Early Efficacy Of Chemoradiotherapy Combined With Endostar For Advanced Cervical Cancers

Background and Objective: Cervical cancer is the most common gynecologic cancer.The incidence of cervical cancer is the second in the common malignant tumor ofwomen, second only to breast cancer. To the health of women, cervical cancer is aserious threat, as the third of the death cause of cervical cancer disease for women.With the widely application of the cervical exfoliated cells smear, its morbidity andmortality rates have fallen.But every year, there are nearly274,000women die from thisdisease in the world. For early stage cervical cancer, surgery and radiation therapy is themain treatment. Due to cervical cancer onset conceals, early symptoms are often notobvious, most patients were diagnosed with advanced disease. For advanced cervicalcancer, radiation therapy is an effective choice. Although the improvement of thetechnology of medical imaging and radiotherapy,significantly improve the tumorconformal target and dose, at the same time,the dose and volume of the surroundingnormal tissues and organs in the former have decreased. But the overall survival rates ofadvanced cervical cancer is continuously around50percent and without significantimprovement.The proliferation and metastasis of tumor cells were not blocked withradiation therapy only. The main causes of treatment failure are still local tissuewithout control, recurrence, lymph node metastasis, and distant metastasis. In recentyears, several randomized clinical trials showed that the use of cisplatin basedconcurrent chemoradiation can obviously improve the survival rates of patients withadvanced cervical cancer compared with radiotherapy alone. Although the best treatment plan requiring further research, the current study results has proved cisplatinbased chemoradiation therapy has advantages for advanced cervical cancer. Butchemoradiation therapy cannot effectively solve the problem of proliferation andmetastasis of locally advanced cervical cancer. In order to improve the local control andoverall survival in patients with cervical cancer, research of new and effective therapy iscurrently one of the focus in the study of cervical cancer. Endostar is ananti-angiogenesis drug. Endostar suppresses the endothelial cell proliferation andmigration, thus suppresess the angiogenesis of tumor. The nutrition supply is blockedand then the tumor cell proliferation and migration are suppressed. Besides, Endostarcould suppress the formation of lymphatic ducts in tumor and lymph node metastasis.Endorstar with chemotherapy has became the first-line drug in the treatment ofmetastatic colorectal cancer、 gastriccarcinoma and non-small cell lung cancer(NSCLC). The effects and the tolerability of the treatment were well. In this paper, toprovide clinical basis for the treatment of advanced cervical cancer, we investigated theearly effect and acute adverse reaction of the Endostar combined withchemoradiotherapy to the advanced cervical cancer.Methods: All the patients of advanced cervical cancer were from the radiationoncology department of the second affiliated hospital of dalian medical university inJanuary2011to December2013. In this clinical retrospective study,56patients weredivided into two groups: the control group of29cases, age30-74, the median age of52;The experimental group of27cases, age34-75, the median age of53. These two groupsof patients with general data comparison difference has no statistical significance (P＞0.05). The patients from control group were given three-demendional conformalradiotherapy, brachytherapy and cisplatin. The patients of the experimental group inaddition to above treatment, were also given endostar. The early efficacies of thepatients from these two groups were evaluated after3month when the treatment hadbeen ended, and according to the results of the clinical examinations and pelvic MRI/CTexaminations. The standards of evaluation were based on response evaluation criteria insolid tumors. The early complications of bone marrow suppression, rectum, gastrointestinal tract and urogenital tract were recorded. The classifications of adversereactions were based on acute radiation injury classification standard of RadiationTherapy Oncology Group.Results: The early complete remission rate was55.17%, partial remission rate was31.03%, stable disease rate was6.90%and the efficacy rate was86.21%in the controlgroup. In the experimental group, the early outcome complete remission rate was62.96%, partial remission rate was29.63%, stable disease rate was3.70%and theefficacy rate was92.59%. The complete remission rate of the experimental group higherthan that of the control group, and the difference has no significance (2=0.351，P＞0.05). In addition, the total response rate of the experimental group higher than that ofthe control group, and the difference has no significance (2=0.596，P＞0.05).Acute adverse reaction: The incidence of hematologic toxicities in the experimentalgroup and the control group were59.26%（16/27） and62.07%（18/29）, respectively.There was no statistically significant difference (P＞0.05). The incidence of the rectalside reaction of the two group were25.93%（7/27） and31.03%（9/29）, respectively.There was no statistically significant difference (P＞0.05). The incidence ofgastrointestinal side reactions of the two group were66.66%（18/27）and62.07%（18/29）, respectively. There was no statistically significant difference (P＞0.05). Theurogenital tract reactions in the two groups were18.52%（5/27） and20.69%（6/29）.There was no statistically significant difference (P＞0.05).Conclusion:The concurrent chemoradiation therapy in combination with recombinanthuman endastar can improve early efficacy of advanced cervical cancer withoutincrease of acute adverse reactions. Human recombinant endostatin not only to theeffect of radiation therapy, and the combined treatment method also has thecharacteristics of relatively safe. The concurrent chemoradiation therapy in combinationwith recombinant human endastatin has hope to become a new and effective model oftreatment for advanced cervical cancer.