Clinical value of three dimensional conformal radiation therapy for postoperative cervical cancer / 肿瘤

ABSTRACT

Objective: To observe the clinical value of three dimensional conformal radiation therapy (3D-CRT) followed by radical surgery and discuss the best radiation technique for cervical cancer patients after radical hysterectomy. Methods: From February of 2003 to June of 2006, 155 stage I-IIIa cervical cancer patients received postoperative radiotherapy in our department after radical surgery. They were randomly divided into two groups. There were 81 patients in 3D-CRT group and 74 patients in traditional radiation group. According to FIGO staging, there were 45 cases in stage I, 77 in stage II a, 31 in stage II b, and 2 in stage III a. Pathological examination confirmed that 148 cases had squamous carcinoma and 7 cases had adenocarcinoma. The target volume included supravaginal portion, the cervical stump, paracervical tissue, common iliac, internal and external iliac, obturator, and sacral lymph nodes, and the pelvic lymphatic drainage area. For 3D-CRT group we designed four-field or two-field rotating irradiation in the left-right and the anterior-posterior direction. For traditional radiation group we designed two-field irradiation, anterior-posterior, at opposed lateral directions. The radiation dose ranged from 48-50 Gy. Stage II b patients with a cervical stump recurrence received postoperative boost irradiation by 8-10 Gy. Results: There were no significant difference in 0.5-year, 1-year, 1.5-year, and 2-year local control rate between 3D-CRT group and traditional radiation group (P > 0.05). The occurrence of early and late complications was significantly lower in 3D-CRT group than that in traditional radiation group (P < 0.05). There was significant difference in gastrointestinal reaction and urinary system reaction between the two groups (P <0.05). In postoperative radiotherapy, 3D-CRT was superior compared with traditional two-field radiation at opposed lateral directions. Conclusion: 3D-CRT is superior compared with traditional two-dimensional radiation. Four-field rotating radiation in 3D-CRT induces focused and even dose distribution and causes less side effects and complications. The side-field and cervical stump-targeted boost irradiation are apparent advantages of 3D-CRT.