Clinical Study Of Concurrent Hyperthermia And Radiochemotherapy In Treatment For Medium-term And Advanced Cervical Cancer And Its Effect On The Expression Of Cell Proliferation And Apoptosis-associated Proteins

Cervical cancer is one of the commonest gynecological malignancy which the morbidity and mortality is inferior to breast cancer. The incidence of cervical cancer is the first place in some developing country. The surgery and radiation are the major therapy for cervical cancer, but 5-year survival rate was still in about 50% due to treatment efficacy with cervical cancer was less satisfied during the recent 30 years.Hyperthermia followed surgery, radiation and chemotherapy is a new therapeutic method. It is believed to be another promising treatment modality for the management of advanced cervical cancer. Hyperthermia not only killed cancer cells,but also enhanced action combined with radiation and chemotherapy to improve the activity of chemoradiotherapy and immunity of the body. As a new strategy of whole tumor therapy, Hyperthermia was regarded as efficacy and safety, and gradually applied to clinical therapy for most malignancies. This study was to explore clinical efficacy and safe of concurrent hyperthermia and radiochemotherapy in treatment for medium-term and advanced cervical cancer and its effect on the expression of cell proliferation and apoptosis-associated proteins.Clinical Study of Concurrent Hyperthermia and Radiochemotherapy in Treatment for Medium-term and Advanced Cervical CancerObjective To explore clinical efficacy and safe of concurrent hyperthermia and radiochemotherapy in treatment for patients with stage IIb-IIIb cervical cancer. Methods From November 2005 through October 2007 at Tumor Hospital of Guangxi Medical University, 118 new patients with stageâ…¡b-â…¢b cervical cancer were divided randomly into the following three groups: group radiotherapy alone(RT) of 38 patients, group concurrent radiochemotherapy(CRT) of 44 patients and group concurrent hyperthermia and radiochemotherapy(H+CRT) of 36 patients. The local tumor regression rates, the short-term efficacy, the survival rate and early toxicity were observed. The 1,2,3-year cumulative survival rates were performed using Kaplan-Meier method and in the same time the survival curves was drawn. The log- rank test was used for the survival comparison. Results Comparison of the short-term efficacy in three groups:(1)the local tumor regression rates of group RT, group CRT, group H+CRT in the end of external beam radiotherapy(45Gy) were 18.4%, 40.9% and 66.7%, respectively, there were significantly statistical difference among them(P <0.05);(2)the short-term efficacy(CR+PR) of them after one month at the end of radiation treatment planning were 86.8%, 90.9%and97.2% respectively,.there were not significantly statistical difference(P >0.05); but there were significantly statistical difference among their CR, PR and SD (x2=14.954, P =0.005<0.05), the CR in group H+CRT was much higher than that in group RT and group CRT. The early toxicity included mainly gastrointestinal reaction and bone marrow suppression among them. there were not significantly statistical difference in the rectal response, the bladder reaction and the dry dermatitis (P>0.05); there were significantly statistical difference in leukopenia, nausea and vomiting(P<0.05), The incidence of leukopenia in group CRT and group H+CRT were significantly higher than that of group RT (P<0.05). The incidence of severe marrow inhibition in group H+CRT was slight higher than that of group CRT (P>0.05);The patients were able to tolerate under treatment of symptomatic support. The cumulative survival rates in 1,2,3-year were 89%,79%,76% in group RT, 89%,77%,77% in group CRT,89%,83%,78% in group H+CRT, respectively. There were not significantly statistical difference among them(P>0.05). Conclusion concurrent hyperthermia and radiochemotherapy in treatment for the patients with stage IIb-IIIb of cervical cancer was shown to be improved the local control,the short-term efficacy and the complete response. Patients were able to tolerate the early toxicity under treatment of symptomatic support. so it was good security. But there were not significant improvement in the 1,2,3-year cumulative survival rates.Effect of Radiochemotherapy or Concurrent Hyperthermia and Radiochemotherapy on the Expression of Cell Proliferation and Apoptosis-associated Proteins in Cervical Cancer OrganizationObjective To investigate and discuss the mechanism and way of radiochemotherapy or concurrent hyperthermia and radiochemotherapy in treatment for medium-term and advanced cervical cancer. Methods 20 patients were selected from group CRT and group H+CRT respectively. Cervical cancer biopsy samples which derived from each patient before treatment and mid treatment(15 times external radiation)between two groups were regarded as study materials. The proteins'expressions of VEGF, Bcl-2, C-myc and HSP70 in the Cervical cancer biopsy samples were detected by immunohistochemistry. The positive rates among VEGF, Bcl-2, C-myc and HSP70 protein were compared by the x2 test and the expressive intensity of the protein among them were compared by the Rank test. Results There was not significantly statistical difference in VEGF, Bcl-2, C-myc and HSP70 protein expressive positive rate comparison between before treatment and treating in patients which derived respectively from group CRT, group H+CRT and both (P>0.05),but there was significantly statistical difference in the VEGF protein expressive intensity which all was weakened(P<0.05). There was significantly statistical difference in the C-myc protein expressive intensity of treating in group CRT and group H+CRT(P<0.05). There was not significantly statistical difference in HSP70 protein expressive intensity comparison between before treatment and treating in the patients of group CRT (P>0.05). There was significantly statistical difference in the HSP70 protein expressive intensity which all was enhanced in both between before treatment and treating in the patients of group H+CRT and treating in the patients of group CRT and group H+CRT(P<0.05),but there was not significantly statistical difference in Bcl-2 protein expressive intensity comparison(P>0.05). Conclusions Radiochemotherapy or concurrent hyperthermia and radiochemotherapy could weaken the VEGF protein expressive intensity and the formation of blood vessels of Cervical cancer and restrain proliferation and metastasis of tumors. Hyperthermia and CRT have cooperative enhancement function. Hyperthermia could weaken the C-myc protein expressive intensity. It remains to be further studied whether CRT and H+CRT may not interfere with the tumor cell Bcl-2 and HSP70 pathways in order to induce and resist apoptosis. Hyperthermia may raise the HSP70 protein expressive intensity.