Efficacy And Safety Of Radical Radiotherapy Combined With Chemotherapy In Elderly Patients With Cervical Cancer

Background:Cervical cancer is the fourth most common cancer in women worldwide and the fourth leading cause of cancer death in women.In the past 30 years,due to the early screening of cervical cancer and the wide application of HPV vaccine,the incidence and mortality of cervical cancer have decreased obviously.However,the survival rate of elderly with cervical cancer has not improved significantly due to the insufficient screening of elderly,fewer patients receiving active treatment as recommended by the guidelines,usually late stage and more and more severe complications.Objective:To investigate the efficacy and safety of combined chemotherapy based on radical radiotherapy in elderly patients with cervical cancer,the influence of the timing of radiotherapy and chemotherapy cycles on the prognosis,as well as independent risk factors affecting the survival and prognosis of elderly patients with cervical cancer.Method:This study retrospectively analyzed 157 elderly patients with cervical cancer aged 60-80 years who received radical treatment in the Radiotherapy Department of the First Affiliated Hospital of Soochow University from January 2018 to July 2022.All patients were regularly followed up to obtain complete clinical and follow-up data.The follow-up period of this study was January 31,2023.In this study,Chi-square test and Fisher precision test were used to compare the baseline data of the chemoradiotherapy group and the radiotherapy alone group,as well as the objective response rate(ORR)and disease control rate(DCR)between each group.Besides,the rank sum test was used to compare the short-term efficacy and adverse reactions among subgroups.The Kaplan-Meier method was used to compare median progression-free survival(PFS)and median overall survival(OS)of each subgroup.Independent risk factors affecting PFS and OS were explored by univariate and multivariate Cox regression analysis.Result:A total of 157 elderly patients were included in this study.124 patients received radical radiotherapy combined with chemotherapy and 33 patients only received radical radiotherapy.All patients completed planned radiotherapy.The demographic and clinical characteristics of the two groups were basically balanced(P>0.05),but the median age(P=0.018)and stage(P=0.047)of the chemoradiotherapy group were significantly different from the radiotherapy group.Objective response rate(ORR)of chemoradiotherapy group and radiotherapy group is 88.8%and 90.9%(P=0.718).Disease control rate(DCR)is 97.7%and 97.0%(P=0.843).The median PFS were 31 months and 23 months(P=0.2257),and the median OS were 53 months and 33 months(P=0.0091).There were statistically significant differences in hematological adverse reactions and gastrointestinal reactions above grade 3 between the two groups(P<0.05).Among the 124 elderlies receiving chemoradiotherapy,76 received sequential chemotherapy and 48 received concurrent chemoradiotherapy.In addition,according to the number of chemotherapy cycles,76 patients receiving sequential chemotherapy were divided into the group receiving 1-3 cycles or≥4 cycles of chemotherapy,with 39 cases(51.3%)and 37 cases(49.7%)respectively.There were no statistically significant differences in short-term efficacy,ORR.DCR,median PFS and median OS between two groups(P>0.05),but there were statistically significant differences in hematological adverse reactions,abnormal liver function and radiation cystitis(P<0.05)between 1-3 chemotherapy cycles and≥4 chemotherapy cycles.The results of univariate Cox regression analysis showed that histological type(P<0.001),total radiation dose(P=0.012),duration of radiation(P=0.017)were correlated with PFS.Histological type(P=0.001),total radiation dose(P<0.001),duration of radiotherapy(P<0.001),SCCA(P<0.001),intervene(P=0.011)were correlated with OS.Multivariate analysis showed that histological type(HR=3.378,95%CI 1.863-6.124.P<0.001)and duration of radiotherapy(HR=1.832.95%CI 1.073-3.128,P=0.027)were independent risk factors for PFS in elderly with cervical cancer,histological type(HR=2.315,95%CI 1.091-4.912,P=0.029)、total radiation dose(HR=3.616,95%CI 1.752-7.464,P=0.001)、duration of radiotherapy(HR=3.072,95%CI 1.471-6.417,P=0.003)、SCCA(HR=3.853,95%CI 1.276-11.637,P=0.017;HR=10.755,95%CI 3.234-35.766,P<0.001)、uncombined chemotherapy(HR=2.655,95%CI 1.360-5.185,P=0.004)were independent risk factors for OS in elderly patients with cervical cancer.Conclusion:For elderly patients with cervical cancer,the OS in the chemoradiotherapy group was significantly longer than the radiotherapy group,the adverse reactions of grade 3 and above were significantly increased,but they were tolerable,therefore clinicians should strengthen the management of side effects.It is suggested that radical radiotherapy combined with chemotherapy is an effective and safe treatment for elderly patients with cervical cancer.