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Objective To investigate the relationship between the body mass index (BMI)/body mass index improved (BMIIMPd) and the dose of the small intestine as well as the acute radiation colitis in the intensity-modulated radiation therapy after cervical cancer surgery.Methods Thirty-nine cervical cancer patients underwent postoperative adjuvant radiotherapy.All patients received Philips large bore CT scan for enhanced CT scan,target delineation and organ at risk.All patients were treated with a single arc 10 MV VMAT plan.The correlation between the radiation dose of the small intestine and the acute radiation enteritis and BMI/BMIIMPd was analyzed.Results The BMI was calculated as (22.23±2.80) kg/m2,BMIIMPd was (21.49±3.95) kg/m2,the small intestine volume VSI was (1 155.71 ± 419.33)cc3.The volume of the small intestine received more than 10 Gy (V10_SI) VMAT was (66.50± 27.01) ％,and the equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were (4 098.87± 184.93) cGy and (7.98±8.73)％.One way ANOVA demonstrated that under the VMAT technology,the BMIIMPd,V30,V40,EUD (or=50) and NTCP in the small intestine were the influencing factors of the occurrence of acute radiation enteritis.Conclusions If the improved BMIIMPd is utilized to distinguish the BMI,the high dose area of the small intestine will be larger and the incidence of acute radiation enteritis will be higher for patients with BMIIMPd between 10.1 and 16.9(normal and thin).Conventional BMI cannot be utilized as a basis for the prediction of the incidence of acute radiation enteritis in patients with cervical carcinoma.
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Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-Ⅱ A cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy.Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion,depth of stromal invasion or tumor size ＞ 4 cm were retrospectively analyzed.The impact of observing (NT),chemotherapy (CT),radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared.The Kaplan-Meier method was used to survival analysis,and log-rank test difference,Cox model was used to prognostic factor analysis.Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0％ and 84.8％.Univariate and multivariate analyses demonstrated that TS＞ 4 cm and therapeutic method were the independent prognostic factors of PFS.The number of risk factors and therapeutic method were the independent prognostic factors of OS.In the whole group,both RT and CCRT could improve the prognosis of patients with no statistical significance (P＞0.05).In the subgroup analysis,for patients with a single intermediate risk factor (low risk group),CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692).Compared with NT and CT,RT and CCRT could improve the PFS and OS,whereas no statistical significance was noted between the RT and CCRT (both P＞0.05).For those with ≥2 risk factors (high risk group),CCRT could significantly prolong the PFS compared with CT (84.9％ vs.70％;P=0.006),but did not improve the OS (P=0.107).Compared with RT,CCRT could significantly improve the PFS and OS (both P＜0.05).Conclusion For patients with only one risk factor,RT can enhance the clinical prognosis.CCRT can improve the clinical prognosis of stage Ⅰ-Ⅱ A cervical cancer patients with ≥ 2 risk factors.
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Objective To evaluate the clinical application of Catalyst system in positioning patients during cervical cancer radiotherapy,and to analyze its correlation with the bladder volume and body mass index (BMI) of patients.Methods A total of 33 patients diagnosed with cervical cancer from July to December 2017 in our hospital were included in the study.All patients were auxiliary positioned by an optical surface imaging system (C-Pad Catalyst) before each treatment.The CBCT imaging was executed twice a week.The setup errors from Catalyst and CBCT in the anterior-posterior (AP),superior-inferior (SI) and leg-fight (LR) directions were recorded.Each patient's bladder volume and BMI were also recorded.Results The setup errors between Catalyst with masks and CBCT had the significant difference in SI (P＜0.05) and LR (P＜0.05).For Catalyst without masks,the setup errors with the bladder volume of 200-300 ml had the significant association in SI (R=-0.316,P＜0.05).For the bladder volume of＞300 ml,the setup errors for Catalyst with masks had the significant association in AP (R=-0.493,P＜0.05),and that without masks had the significant association in SI and LR (R=0.335,P＜0.05,R=-0.348,P＜0.05).For patients of＜25 kg/m2,setup errors for Catalyst with masks had the significant association with the BMI in LR (R=0.197,P＜0.05);for ≥ 25 kg/m2,that with masks had the significant association in AP and SI (R =0.818,P＜0.05;R=-0.498,P＜0.05),that without masks had the significant association in AP and LR (R=0.652,P＜0.05;R=-0.558,P＜0.05).Conclusion Unlike CBCT system,the patient positioning by Catalyst system was easily affected by the bladder volume and BMI of patients.
