Treatment results of different radiotherapy for 763 patients with advanced cervical cancer / 中华放射肿瘤学杂志

ABSTRACT

Objective To evaluate the clinical value of different radiotherapy protocols in the treatment of advanced cervical cancer. Methods From 1976 to 2006,763 patients with stage Ⅲ cervical cancer(722 with squamous cell carcinoma and 41 with adenocarcinoma)were treated by radiotherapy in our hospital. 113 patients were treated by two-field whole pelvic irradiation in conventional fractionation plus brachytherapy (CF group), 44 by four-field whole pelvic irradiation in accelerated hyperfractionation plus brachytherapy( AHF group), and 606 by concomitant four-field unconventional fractionation radiotherapy and brachytherapy(FRT group). Sixty-one patients were treated by radiotherapy and chemotherapy. Among 350 patients who had complete data, the short-term efficacy and toxicities were compared. Results For patients in CF,AHF and FRT groups, the 3-year overall survival rates (OS) were 65.7%, 66.8% and 44.3%, respectively (P=0.000), and the 5-year OS were 65.7 % ,66.8 % and 36.3 %, respectively (P=0.000). The 10-year OS were 43.3% and 31.9% in CF and FRT groups(P=0.200). For squamous cell carcinoma,the OS was higher of patients with chemotherapy than those without. In 350 patients who had complete data,the local control rates of CF, AHF and FRT groups were 83.0% ,93.2% and 86.1%, respectively(X2=2.70, P=0.259);AHF group had the lowest side effect rate, especially skin reaction (9.1%,X2=20.25,P=0.002) ;CF group had the lowest acute bone marrow suppression rate(X2=25.95,P=0.000);for squamous cell carcinoma, the OS was higher in patients with chemotherapy than those without;the acute bone marrow and intestinal toxicities were more in patients with chemotherapy than those without. Conclusions CF and AHF groups have similar 5-year OS of patients with advanced cervical cancer. AHF group has less toxicities, shorter treatment course and a trend of better local control. Concurrent chemoradiation could improve survival and local control of the patients with advanced squamous cell cervical cancer while increase the side effects. The individual condition should be considered to choose the treatment protocol.