Study Of Hyperfractionation Treatment For Locally Advanced Uterine Cervical Carcinoma And Its Effects On The Expression Of Apoptosis-associated Gene

Cervical cancer is a serious disease threatening women's health worldwide and is very common in China.There are approximately 470,000 new cases every year;in which 230,000 died.Eighty percent are squamous cell carcinoma,most are in advanced stage(Ⅱb～Ⅳb). Radiotherapy is the preferred effective treatment for locally advanced cervical cancer. However,some primary tumor still exists in some patients after radical radiotherapy,causing local relapse and metastasis.With the development of the stage of cervical cancer,5-year survival rate decreases.5-year survival is only 15 to 43.3 percent after conventional radiotherapy in stageⅢb cervical carcinoma patients.Therefore it is a core problem in the therapy improvement for locally advanced cervical cancer to study how to improve the control rate of primary tumor.Cisplatin-based chemoradiotherapy being accepted,we study the therapeutic effect of hyperfractionation combined with concurrent chemotherapy for treatmentⅢb stage patient of cervical cancer, and observe the effect of hyperfractionation on expression of apoptosis-associated gene(bcl-2, bax)and PCNA in cervical cancer specimens.Therapeutic effect observation on hyperfractionation combined with concurrent chemotherapy treatment for stageⅢB cervical carcinomasObjective:To evaluate the feasibility of hyperfactionation in combination with concurrent cisplatin-based chemotherapy for locally advanced cervical cancer and its clinical value.Methods:Forty-five patients with StageⅢB carcinoma of the uterine cervix were treated with external beam irradiation to the pelvis combined with intracavitary brachytherapy.All patients were randomly divided to one of the following two groups:the hyperfractionated radiotherapy(HRC)group of 24 patients who were given hyperfractionation,1.2Gy/F,10/W, twice daily with 6-8 hours intervals between the two fractions,pelvic external beam irradiation total dose is 55.2Gy,and the convoentional radiotherapy(CRC)group of 21 patients who were given conventional radiotherapy,1.8Gy/F,5F/W,total dose 45Gy.Two groups were received PVB(cisplatin 100mg+VCR1mg+BLM30mg)chemotherapy concurrently.Results:HRC group have more serious side-effects on skin than CRC(p＜0.05).There is no statistical difference on other side-effects between two groups(P＞0.05).Radioreaction rate of HRC and CRC group is 100%and 76.19%,respectively(p＜0.05).2-year survival of HRC and CRC group are 92%and 55%,respectively(p＞0.05).Multivariate regression analysis shows that the response of tumor to radiation is the unique factor affecting prognosis of advanced cervical cancer.Conclusions:Hyperfractionation does not aggravate the side-effects of radiation.Both groups of patients have similar toxicities appearance.HRC group was found to result in better treatment responses than CRC for patients with StageⅢB cervical carcinoma.Although 2-year accumulative survival of hyperfractionation is higher than that of conventional fraction, it makes no sense in statistics.The response of tumor to external beam irradiation is a factor of patients' prognosis.The effect of fraction radiotherapy on expression of cell proliferation and apoptosis-associated proteinsObjective:To investigate and discuss the effects of fraction radiotherapy on expression of cell proliferation PCNA and apoptosis-associated bcl-2,bax proteins of locally advanced uterine cervical cancer.Methods:Ninety-nine specimens of the cervical tumors were obtained by punch biopsy before and in the course of the treatment(after two weeks and four weeks).There were 23 patients in HRC group and 10 patients in CRC group.The samples obtained in the treatment were employed to determine the expression of bcl-2,bax and PCNA protein using immunohistochemical methods and then to analyze the difference between two groups on the basis of the percentage of immunopositive cells and stain.Results:After two weeks irradiation,the positive rates of bax protein was higher than before in two groups(p＜0.05).There was no significant difference on bcl-2 and PCNA protein during therapy in two groups.There was no significant correlation between the expression of bcl-2,bax,PCNA and radiation response after treatment in both groups. Conclusions:Fraction radiotherapy can up-regulate the expression of bax protein.We did not observe cell accelerated repopulation during radiotherapy.Radiotherapy for cervical cancer depressed its repopulation and inducted apoptosis.The effects of fraction radiotherapy on mRNA expression of cell proliferation and apoptosis-associated geneObjective:To detect and discuss the effects of fraction radiotherapy on expression of cell proliferation PCNA and apoptosis-associated bcl-2,bax mRNA of locally advanced uterine cervical cancer.Methods:Ninety-nine specimens of the cervical tumors were obtained from patients who enter into the clinic trial.There were 23 patients in HRC group and 10 patients in CRC group. We detect the expression of bcl-2,bax and PCNA mRNA of cervical cancer specimens using RT-PCR and then analyze the changing and difference between before treatment and during treatment in two groups.Results:There was an increasing of bax mRNA after treatment two weeks than before in two groups.But there was no statistic significance in CRC group.There was no statistic significance difference on expression of bcl-2 and PCNA mRNA pre- and post- radiotherapy.Conclusions:Hyperfraction radiotherapy could up-regulate expression of bax.We did not observe tumor cell accelerated repopulation during radiotherapy.