Clinical Analysis Of Different Chemoradiotherapy Regimens And Evaluation Of Image Guided Brachytherapy For Cervical Carcinoma

Objective1.To assess the efficacy and toxicities of radiotherapy alone,cisplatin concurrent chemoradiotherapy or adjuvant chemotherapy for cervical carcinoma.2. It is hard to show the dose distribution of tumor and organs at risk when use the traditional 2D-brachytherapy.To evaluate the advantages and disadvantage of CT image-based brachytherapy for cervical cancer by comparing the dose volume between Image Guided Brachytherapy(IGBT)and traditional two-dimensional(2D)plan.MethodsSection one127 patients with cervical cancer were enrolled into the study and randomized into three groups: 45 of radiotherapy alone and 58 of cisplatin concurrent chemoradiotherapy and 24 of adjuvant chemotherapy. The adjuvant chemotherapy group were transfused with Paclitaxel and Carboplatin.Radiotherapy include pelvic external radiotherapy and 192 Ir brachytherapy. The efficacy and toxicities in each group were compared.Section two12 patients with mid-to-late cervical cancer were enrolled into the study.All the patients accepted the radical radiotherapy from February 2014 to December 2014 in the First Affiliated Hospital of Soochow University.The images of the patients were scanned underwent by the Phillip’s 16 row spiral CT for 59 times. Three-dimensional and two-dimensional plan were designed based GEC-ESTRO recommendation on the Oncentra Treatment Plan System.Compared the dose parameters of two different plans.ResultsSection oneAll patients finished the treatment,the median follow-up time was 41 months.In radiotherapy alone group,there were 24 CR(Complete Response),14 PR(Partial Response), 4 SD(Stable Disease), 3 PD(Progressive Disease), the CR rate was 53.33%; in cisplatin concurrent chemoradiotherapy group, there were 45 CR,8PR,3SD,2PD, the CR rate was 77.59%; in adjuvant chemotherapy group, there were 15 CR,6PR,2SD,1PD, the CR rate was 62.50%(P=0.496>0.05).The 2-year overall survival rate of radiotherapy alone group, cisplatin concurrent group and adjuvant chemotherapy group were 66.2%、85.4%、74.9%; the 3-year overall survival rate were 64.2%、82.4%、74.9%; the 5-year overall survival rate were 54.8%、78.1%、74.9%; the 2-year progression-free survival rate were 57.9%、85.4%、69.3%; the 3-year progression- free survival rate were 56.1%、82.4%、69.3%.There were significant differences between the three groups(P<0.05).The toxicities were mainly in grade 1-2,and the incidence of blood,gastrointestine and bladder had the significant differences(P<0.05)between the three groups.Section twoThe maximum,minimum, median and mean of D90 in 3D plan were higher than those in 2D plan(P=0.000).The mean of D90 was( 528.06±70.29) c Gy in 3D plan,( 425.66±95.94) c Gy in 2D plan. The maximum,minimum and mean of bladder D0.1cm3,D1cm3,D2cm3 in 3D plan were lower than those in 2D plan,but there were no significant differences(P=0.824,0.885,0.899).11.86% bladder D0.1cm3 was higher than 600 c Gy in 2D plan,while 10.17% in 3D plan. 1.69% bladder D1cm3 was higher than 600 c Gy in 2D plan, while 0% in 3D plan. The maximum,minimum and mean of rectal D0.1cm3,D1cm3,D2cm3 in 3D plan were lower than those in 2D plan,and the differences were significant(P=0.042,0.031,0.015). 22.03% rectal D0.1cm3 was higher than 600 c Gy in 2D plan, while 8.47% in 3D plan.18.64% rectal D1cm3 was higher than 600 c Gy in 2D plan, 6.78% higher than 500 c Gy,while 5.08% and 0% in 3D plan. 6.78% rectal D2cm3 was higher than 500 c Gy in 2D plan, while 0% in 3D plan(P<0.05).Conclusion1.Concurrent chemoradiotherapy for cervical cancer can significantly improve the 5-year overall survival rate and progression-free survival rate.It is a better therapy for cervical carcinoma,but the treatment related complications should be considered.To the patients who can not tolerate concurrent chemoradiotherapy, the adjuvant chemotherapy still has benefits for the survival rate compared with RT alone.2.Compared with the traditional 2D plan,the CT image-based 3D plan for cervical cancer brachytherapy can increase the target dose and conformity significantly, and decrease the volume of OAR in high dose region effectively,reduce the complications of brachytherapy.But the IGBT begins just a few years,more experience should be collected and improved.