Study Of Uterine Arterial Chemoembolization And Uterine Arterial Infusion Chemotherapy Before Radical Radiotherapy For Advanced Cervical Cancer

Objectives:The reports about long-term outcome of patients who underwent uterine arterial chemoembolization (UACE) and uterine arterial infusion chemotherapy (UAIC) before radiotherapy are limited, and their effect to late radiotherapy toxicity remains unknown. Thus, the objective of the present study is to investigate the contribution of UACE and UAIC before radical radiotherapy to prognosis and late radiotherapy toxicity in the patients with primary uterine advanced cervical cancer.Methods:1 The patientsThe patients with primary advanced cervical cancer were retrospectively studied from January 1,2000 to April 30,2011. The patients were classified according to international gynecology and obstetrics department federation (FIGO) staging standard.2 Inclusion criteria2.1 The primary cervical cancer whose pathological types included squamous cell carcinoma and adenocarcinoma.2.2 No previous surgery, adjuvant chemotherapy and other anti-cancer therapy were performed.2.3 Ⅱ-Ⅳa period according to FIGO staging.2.4 No severe heart, lung, kidney primary disease, and the radical radiotherapy treatment planning was completed.3. Exclusion criteria3.1 pregnant or lactating patients.3.2 simultaneous or previous history of other primary cancers.3.3 The radical radiotherapy treatment planning was not completed (the prolonged time more than 7 days).3.4 Follow-up time of less than 12 months or died of non-neoplastic causes.3.5 the recurrent primary cervical cancer.4 Statistical analysisFollow-up visits were initiated from the end of radiotherapy. Patients follow-up was performed with outpatient re-examination or telephone communication, and were discontinued when patients died or until the last scheduled follow-up visit. The end time of follow-up was August 31,2011.Statistical analysis was performed with SPSS 15.0. Disease-specific survival (DSS), pelvic control (PC), distant metastasis-free survival (MFS), and risk factors of late toxicity were analyzed. The clinical data and incidence of complications were analyzed among three groups using cross-table comparisons. DSS, PC, and MFS were analyzed using the Kaplan-Meier method and checked using log-rank analysis. Multivariate analysis model of the factors of the survival time was performed with Cox regression analysis (Forward Wald). Late injury responses to radiotherapy were evaluated by Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer (RTOG/EORTC) grading criteria. The risk factors for late radiotherapy toxicity were further analyzed using binary logistic model (Backward LR).Results:A total of 735 patients with primary advanced cervical cancer were retrospectively studied. Of these patients,299 were classified as FIGO stage II, 359 as stage Ⅲ, and 77 as stage IVa (age,24-80 years; median,50 years).126 patients underwent UACE before radiotherapy,103 underwent UAIC before radiotherapy, and 506 received radical radiotherapy (RT) alone.The 1-,2-,5-, and 8-year DSS of all patients was 94.4,82.1,50.2, and 30.7%, respectively. Compared with RT group, DSS of UAIC was better, but the difference was not signficant statistically (P>0.05), while DSS of UACE was worse, and the difference was signficant statistically (P< 0.05). The 1-and 2-year DSS of the UAIC and UACE groups was slightly higher than those of the RT group, but the difference was not signficant statistically (P>0.05). The 5-and 8-year DSS of the UACE group was obviously decreased compared with UAIC and RT group, and the difference was signficant statistically (P< 0.05). PC and MFS were highest in the UAIC group and lowest in the UACE group, but the difference was not signficant statistically (P>0.05). The incidence of late radiation toxicity of the small intestine and rectosigmoid was similar. The bladder injury was highest in the UACE group (UACE:UAIC:RT=11.1:4.8:4.2%,χ2=9.579, P< 0.05). UACE was a risk factor for late radiation toxicity of the urinary bladder (OR=2.869, P<0.05).Conclusion:UAIC before radical radiotherapy could improve the treatment outcome and prognosis of patients with advanced cervical cancer, while UACE would significantly decrease long-time survival, and it is also a risk factor for late radiation toxicity of the urinary bladder.