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Objective To evaluate the effect of the bladder scanner upon maintaining the consistency of bladder filling in cervical cancer patients during the intensity-modulated radiotherapy.Methods The bladder volume change of 20 patients diagnosed with cervical cancer throughout radiotherapy were retrospectively analyzed to determine the timing of introducing the bladder scanner. Ten patients undergoing cervical cancer radiotherapy were selected to analyze the consistency between the bladder volume measured by bladder scanner and cone-beam CT (CBCT).The changes of bladder volume before and after the intervention of bladder scanner were statistically compared. Results In total,100 CBCT images of 20 patients were retrospectively analyzed. Nonparametric test demonstrated that the bladder volume significantly differed compared with the planning volume ( P< 0. 05). Bland-Altman plot illustrated high consistency between the bladder volume measured by the bladder scanner and CBCT images with a mean difference of-6. 66 cm3 (95％CI: - 53. 1-39. 83 cm3 ). Paired-t test showed there was statistical difference between the bladder volume before intervention and the planning bladder volume (P= 0. 000).The bladder volume after intervention did not significantly differ from the planning bladder volume (P= 0. 745). Conclusions The bladder volume significantly varies throughout the treatment process. Bladder scanner should be utilized prior to treatment. The bladder volume measured by the portable bladder scanner is consistent with the planning bladder volume.
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Objective To compare the setup errors of the negative pressure vacuum air cushion (vacuum bag) and the Orfit body foam fixator (Orfit frame) in radiotherapy for cervical cancer.Methods A total of 40 patients receiving three-dimensional radiotherapy for cervical cancer were enrolled in this study and equally and randomly divided into vacuum bag group and Orfit frame group.And the two groups were divided into Orfit-1 group, Orfit-2 group, vacuum-1 group, and vacuum-2 group according to the treatment course.The Orfit-1 group and vacuum-1 group were the data in the first 12 treatments, while the Orfit-2 group and vacuum-2 group were the data in the following 13 treatments.A cone-beam computed tomography scan was performed before each treatment to analyze setup error and then the body position was corrected to start the treatment.Comparison of continuous data between groups was made by paired t-test, while comparison of categorical data was made by chi-square test.Results There was a significant difference in the setup error in y-axis direction between the Orfit-1 group and the Orfit-2 group (P=0.003) and the setup error in r-axis direction between the vacuum-1 group and the vacuum-2 group (P=0.013).There were no significant differences in the setup errors in four directions (x-axis, y-axis, z-axis, and r-axis) between the Orfit-1 group and the vacuum-1 group (P>0.05).There were significant differences in the setup errors in y-axis and z-axis directions between the Orfit-2 group and the vacuum-2 group (P=0.007;P=0.001).Conclusions The Orfit frame and the vacuum bag have their own advantages and disadvantages in the fixation of body position in radiotherapy for cervical cancer.The setup error can be improved by long vacuum bags, ultrasound bladder capacity scanner, image-guided radiotherapy, or sectional radiotherapy plan.
