Safety and prognosis analysis of different regimens in the treatment of patients with stage Ⅲ cervical cancer / 中华放射医学与防护杂志

ABSTRACT

Objective:To compare the toxicity and prognosis of patients with stage Ⅲ cervical cancer treated using different regimens.Methods:A retrospective analysis was carried out for 194 patients with stage Ⅲ cervical cancer determined according to the revised 2018 International Federation of Gynecology and Obstetrics staging system (16 cases of stage Ⅲ A, 23 cases of stage Ⅲ B, 136 cases of stage Ⅲ C1, and 19 cases of stage Ⅲ C2) admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2020. They were divided into a radical radiotherapy±chemotherapy group (81 cases) and a radical hysterectomy + radiotherapy±chemotherapy group (113 cases) according to different treatment method. The difference in toxicity between the two groups was determined using the χ2 test. The survival curves and progression-free survival curves were plotted using the Kaplan-Meier method, and the Log rank test was also performed. The differences in toxicity and prognosis were further analyzed in 136 patients with stage Ⅲ C1 cervical cancer result patients in the radical radiotherapy±chemotherapy group were more likely to have hemoglobin decline ( χ2=10.68, P=0.004), rectal mucositis ( χ2=14.41, P=0.001), and vaginal fistula ( χ2=7.16, P=0.012) of grades 3 and 4. Patients in the radical hysterectomy+ radiotherapy±chemotherapy group were more likely to have increased aspartate aminotransferase ( χ2=10.96, P=0.002) and alanine aminotransferase ( χ2=8.49, P=0.010). The differences were statistically significant. The 5-year progression-free survival rate of the radical radiotherapy±chemotherapy group was 58.3%, which was lower than that of the radical hysterectomy + radiotherapy±chemotherapy group (74.5%; χ2=5.33, P=0.021). Among the 136 patients with stage Ⅲ C1 cervical cancer, the ones in the radical radiotherapy±chemotherapy group (34 cases) were more likely to develop rectal mucositis ( χ2=13.25, P=0.003), while the ones in the radical hysterectomy + radiotherapy±chemotherapy group (102 cases) were more likely to have elevated aspartate aminotransferase ( χ2=6.18, P=0.046). The differences were statistically significant. The 5-year survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy+ radiotherapy±chemotherapy group were 85.5% and 86.3%, respectively. The difference was not statistically significant ( P=0.893). The 5-year progression-free survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy + radiotherapy±chemotherapy group were 65.6% and 77.1%, respectively. The difference was not statistically significant ( P=0.244). Conclusions:For patients with stage Ⅲ cervical cancer, the ones in the radical radiotherapy±chemotherapy group were more likely to progress and have a poorer prognosis compared with the ones in the radical hysterectomy+ radiotherapy±chemotherapy group. For patients with stage Ⅲ C1 cervical cancer, there was no significant difference in the prognosis of patients between the groups. The two treatment method lead to different toxicity, with no obvious advantages and disadvantages. Considering the risks and economic burdens caused by surgery, radical radiotherapy and chemotherapy is recommended for patients with stage Ⅲ C1 cervical cancer.