| Objective : This study evaluated the curative effect of radical radiotherapy on patients with recurrent vaginal stump after cervical cancer surgery,identified the factors related to the curative effect of radiotherapy,and further explored the clinical significance of Three-dimensional brachytherapy followed by radiotherapy in the treatment of patients with recurrent vaginal stump after cervical cancer surgery.Methods : Clinical medical records of patients diagnosed with recurrent vaginal stump after cervical cancer surgery who underwent cervical cancer surgery in Yunnan Cancer Hospital from July 2013 to July 2022 were retrospectively analyzed.All patients diagnosed with recurrent vaginal stump received radiotherapy with or without concurrent chemotherapy,and the efficacy of radiotherapy was evaluated within 1-3 months after treatment.Furthermore,relevant factors were included in the analysis to further compare the clinical efficacy and prognosis differences of two different 2D and 3D retrofitting methods in the treatment of patients with recurrent vaginal stump after cervical cancer surgery.All patients were followed up to March 2023.Survival time after radiotherapy was included in survival analysis,and univariate analysis of prognosis was performed by Cox regression model.P<0.05 was considered statistically significant.After univariate analysis,combined with professional significance,Cox regression was further adopted to conduct multi-factor analysis to explore related factors affecting the outcome.Chi-square test was performed for the occurrence of toxic and side effects after radiotherapy.Results: A total of 68 patients were included in the analysis.At the last follow-up,9 patients died,7 were lost to follow-up,and 52 survived.The survival time ranged from 7 to 185 months,with an average of 51.76±34.60 months.There were 46 effective CR+PR patients,accounting for 79.31%,and 12 ineffective SD+PD patients,accounting for 20.69%.CR had 26 people,accounting for 44.83%;The other 32,accounting for 55.17%.Cox univariate regression analysis of possible influencing factors of objective effective rate(ORR)showed that age,recurrence site and types of brachytherapy were related to the occurrence and time of ORR,and the difference was statistically significant.The results of multivariate analysis suggested that 3D brachytherapy had a better prognosis than 2D brachytherapy,and the difference was statistically significant(HR=0.113,95%CI= 0.039-0.331,P≤0.001).Without concurrent radiotherapy and chemotherapy,the prognosis was worse(HR=2.958,95%CI=1.197-7.312,P=0.019).Adenocarcinoma had a worse prognosis than squamous cell carcinoma(HR=1.503,95%CI= 1.051-4.420,P=0.026).Univariate COX analysis of the possible influencing factors of complete response(CR)showed that the recurrence site,tumor size and types of brachytherapy were related to the occurrence and time of CR,and the difference was statistically significant.Multivariate results suggested that stump + lymph node recurrence had a worse prognosis than vaginal stump recurrence,and the difference was statistically significant(HR=3.420,95%CI= 1.138-10.280,P=0.029).Compared with patients with recurrent tumor ≥4cm,patients with < 4cm had better prognosis(HR=0.459,95%CI= 0.122-0.733,P=0.025).Without concurrent radiotherapy and chemotherapy,the prognosis was worse(HR=3.511,95%CI=1.163-10.598,P=0.026).Compared with 2D,3D brachytherapy had a statistically significant prognosis(HR=0.248,95%CI= 0.111-0.555,P=0.001).A subgroup analysis was conducted on 58 patients who received external pelvic irradiation plus post-brachytherapy radiotherapy at the same time,and the clinical efficacy and prognosis of the two different types of brachytherapy were further compared.The results showed that the radiotherapy efficacy(ORR,CR)of the patients who received Three-dimensional brachytherapy followed by radiotherapy guided by CT image was higher than that of the patients who received two-dimensional post-brachytherapy.The results were statistically significant(P=0.010,P=0.001).At the same time,the toxic and side effects of radiotherapy after different brachytherapy methods were analyzed,and the results showed that the side effects(such as radiation enteritis,radiation cystitis,etc.)in the patients with recurrent vaginal stump after Three-dimensional brachytherapy followed by radiotherapy brachytherapy were significantly lower than those in the patients after two-dimensional brachytherapy,and the difference was statistically significant(P=0.010,P=0.016).Conclusion : Patients with recurrent vaginal stump after cervical cancer surgery can achieve good local control effect through radiotherapy.Analysis of related factors showed that the therapeutic effect of radiotherapy was affected by the patient’s age,pathological type,size of recurrent tumor,whether accompanied by pelvic lymph node metastasis,whether concurrent chemoradiotherapy,brachytherapy,etc.Patients with recurrence age less than 55 years old,pathological type of adenocarcinoma,recurrence tumor >4cm,pelvic lymph node metastasis,and no concurrent chemoradiotherapy have poor efficacy compared with other group radiotherapy.In brachytherapy,Three-dimensional brachytherapy followed by radiotherapy compared with two-dimensional brachytherapy can obtain better short-term efficacy and lower toxic and side effects after radiotherapy. |
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