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Objective To investigate the time efficiency and accuracy of atlas-based auto-segmentation ( ABAS ) software with different atlas template numbers and layers of computed tomography ( CT ) scans in delineation of the target tissues of cervical cancer patients receiving radiotherapy . Methods The CT images from 20, 40, 60, 80, 100, and 120 patients with cervical cancer were separately selected as atlas templates for MIM auto-segmentation software, and the CT-based tumor volumes of another 20 patients with cervical cancer were manually contoured by physicians. The quality of contours obtained automatically from the software and manual contouring was compared by one-way analysis of variance ( ANOVA ) , randomized block ANOVA, and least significant difference t test. The impact of atlas template numbers and layers of CT scans on the accuracy and time efficiency of MIM software was analyzed based on the time spent in delineation, dice similarity coefficient, and overlap index. Results Taking manual contouring as the reference, no significant differences were observed in the accuracy and time efficiency of auto-contouring when atlas template numbers ranged from 20 to 120(all P>005). The ABAS auto-contouring significantly shortened the time for target contours when the layers of CT scans were less than 65 ( all P>005 ) , but reduced the accuracy of rectal contours (P=0000), while CT scans with 67 layers achieved the highest accuracy of rectal contours ( P= 0037 ) . Conclusions The ABAS software shows an advantage in delineation of the target tissues of cervical cancer patients receiving radiotherapy, and 20 templates are suggested to construct this atlas. The CT scans with 65 layers are recommended for patients when target tissues include the bladder, femur, and spinal cord, and CT scans with 67 layers are recommended for patients when target tissues include the rectum.
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Objective To explore the nursing method for the prevention and treatment of vaginal adhesions in patients treated with full-dose radiotherapy for cervical cancer. Methods From 2015 to 2016, 80 cervical cancer patients who received radiotherapy were treated with domestic vaginal washing, vaginal local use of"Fufangbao", infection control, diet and sexual rehabilitation guidance, and so on, and the nursing outcome was evaluated. Results Of the 80 patients, 6 were lost during follow-up, resulting in a follow-up rate of 925%. Ten, five, and three patients were found to have grade 1, 2, and 3 vaginal toxicity, respectively. The patients with grade 1 vaginal toxicity were not treated with special treatment and were asked to do more vaginal washing. The patients with grade 2 and 3 vaginal toxicity were treated with daily vaginal washing and"Fufangbao" for repairing the vagina;vaginal adhesions disappeared or improved 3 months later. The patients with no vaginal adhesions had regular sexual intercourse and thus had improved quality of life. Conclusions Effective clinical nursing can reduce the incidence of vaginal adhesions and stenosis, improve patients' quality of life, and promote the harmony of family.
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Objective To investigate the time efficiency and accuracy of atlas-based auto-segmentation ( ABAS ) software with different atlas template numbers and layers of computed tomography ( CT ) scans in delineation of the target tissues of cervical cancer patients receiving radiotherapy . Methods The CT images from 20, 40, 60, 80, 100, and 120 patients with cervical cancer were separately selected as atlas templates for MIM auto-segmentation software, and the CT-based tumor volumes of another 20 patients with cervical cancer were manually contoured by physicians. The quality of contours obtained automatically from the software and manual contouring was compared by one-way analysis of variance ( ANOVA ) , randomized block ANOVA, and least significant difference t test. The impact of atlas template numbers and layers of CT scans on the accuracy and time efficiency of MIM software was analyzed based on the time spent in delineation, dice similarity coefficient, and overlap index. Results Taking manual contouring as the reference, no significant differences were observed in the accuracy and time efficiency of auto-contouring when atlas template numbers ranged from 20 to 120(all P>005). The ABAS auto-contouring significantly shortened the time for target contours when the layers of CT scans were less than 65 ( all P>005 ) , but reduced the accuracy of rectal contours (P=0000), while CT scans with 67 layers achieved the highest accuracy of rectal contours ( P= 0037 ) . Conclusions The ABAS software shows an advantage in delineation of the target tissues of cervical cancer patients receiving radiotherapy, and 20 templates are suggested to construct this atlas. The CT scans with 65 layers are recommended for patients when target tissues include the bladder, femur, and spinal cord, and CT scans with 67 layers are recommended for patients when target tissues include the rectum.
