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Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging ( IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0?1 000 s/mm2), and contrast?enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer ( stage ≥Ⅱb ) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi?exponential model to generate three parameters, containing pure diffusion coefficient ( D ) , pseudodiffusion coefficient ( D?) , and perfusion fraction ( f ) . Apparent diffusion coefficient ( ADC ) was obtained using the mono?exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment ( 0?96 × 10-3 vs. 1?77 × 10-3 mm2/s, P=0?000;0?76 × 10-3 vs. 1.34± 0?12 × 10-3 mm2/s, P=0?000;0?14% vs. 0?24%, P=0?012). The above three values significantly increased after two weeks of treatment (all P=0?000) and kept increasing until the end of the treatment. In contrast, the D? value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.
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Objective To investigate the diagnostic value of serum vascular endothelial growth factor (VEGF) level for cervical cancer and its relationship with the therapeutic efficacy of concurrent chemoradiotherapy (CCRT).Methods Eighty patients with a pathologically confirmed diagnosis of advanced cervical squamous cell carcinoma (CSCC),20 patients with chronic cervicitis,and 20 healthy persons (as controls) were enrolled in the study.The CSCC patients received CCRT.All the subjects had their baseline serum VEGF levels measured by enzyme-linked immunosorbent assay (ELISA);also,the CSCC patients had their serum VEGF levels measured by ELISA at 3 months after CCRT.The relationship between the serum VEGF levels and therapeutic efficacy of CCRT was analyzed.Results The CSCC patients had a significantly higher baseline serum VEGF level than the chronic cervicitis patients and controls (237.36 μg/L vs.142.36 μg/L,t =4.03,P =0.000).The serum VEGF level was closely related to tumor stage,tumor differentiation,and lymph node metastasis.A serum VEGF level above 197.52 μg/L was the optimal cut point for diagnosing cervical cancer,with a sensitivity of 0.88 and a specificity of 0.72.The serum VEGF levels before and after CCRT showed a close relationship with the therapeutic efficacy.The patients achieving a complete remission had a significantly greater change in serum VEGF level than those with progression; the patients with high baseline serum VEGF levels had a significantly higher tumor progression or death rate than those with low baseline serum VEGF levels.Conclusions Serum VEGF level has poor diagnostic value for cervical cancer,though it is closely related to the tumor stage,tumor differentiation,and lymph node metastasis of cervical cancer.However,serum VEGF level has some predictive value for the therapeutic efficacy of CCRT in patients with cervical cancer.
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Objective To compare the treatment outcome and prognostic factors in patients with advanced cervical cervical cancer between Han and Uygur in Xinjiang district.Methods 204 patients with advanced cervical cancer were retrospectively analyzed.Eighty patients were Han 80 and 124 were Uyghur.100 patients received radiotherapy alone and 49 with concurrent radiochemotherapy,and 55 had brachytherapy followed by surgery.The survival rate was calculated by Kaplan-Meier method and the difference was compared by Logrank test.Multivariate analysis was performed using Cox regression model.Results The follow-up rate was 97.5％.The number of patients with at least 5 years of follow up was 102.The 1-,3-and 5-year overall survival rates in Han and Uygur patients were 81.2％,66.3％,51.4％ and 83.4％,62.8％,49.2％,respectively (x2 =3.21,P =0.273).Univariate analysis showed that parity,geographical distribution,pathological type,clinical stage,lymph node involvement and treatment were prognostic factors for overall survival (x2 =2.35,11.34,7.12,6.73,4.79,13.60,P=0.049,0.029,0.031,0.037,0.041,0.021).Multivariate analysis showed that parity,geographical distribution,pathological type,clinical stage,lymph node involvement and treatment were independent prognostic factors for overall survival (x2 =8.36,24.94,10.69,5.63,9.50,P =0.002,0.001,0.021,0.018,0.031).Conclusions There is no significant difference in overall survival rate of patients with advanced cervical cancer between Han and Uighur.Patients with parity more than or equal to 3 times,advanced clinical stage or adenocarcinoma have poor prognoses.
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Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.