The Short-term Curative Effects Of HT And IMRT For Postoperative Cervical Cancer And The Clinical Research On Different Patterns Of Radical Radiotherapy For Cervical Cancer

【Objective】①To discuss the short-term curative effects and the prognostic factors ofhelical tomotherapy and conventional intensity-modulated radiotherapy for cervicalcarcinoma after operation.②To retrospectively study the side effects of different patterns and thefeasibility of shortening the treatment period of radical radiotherapy for cervical cancer.【Methods】①Of the281patients with cervical carcinoma,194underwent HT and87received IMRT after operation. The irradiation dose for the drainage region of lymphnodes of pelvic, high risk areas and the residual tumor or metastasizing lymph nodeswere DT46-50Gy/23-28F, DT54-60Gy/25-28F and DT64-66Gy/25-28F, respectively.All the patients received introvaginal brachytherapy of16-32Gy/2-4F. Side effects ofbladder and rectum and the short-term survival rates were evaluated and the prognosticfactors of chemotherapy, lymph node metastasis, irradiation dose, clinical stage andpathological type were also analyzed.②Of the131patients with radical radiotherapy of cervical carcinoma,37received3D-CRT,38IMRT and56HT. After DT40Gy/4weeks of external irradiation,3D-CRT group received once-a-week brachytherapy and the total treatment periodswere9-10weeks. After DT36Gy/3weeks of external irradiation, IMRT and HT groupsreceived twice-a-week brachytherapy with the treatment periods of6-7weeks. All thepatients underwent6-7fractions of brachytherapy. The acute and late side effects wereevaluated.【Results】①The incidence of grade1acute side effects of HT and IMRT in rectumwere29.38%and45.98%（P=0.007）; bladder13.40%and18.39%（P=0.278）,respectively. No acute side effects of≥2grade occurred in two groups. Twopatients with grade2late rectum effect occurred in IMRT group after8and10months. The1-4-year overall survival rates of HT and IMRT were95.4%,89.8%,86.0%,73.0%and92.1%,89.2%,72.0%,61.7%（P=0.113）, respectively. The1-4-year overall survivalrates of stage Ⅰ patients in two groups were97.5%,88.9%,86.8%,86.8%and91.0%,87.5%,78.6%,78.6%（P=0.372）, respectively. The1-3-year overall survival rates ofstage Ⅱ patients in two groups were95.2%,92.5%,86.2%and94.9%,92.2%,64.6%（P=0.226）, respectively. Univariate analysis indicated that chemotherapy, lymph nodemetastasis, irradiation dose and clinical stage were of prognostic significance.Multivariate analysis showed that chemotherapy, lymph node metastasis and irradiationdose were independent prognostic factors.②The incidence of grade1acute side effects of3D-CRT, IMRT and HT inrectum were86.49%,55.26%and30.36%(p<0.01); bladder56.76%,21.05%and17.86%(P<0.01). The incidences of grade1late side effects in rectum were37.50%,10.81%and10.00%(P<0.01); bladder15.63%,5.41%and4.00%（P>0.05）.【Conclusion】①The incidence of acute side effects of HT is lower than IMRT,especially in rectum, which increase the survival rates to some extent. Univariateanalysis indicated that non-chemotherapy, more lymph node metastasis, high irradiationdose and late clinical stage were related to poor prognosis. Multivariate analysis showedthat chemotherapy, lymph node metastasis and irradiation dose were independentprognostic factors.②Compared with3D-CRT, IMRT and HT can shorten2-3weeks of treatmentperiod and reduce the side effects.