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Objective To explore the nursing method for the prevention and treatment of vaginal adhesions in patients treated with full-dose radiotherapy for cervical cancer. Methods From 2015 to 2016, 80 cervical cancer patients who received radiotherapy were treated with domestic vaginal washing, vaginal local use of"Fufangbao", infection control, diet and sexual rehabilitation guidance, and so on, and the nursing outcome was evaluated. Results Of the 80 patients, 6 were lost during follow-up, resulting in a follow-up rate of 925%. Ten, five, and three patients were found to have grade 1, 2, and 3 vaginal toxicity, respectively. The patients with grade 1 vaginal toxicity were not treated with special treatment and were asked to do more vaginal washing. The patients with grade 2 and 3 vaginal toxicity were treated with daily vaginal washing and"Fufangbao" for repairing the vagina;vaginal adhesions disappeared or improved 3 months later. The patients with no vaginal adhesions had regular sexual intercourse and thus had improved quality of life. Conclusions Effective clinical nursing can reduce the incidence of vaginal adhesions and stenosis, improve patients' quality of life, and promote the harmony of family.
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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 analyze the setup errors of external?beam and intracavitary radiotherapy for cervical cancer based on the data of cone?beam computed tomography ( CBCT) , and to provide a basis for clinical practice. Methods Sixty patients with stage ⅡA?ⅢB cervical cancer who were admitted to our hospital and underwent external?beam and intracavitary radiotherapy from March to June, 2015 were enrolled as subjects. Sixty patients with stage ⅡA?ⅢB cervical cancer undergoing conventional external?beam radiotherapy within the same period were also enrolled. The CBCT?based setup errors, containing setup errors in x, y, and z directions and three?dimensional vector deviation, in the initial treatment were obtained from each patient. Comparison of errors between the two treatment approaches was made by independent?samples t test. Results Fitting the data to a linear model revealed that the setup errors in x, y, and z directions increased with the increase in the distance between the position reference point and the center point of the target volume. External?beam radiation combined with intracavitary radiation had significantly reduced setup errors in x, y, and z directions than the conventional external?beam radiation ( 0.13± 0?12 vs. 0.31± 0?24, P=0?000;0.23±0?18 vs. 0.47±0?36, P=0?001;0.18±0?11 vs. 0.27±0?18, P=0?001). Conclusions In order to reduce the setup errors, CT scan needs not only a reference marker as close as possible to the center of the tumor, but also a reliable and accurate approach for postural fixation.
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At present,reports at home and abroad suggest a low probability of successful preservation of ovarian endocrine function after ovarian shift radiotherapy.After radiotherapy for cervical carcinoma,the ovarian function is associated with various factors,such as radiotherapy dose and method,patient's age,shift position,and concurrent chemotherapy drugs.Therefore,as for each patient,the dose to the ovarian tissue should be controlled within the individual dose limit to effectively preserve the ovarian function.
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Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma.Methods A total of 62 patients with cervical adenosquamous carcinoma,149 patients with cervical adenocarcinoma,and 2687 patients with cervical squamous cell carcinoma,all of whom were in stage Ⅰ B-Ⅱ A and were treated from 2006 to 2012,were enrolled,and some of them received postoperative pelvic radiotherapy ± para-aortic extended field radiation ±afterloading radiotherapy.The chemotherapy regimen consisting of DDP,TP,and FP was given to these patients.The chi-square test was used for comparison of general clinical data,the Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis.Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639).The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000).In the patients treated with surgery and radiotherapy,those with adenosquamous carcinoma had the shortest median survival time,followed by those with adenocarcinoma and squamous cell carcinoma (P =0.134,0.787);in the patients treated with surgery and concurrent chemoradiotherapy,those with adenocarcinoma had the shortest median survival time,followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131,0.643),and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P =0.000).In the patients with adenosquamous carcinoma and adenocarcinoma,the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037,0.003),but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861,0.655).In the patients with adenosquamous carcinoma,the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P =0.003) and prolonged median overall survival and disease-free survival (both increased by 17 months) (P=0.811,0.799),as compared with those treated with postoperative radiotherapy,while in the patients with adenocarcinoma,the median overall survival and disease-free survival were reduced by 11 and 9 months,respectively (P=0.330,0.115).Conclusions Compared with postoperative radiotherapy,postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis.Compared with radiotherapy,postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.
