0. 05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS (HR= 2. 963, 2. 473, 2. 574, P<0. 05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR = 3. 014, 1. 988, 1. 914, P< 0. 05). Conclusions By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
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Objective:To explore the predictive value of serum thyroglobulin autoantibody (TgAb) for recurrence / metastasisin of thyroglobulin (TG)-negative and TgAb-positive patients with differentiated thyroid carcinoma(DTC) after thyroid ablation.Methods:The clinical data of 57 patients with DTC,undergoing complete resection of thyroid tissue,TG negative and TgAb positive,who were reviewed in Liaocheng People's Hospital during April 2013 to April 2015,were selected and divided into recurrence/metastasis group (n=20) and no recurrence/metastasis group (n=37).The TG and TgAb levels in the two groups were detected and compared by the electrochemical luminescence method,the sensitivity,specificity,positive predictive value and negative predictive value of TgAb in the diagnosis of DTC recurrence / metastasis were analyzed;the independent risk factors of DTC recurrence / metastasis were analyzed by Logistic regression.Results:The TgAb levels(72～3850 IU/mL) in the recurrence/metastasis group was higher than that(18～3638 IU/mL) in the no recurrence/metastasis group,the difference was statistically significant (P＜0.05).The sensitivity,specificity,positive predictive value,negative preictive value of TgAb in the diagnosis of recurrence/metastasis of DTC were 85.71％,83.33％,75.00％,90.91％,respectively.Logistic Regression analysis showed that the 100≤ TgAb ＜204 IU/mL,204≤ TgAb≤ 1000IU/mL,and ＞ 1000IU/rnL levels of TgAb were the independent risk factors of rucurrence/metastasis ofDTC (OR=1.267,2.853,6.791,P＜0.05).Conclusion:TgAb can be used as evaluation of an important index of the recurrence/metastasis of patients with DTC when serum thyroglobulin (TG) was negative and TgAb was positive after thyroid ablation.The higher the TgAb levels,the more probability of the recurrence/metastasis.