| Part one Status of Anemia and Prognosis in Patients with Cervical Cancer Undergoing Radical ChemoradiotherapyObjective:To analyze the status of anemi in cervical cancer patients who received radical chemoradiotherapy,the related risk factors of anemia,and the correlation between anemia and prognosis.Methods:The clinical data of 108 patients with cervical cancer who received radical radiotherapy and chemotherapy in the Department of Oncology,affiliated Hospital of North Sichuan Medical College from May 2017 to January 2019 were systematically collected.In the baseline phase,the hemoglobin values were collected before the first radiotherapy,during radiotherapy(the end of external radiotherapy)and after radiotherapy(the end of brachytherapy),and the incidence of anemia at each time point was calculated.The relationship between the occurrence of anemia and age,clinical stage,pathological type,duration of vaginal bleeding,tumor size,synchronous chemotherapy and brachytherapy times were analyzed.During the follow-up period,patients’ reexamination and survival data were obtained through outpatient clinic and telephone follow-up.The statistical software SPSS25.0 was used to analyze the data.Chi-square test was used for enumeration data,Kaplan-Meier method was used for survival analysis,Log-rank test was used for predictive univariate analysis,and cox regression model was established to analyze the prognosis of the patients.The difference was statistically significant(P<0.05).Results:1.The incidence of anemia before radiotherapy was 24.07%,and the incidence of anemia during radiotherapy was 49.07%,which was significantly different from that before radiotherapy(P<0.05).The incidence of anemia after radiotherapy was 46.29%,which was significantly different from that before radiotherapy(P<0.05).During the whole course of radiotherapy,the degree of anemia in patients was mainly mild anemia,and severe anemia was rare.2.Anemia before radiotherapy was correlated with clinical stage and duration of vaginal bleeding and tumor size(P<0.05),but was not correlated with age,pathological type(P>0.05).The occurrence of anemia during radiotherapy was related to clinical stage(P<0.05),but was not significantly related to age,pathological type,tumor size,duration of vaginal bleeding,and synchronous chemotherapy(P>0.05).The occurrence of anemia after radiotherapy was related to clinical stage(P<0.05),but was not significantly related to age,pathological type,tumor size,duration of vaginal bleeding,synchronous chemotherapy,and the brachytherapy times(P>0.05).3.The 1-year,2-year,and 3-year OS of the 108 patients who were followed up were 93.52%,83.33%,and 78.7%,respectively;the 1-year,2-year,and 3-year PFS were 78.7%,72.22%,and 68.52%,respectively.The results of multivariate analysis showed that anemia status after radiotherapy was an independent factor affecting the prognosis of patients(P=0.035,HR=2.73,95%CI 1.08-6.90).Conclusion:1.Anemia is very common in patients with radical radiotherapy and chemotherapy of cervical cancer,and the incidence of anemia increases significantly after radical radiotherapy and chemotherapy.2.The occurrence of anemia in the whole process of radiotherapy is closely related to the clinical stage.3.Anemia after radiotherapy is an independent risk factor for the prognosis of patients with cervical cancer.4.Patients with cervical cancer should see a doctor as soon as possible when abnormal vaginal bleeding occurs and be diagnosed as soon as possible.Doctors should dynamically monitor the hemoglobin level of patients,stop bleeding and intervene anemia in time,and actively follow up and deal with anemia after radiotherapy,in order to improve the quality of life of patients and improve the effect of anti-tumor therapy.Part two Study on the dose and volume of bladder and rectum in three-dimensional intracavitary brachytherapyObjective:Brachytherapy is an important part of radiotherapy for cervical cancer.There is no consensus on the best bladder capacity in three-dimensional brachytherapy.The purpose of this study was to evaluate the relationship between the radiation dose of bladder and rectum under different volumes and the changes of bladder and rectal volume on the target dose during three-dimensional brachytherapy.To find the most suitable filling volume of bladder to reduce the side effects of digestive system and urinary system.Methods:42 patients with cervical cancer who received three-dimensional brachytherapy in the Department of Oncology,affiliated Hospital of North Sichuan Medical College from November 2019 to April 2020 were analyzed retrospectively.The prescription dose of 600cGy was given,and the corresponding radiation doses of different volumes of bladder and rectum were evaluated by dose-volume histogram(DVH).The bladder volume was divided into<120cm3 group,120～160cm3 group and>160cm3 group,and the rectal volume was divided into ≤45cm group and>450cm3 group.SPSS25.0 software was used for statistical analysis of the data.Normal data is expressed as mean ±standard deviation.Independent sample t-test was used for comparison between the two groups,analysis of variance was used for comparison between groups,and pairwise comparison was conducted with LSD.The difference was statistically significant(P<0.05).Results:1.Comparing the effects of different bladder filling volumes on the bladder irradiation dose:Compared with the bladder filling volume group of 120～160cm3,the doses of D1cc,D2cc and D50%of the bladder in the>160cm3 group were significantly lower(P<0.05);the bladder filling volume of the 120～160cm3 group was compared with the bladder D2cc dose of the<120cm3 group significantly increased(P<0.05),while the bladder D0.1cc dose of<120cm3 group and 120～160cm3 group had no significant difference(P>0.05).2.Comparing the effects of different rectal volumes on rectal volume:compared with the rectal volume ≤45cm3 group,there was no significant difference in the rectal doses of D0.1cc,D1cc,D2cc,D50%in the>45cm3 group(P>0.05).3.Comparing the effects of different bladder filling volumes on the rectum and the target area:Compared with the bladder filling volume<120cm3 group,the rectal D1cc dose in the>160cm3 group was significantly lower(P<0.05);compared with the bladder filling volume<120cm3 group,the rectal D2cc dose in the 120～160cm3 group was significantly lower(P<0.05).With the gradual increase of bladder filling volume,rectal dose decreased,and with the gradual increase of bladder filling volume,CTV D90 dose increased,but there was no significant difference in CTV D90 results(P>0.05).4.Comparing the effects of different rectal volumes on the dose of bladder and target area:There was no significant difference in the doses of bladder D0.1cc,D1cc,D2cc,D50%and the CTV D90 dose of the target area between the two groups with rectal volume ≤45cm3 and>45cm3(P>0.05).Conclusions:1.When patients with cervical cancer received three-dimensional brachytherapy,with the filling of bladder,the volume of bladder increased and the radiation dose of bladder decreased.2.With the gradual increase of bladder filling volume,the rectal volume has a tendency to decrease.3.Combined with the situation of this radiotherapy center,it is recommended that the bladder filling volume of cervical cancer patients during brachytherapy treatment is more than 160cm3.In this state,not only the irradiation dose to the bladder and rectum is reduced,but also the tumor target dose is higher within the safety range. |
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