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Objective To study three contouring approaches of the bowel and evaluate the bowel dose volume with cervical cancer patient.Methods Twelve patients were selected,prescribed dose 45 Gy/ 25f.For each patient we contoured the bowel according to three different definitions:bowel loops,bowel bag and peritoneal space.Then we generated three rival plans each considering a different bowel definition and to evaluate dose differences of the HI,CI of PTV and D D V5-V45 of bowel loops with paired t-test.Results Comparison between BL and BB plan,Dmax,HI and CI of PTV,V5-V45 of bowel loops were not significantly different (P =0.171,0.076,0.192,P =0.315-0.855),D of PTV and Dmax of bowel loops had difference (P=0.017,0.038).Comparison between BL and PS plan,Dmax,D HI and CI of PTV and Dmax of bowel loops had differences (P=0.033,0.044,0.046,0.041,0.013),V5-V45 of bowel loops were not significantly different (P=0.416-0.977).If the bowel loops V40 ≤ 15％,and bowel bag and peritoneal space V40≤20％.Conclusions All definitions provided a very similar dose volume of bowel loops.Taking into account HI and CI of PTV and max dose of bowel loops,BB seems better than PS.
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ABSTRACT OBJECTIVE To describe the waiting time for radiotherapy for patients with cervical cancer. METHODS This descriptive study was conducted with 342 cervical cancer cases that were referred to primary radiotherapy, in the Baixada Fluminense region, RJ, Southeastern Brazil, from October 1995 to August 2010. The waiting time was calculated using the recommended 60-day deadline as a parameter to obtaining the first cancer treatment and considering the date at which the diagnosis was confirmed, the date of first oncological consultation and date when the radiotherapy began. Median and proportional comparisons were made using the Kruskal Wallis and Chi-square tests. RESULTS Most of the women (72.2%) began their radiotherapy within 60 days from the diagnostic confirmation date. The median of this total waiting time was 41 days. This median worsened over the time period, going from 11 days (1995-1996) to 64 days (2009-2010). The median interval between the diagnostic confirmation and the first oncological consultation was 33 days, and between the first oncological consultation and the first radiotherapy session was four days. The median waiting time differed significantly (p = 0.003) according to different stages of the tumor, reaching 56 days, 35 days and 30 days for women whose cancers were classified up to IIA; from IIB to IIIB, and IVA-IVB, respectively. CONCLUSIONS Despite most of the women having had access to radiotherapy within the recommended 60 days, the implementation of procedures to define the stage of the tumor and to reestablish clinical conditions took a large part of this time, showing that at least one of these intervals needs to be improved. Even though the waiting times were ideal for all patients, the most advanced cases were quickly treated, which suggests that access to radiotherapy by women with cervical cancer has been reached with equity.
