Three-Dimensional Contrast Two-Dimensional Afterloading Radiotherapy For ⅡB-ⅣA Stage Uterus Correlation Study On Clinical Efficacy Of Cervical Cancer

Objective:To explore whether external beam radiation combined with three-dimensional afterloading radiotherapy or two-dimensional afterloading radiotherapy has advantages in the short-term and long-term curative effect and side effects of radiotherapy for stage IIB-IVA cervical cancer.Methods:A retrospective analysis of the clinical data of 136 patients with stage IIB-IVA cervical cancer who were hospitalized in the Cancer Center of the First Affiliated Hospital of Xinjiang Medical University from September 2013 to December 2018.Among them,71 patients received CT image-guided three-dimensional afterloading radiotherapy,named as the three-dimensional group,and 65 patients underwent two-dimensional afterloading radiotherapy,which was referred to as the two-dimensional group.Both groups used external irradiation(3D-CRT or IMRT),1 month after the end of radiotherapy ± chemotherapy,pelvic MRI was performed to evaluate the short-term curative effect and compare it.All patients were followed up to compare the 1,2,and3 year overall survival rate(OS)and the occurrence of side effects of acute radiotherapy.Results:In the short-term efficacy evaluation,the objective response rate was 74.64% in the three-dimensional group and 58.46% in the two-dimensional group.The comparison between the two groups was P=0.045.Overall comparison of adverse reactions between the two groups,radiation proctitis three-dimensional comparison two-dimensional: 28.17% vs 53.84%,P=0.002;radiation cystitis difference is smaller: 13.85% vs7%;There were statistically significant differences in the three-dimensional and two-dimensional comparisons of grade 1-2 and grade 3-4radiation proctitis(P=0.044,P=0.048);while there was no difference between the two groups of grade 1-2 and grade 3-4 radiation cystitis significance.In the long-term efficacy,there was no statistical difference between the two groups in 1-year OS,and the statistical significance of OS at 2 and 3 years was different(P=0.002,P<0.001).In univariate analysis,the factors that affect the prognosis of cervical cancer are tumor size,FIGO staging,pelvic lymph node metastasis,and afterloading radiotherapy.After multi-factor analysis,independent risk factors affecting cervical cancer OS were tumor size,FIGO staging,pelvic lymph node metastasis,and afterloading radiotherapy was a protective factor.Conclusion:Compared with the traditional two-dimensional afterloading under CT guidance,the three-dimensional afterloading improves the short-term and long-term curative effect in patients with stage IIB-IVA cervical cancer,and reduces the occurrence of side effects of radiotherapy.Among them,tumor size,FIGO staging,pelvic lymph node metastasis,and afterloading radiotherapy are independent prognostic factors for cervical cancer.