ABSTRACT
Objective To analyze the result and adverse reactions of radiation therapy in patients with pelvic recurrence following cervical cancer postoperative.Methods A retrospective analysis of 147 patients with pelvic recurrence after surgical treatment of cervical cancer in the Fourth Hospital of Hebei Medical University from August 2004 to December 2016 was performed.All patients received radiotherapy with or without chemotherapy.According to different clinical factors and pathological factors,Logistic regression analysis was used to analyze the factors influencing radiotherapy outcomes in patients with pelvic recurrence after cervical cancer surgery.The Kaplan-Meier method was used to analyze the survival rate,and the corresponding survival curve was drawn.The survival rate and prognosis related factors were compared by using the log-rank test.The COX proportional hazards regression model was used for multivariate analysis of statistically relevant factors in univariate analysis.After treatment,toxicities were analyzed using chi-square test.Results The median follow-up time was 33.2 months.95％ of the patients completed radiation therapy with a dose of ≥ 67 Gy (median radiotherapy dose),and 91 patients (61.9％) had complete remission (CR).The 5-year local control (LC),progression-free survival (PFS),distant metastasis-free survival (DMFS),and overall survival (OS) were 63.6％,56.0％,73.9％,and 55.0％,respectively.Univariate logistic regression analysis showed that FIGO staging (stage 0-ⅠB and ⅡA-ⅡB),pelvic sidewall involvement,and recurrent tumor volume were associated with complete remission (P＜0.05).Multivariate statistical analysis found that FIGO staging and pelvic sidewall invasion were independent factors influencing the efficacy and survival of patients with pelvic recurrence after cervical cancer surgery (P＜0.05).Patients with pelvic wall invasion after cervical cancer surgery had a higher incidence of ≥ grade 2 proctitis than those without pelvic walls involved,which were 26.9％ and 16.7％,respectively.Conclusions This study shows that after the surgical treatment of cervical cancer patients with pelvic recurrence can be tolerated by toxicities after radiation therapy.In addition,the incidence of toxicities in patients with pelvic wall invasion was significantly higher than those without pelvic wall invasion.Preoperative staging and the pelvic wall involvement are independent influencing factors influencing the effect of radiotherapy and long-term prognosis in patients with pelvic recurrence after cervical cancer surgery.
ABSTRACT
Objective To compare dosimetric parameters between automated and manualvolumetric modulated arc therapy(VMAT) plans in the treatment of postoperative cervical cancer patients,and to investigatethe feasibility and dosimetric advantage of the automated VMAT planning.Methods Automated and manual VMAT plans were generated with Pinnacle3 treatment planning system (TPS) for twenty-three postoperative cervical cancer patients,including eight patients in stage Ⅱ A and fifteen in stage Ⅱ B,respectively.The differences in D D95,conformity index (CI) and homogeneity index (HI) of target,as well as dose volume histogram (DVH) of organs at risk (OAR),planning time,average optimization time and monitor unit (MU) were compared between automated and manual VMAT plans.Results The average D CI and HI of automated VMAT plans were better than those of manual VMAT plans (t=4.65-14.92,P ＜0.05).There was no significant difference in D95 (P ＞0.05).The automated VMAT plans achieved better average dosimetric parameters on OARs compared with the manual VMAT plans (t =3.30-14.42,P ＜ 0.05).Automated VMAT plans had a significantly shorter planning time (72 min,t =3.85,P ＜ 0.05) and interruption frequency (twice,t =5.41,P ＜ 0.05) than manual VMAT plans.However,automated VMAT plans had a higher average MU than manual VMAT plans with an average MU of 819 ± 53 and 638 ± 41 for automated and manual VMAT plans,respectively.Conclusions It is feasible to generate automated VMAT plans with Pinnacle3 TPS for postoperative cervical cancer patients.The automated VMAT plans increase the plan quality and reduce the optimization time compare with manual VMAT plans.Automated technique also eliminates the influence of human factors on the plan quality.
ABSTRACT
Objective To explore the use of Swedish medical company CMS 4.6.4 radiotherapy XIO system for the design process of cervical cancer postoperative IMRT plans in different iterative times of the same case,and to observe the Segment Weight Optimization(SWO)effect generated after the plan results.Methods Ten cases of cervical cancer patients were chosen ,the use of XIO 4.6.4 CMS treatment system was performed for the development of the intensity modulated radiation therapy .In the SWO process , iterative times were used to generate different plans ,without affecting the clinical dose target area requirements , and compared the organs at risk( OAR) by determining whether there were differences between dose and the number of segments ,monitor units (MU).Results For the same patients,different iterative times within a certain range of SWO IMRT plan were selected to compare the different iterative times plan ,femoral head,rectum and the bladder dose did not change the basic plan.The total number of segments and MU did not change significantly (P>0.05).Conclusion IM-RT plans in the use of CMS XIO 4.6.4 design of cervical cancer after operation in the process of using the itera-tive times below 100 times for SWO is the most suitable method for ensuring the organ dosimetry in radiotherapy . The total number of segments and the MU reduces the radiotherapy plan time so as to improve work efficiency .