RESUMO OBJETIVO Descrever o tempo de espera para realização de radioterapia em casos de câncer do colo do útero. MÉTODOS Estudo descritivo conduzido com 342 mulheres com câncer do colo do útero encaminhadas para radioterapia primária na Baixada Fluminense, RJ, período de 1995 a 2010. O tempo de espera foi calculado tendo como parâmetro o prazo de 60 dias para obter o primeiro tratamento do câncer e considerando a data da confirmação diagnóstica, a da primeira consulta oncológica e da primeira sessão de radioterapia. A comparação de medianas e proporções foi feita pelos testes de Kruskal Wallis e Qui-quadrado. RESULTADOS A maioria das mulheres (72,2%) iniciou a radioterapia dentro de 60 dias da data da confirmação diagnóstica. A mediana do tempo de espera total foi de 41 dias. Essa mediana piorou ao longo do período e passou de 11 dias (1995 a 1996) para 64 dias (2009 a 2010). A mediana do intervalo entre confirmação diagnóstica e primeira consulta oncológica foi de 33 dias, e da primeira consulta oncológica à primeira sessão de radioterapia, foi quatro dias. Houve diferença estatisticamente significativa (p = 0,003) da mediana do tempo de espera total segundo o estadiamento do tumor, obtendo-se 56 dias, 35 dias e 30 dias para os casos classificados até IIA, IIB-IIIB, e IVA-IVB, respectivamente. CONCLUSÕES Embora a maioria das mulheres tenha tido acesso à radioterapia dentro de 60 dias, a implementação de procedimentos para definição do estadiamento do tumor e restabelecimento das condições clínicas consumiu grande parte do tempo e precisa de aprimoramento. Ainda que o tempo de espera não tenha sido o ideal para todas as pacientes, os casos mais avançados chegaram mais rápido ao tratamento, sugerindo que o acesso à radioterapia para esse tipo de câncer tem sido alcançado com equidade.
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Humans , Female , Adult , Aged , Aged, 80 and over , Young Adult , Uterine Cervical Neoplasms/radiotherapy , Waiting Lists , Time-to-Treatment , Appointments and Schedules , Socioeconomic Factors , Brazil , Retrospective Studies , Health Services Accessibility , Middle AgedABSTRACT
Objective To compare the efficacy between californium?252 ( 252 Cf ) neutron intraluminal brachytherapy combined with external?beam radiotherapy with lead?shielding pelvic parallel opposing field technique and non?lead?shielding four?field box technique for cervical cancer. Methods A total of 52 patients with stage Ⅱa?Ⅲb cervical squamous cell carcinoma who were admitted to our hospital from 2004 to 2007 were enrolled as subjects and paired by clinical stage, age, tumor size, and degree of anemia. The 26 pairs of patients were divided into lead?shielding pelvic parallel opposing field group (lead?shielding group) and non?lead?shielding four?field box group (non?lead?shielding group). For all patients in both groups, 252 Cf neutron brachytherapy was added in external?beam radiotherapy. The local control (LC), overall survival (OS), and disease?free survival (DFS) rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The difference in the incidence of late complications was analyzed using the McNemar method. Results There were significant differences in 5?year LC, OS, and DFS rates between the lead?shielding group and the non?lead?shielding group (85% vs. 81%, P= 0?? 014;89% vs. 73%, P=0?? 013; 89% vs. 73%, P= 0?? 013 ). There was also significant difference in the incidence of late complications between the lead?shielding group and the non?lead?shielding group ( 12% vs. 23%, P=0?? 008). Conclusions When intraluminal brachytherapy combined with external?beam radiotherapy is used to treat cervical cancer, the centers of the front and back fields should be shielded by lead, regardless of whether the parallel opposing field technique or the four?field box technique is used.
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Objective To investigate the clinicopathological features,survival,and the impact of postoperative adjuvant radiotherapy on the ovarian function in patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer.Methods One hundred and eighty-six patients who were admitted to our hospital from 2000 to 2011 were retrospectively analyzed.An equal number of patients older than 35 years of age with cervical cancer within the same period were used as stage-marched controls.The Kaplan-Meier method was used to calculate the survival rates,and the log-rank test was used for pairwise comparison and univariate prognostic analyses.The Cox proportional hazards model was used for multivariate prognostic analyses.Results The patients less than or equal to 35 years of age had a significantly higher incidence of non-squamous carcinoma but significantly lower incidence rates of deep stromal invasion and lymph-vascular space invasion (LVSI) compared with the control group (P =0.000;P =0.008;P =0.000).Though young patients had significantly higher 5-year disease-free survival (DFS) and overall survival (OS) rates than the control group (93.7％ vs.84.5％,P=0.005;96.1％ vs.89.5％,P=0.033),age was not an independent prognostic factor (P =0.202;P =0.950).Among patients less than or equal to 35 years of age,lymph node metastasis and LVSI were independent prognostic factors for DFS (P =0.000;P =0.000),while LVSI and initial tumor size were independent prognostic factors for OS (P =0.000;P =0.000).There was no significant difference in the incidence of normal ovarian function between young patients treated with and without adjuvant radiotherapy after ovarian transposition (63％ vs.73％,P =0.422).Conclusions Patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer have a better prognosis than the control group.However,age is not an independent prognostic factor.Postoperative adjuvant radiotherapy will not impair the function of transposed ovaries.
