| Background and Objective: Cervical cancer is one of the most common malignancy of women,whose incidence is slightly lower than breast cancer,in the second place.Every year nearly 274,000 women die of the disease in the worldwide,accounting for the third cause of death,so that women's health is seriously affected.Because cervical cancer onset occult,most of them already have advanced when diagnosed.We can not apply surgery to remove the tumor,so radiation therapy becomes the best means of reducing tumor burden.In recent years,medical imaging technologies and radiation therapy techniques continue to mature,the conformal degree and the dose distribution of gross tumor volume(GTV)were significantly improved,so that the tumor can receive higher doses of irradiation,normal tissue and organ surrounding the target can receive lower radiation dose.However,overall survival did not improve significantly with the improvement of clinical cure rate,just hovering in the 50%.Relying solely on radiation therapy can not solve the proliferation and metastasis of tumor cells,tumor local uncontrol,relapse after treatment,lymph node and distant metastasis are the main causes of treatment effect less than ideal.Comprehensive treatment to reduce local tumor burden,subclinical metastases and systemic metastasis raise higher requirements,who becomes one of the main research directions in treatment of cervical cancer in recent years.In recent years,several randomized clinical trials showed that compared with radiotherapy alone,in its basic treatment based on the use of cisplatin as the representative of platinum-based chemotherapy drugs chemoradiotherapy,the overall survival is enhanced in the maximum extent,so advanced cervical cancer patients benefit.But concomitant chemoradiotherapy still can not effectively solve the problem of tumor proliferation and metastasis.Since the transfer through blood is one of the primary tumor metastasis model,which is the only channel on which to provide nutrients for the survival of tumor tissue,thus inhibiting angiogenesis drugs in recent years,in combination with standard radiation therapy,cisplatin chemotherapy to treat advanced cervical cancer becomes the new hot spots.Our researchers independently developed drugs inhibit the effects of vascular endothelial newborn-recombinant human endostatin(Endostar).It can selectively significantly deter the proliferation and migration of vascular endothelial cells,thereby reducing the nutrients needed for growth of tumors,tumor metastasis blocking vascular access required.Some scholars have also found that addition to its influence on the blood vessels,there is a similar effect on lymph nodes and lymphatic vessels.Endostar can hinder the regeneration of lymphatic vessels and metastasis of tumor cells through the lymph node.In the current Endostar combination chemotherapy as first-line program has also been used to treat a variety of solid tumors.Except for cancer,but in non-small cell lung cancer(NSCLC),gastrointestinal cancer,melanoma and other malignant tumors,its effectiveness and tolerability have also been confirmed in many studies.This issue select 53 cases in our department who have received the treatment process of Endostar therapy in patients with advanced cervical cancer,after retrospective analysis,to observe Endostar's efficacy and adverse reactions in different treatments in patients with advanced cervical who accepted this treatment of concomitant chemoradiotherapy.Methods: In this paper,we collected the clinical data of 53 cases with advanced cervical cancer(?b-?a stage)who was treated in our department from March 2013 to November 2014.we divided them into two groups,and given one or two courses of Endostatin treatment.Endostar one course group(Group A)had 27 cases while Endostar two courses group(Group B)had 26 cases.Aged 33-71 years old and 32-70 years old.The median age was 52 years and 51 years old.There is no significant difference(P> 0.05)of general information on the results compared in the two groups in statistical significance.Both groups received Endostar combine with pelvic three-dimensional conformal intensity modulated radiation therapy and synchronization cisplatin.Brachytherapy is behind vitro radiotherapy,there is only a difference of treatment applied Endostar.After treatment for 3 months we checked the patient's gynecological examination,the tumor marker levels and pelvic CT / MRI,as a result of the comparison based on short-term effect.We recorded early complications such as hematopoietic function,digestive system and urogenital system response during treatment and after 3 months of treatment.Adverse reactions graded is according to RTOG acute radiation injury classification criteria for evaluation.Results: 3 months after the treatment,we record and sum up the recent clinical outcomes: Group A had complete remission(CR)14 cases(51.85%);partial remission(PR)10 cases(37.04%);stable disease(SD)3 cases(11.11%);efficiency(CR + PR)% is 88.89%.Group B had complete remission(CR)16 cases(61.54%);partial remission(PR)8 cases(30.77%);stable disease(SD)2 cases(7.69%);efficiency(CR + PR)% is 92.31%.Group B had a higher rate of complete remission(CR%)than Group A,but there is no difference in statistically significant(?2=0.506,P>0.05).Group B had a higher efficient [(CR+PR)%],there is no difference in statistically significant either(?2=0.000,P>0.05).The results of comparison of effects in squamous cell carcinoma show an advantage in Group B,however there is no difference in statistics(P>0.05).Statistical results in adenocarcinoma were the same.Two groups of patients 1 year survival rate was 100%,there is no difference in statistics(P>0.05).Comparing results of Endostar one course or two in toxicity aspects,intramedullary inhibition rate was 51.85%(14/27)and 61.54%(16/26);rectal reactions were 37.04%(10/27)and 30.77%(8/26),the difference was not statistically significant(P> 0.05).Upper gastrointestinal reaction were 51.85%(14/27)and 61.54%(16/26);urogenital tract reaction rates were 22.22%(6/27)and 19.23%(5/26),there was no statistical difference significance(P> 0.05).Conclusion: In advanced cervical cancer patients who are receiving concurrent chemoradiotherapy,combined two courses Endostar has improved treatment efficacy than single one,especially in patients with squamous cell carcinoma will get greater benefit.There were no significant adverse reactions in two groups.So the United Endostar targeted therapy may be used as a new way in treatment of advanced cervical cancer. |
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