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Objective To investigate the relationship between dose-volume histogram (DVH) parameters and the late side effects (LSE) of the rectum in external-beam radiotherapy combined with computed tomography (CT)-based brachytherapy for locally advanced cervical cancer.Methods From 2008 to 2011,18 patients with stage ⅡB-ⅢB cervical cancer received external-beam radiotherapy and CTbased brachytherapy.The DVH parameters of high-risk clinical target volume (HR CTV) D90,point A dose,and D1 cm3 and D2 cm3 of the rectum and bladder were calculated by Oncentra HDR treatment planning system.Survival outcomes were followed up and rectal LSE were evaluated by RTOG/EORTC grades.Results The point A dose and HR CTV D90 were (93.0 ± 5.5) Gy and (73.6 ± 11.9) Gy,respectively.The median follow-up was 26 months.No recurrence was found during follow-up.Eight patients had mild and moderate rectal LSE,and their rectum D2 cm3 and D1 cm3 were significantly higher than those of patients without mild and moderate rectal LSE (D2 cm3:(87.4 ± 3.8) Gy vs.(75.8 ± 7.4) Gy,P =0.004 ; D1 cm3:(96.4±6.6) Gy vs.(80.5± 7.1) Gy,P=0.001).Conclusions HR CTV D90 in CT-based brachytherapy for locally advanced cervical cancer might be lower than that in the MRI-based plan.Rectum D2 cm3 is recommended to be less than 75 Gy.
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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 clinical outcome and prognostic factors of concurrent radiochemotherapy (CRCT) or radiotherapy (RT) alone followed by radical hysterectomy in cervical cancer.MethodsBetween April 2006 and June 2011,182 patients with FIGO ⅠB2-ⅢB cervical carcinoma were treated with preoperative CRCT ( 123 patients) or RT alone ( 59 patients) followed by radical surgery.Weekly cisplatin (40 mg/m2)were administered during radiotherapy for patients treated with CRCT.Preoperative RT doses were 40-50 Gy in 20-25 fractions.Total hysterosalpingo-oophorectomy and pelvic lymph node dissection was performed 2-3 weeks after neoadjuvant therapy.The prognostic factors were analyzed by Cox-regression method.ResultsSixty-nine patients were followed up for 3 years.For patients with tumor ≥4.5 cm,there were no significant differences in the 3-year progression-free survival (PFS) and overall survival (OS) rates between CRCT and RT alone ( x2 =1.84 and 1.56,P =0.176 and 0.221 ).For patients with tumor ＜ 4.5 cm,CRCT group had higher PFS and OS rates than RT alone ( x2 =5.22 and 4.81,P=0.022 and 0.018).The 3-year PFS and OS rates were 92.0％ and 93.8％.By multivariate analysis,tumor diameter ( ≥6 cm vs.＜ 6 cm) was significant prognostic factor for PFS and OS (x2 =2.56,P =0.011 ;x2 =4.06,P =0.007 ),age ( ＜ 48 vs.≥ 48 years) was significant prognostic factor for OS (x2=4.86,P =0.046),and postoperative lymph node status (positive vs.negative) was significant prognostic factor for PFS ( x2 =1.04,P =0.010).ConclusionsTreatment with CRCT or RT followed by radical surgery has achieved good OS and PFS for patients with FIGOⅠB2-ⅢB cervical cancer.Tumor diameter,age and postoperative lymph node status are important prognostic factors for survival.