| Objective:To evaluate the outcomes and toxicities of cervical cancer patients treated with intensity-modulated radiotherapy in the Second Affiliated Hospital of Soochow University,and to analyze the prognostic factors and risk factors for toxicities.Material&Method:A retrospective analysis was conducted in the patients with cervical cancer treated with IMRT from the Second Affiliated Hospital of Soochow University between January 2014 and December 2017,including postoperative adjuvant radiotherapy and radical radiotherapy.The Kaplan-Meier method was used to determine overall survival and progression-free survival,and Cox regression analysis was used to identify potential prognostic factors.Analysis of variance was used to determine factors associated with toxicities,and logistic regression was used to analyze risk factors for toxicities.Results:A total of 172 patients were included in the analysis.The median follow-up time was 28.1 months.The 3-year and 5-year OS were 81.0%and 64.5%,respectively.The 3-year and 5-year PFS were 77.1%and 67.6%,respectively.In the group analysis,106 patients in the postoperative adjuvant radiotherapy group had 88.1%of 3-year OS,77.3%of 5-year OS,84.5%of 3-year PFS and 79.8%of 5-year PFS,respectively.In multivariate analysis,tumor histopathological types(PFS:HR 9.643,p=0.004;OS:HR 12.368,p=0.009),pelvic lymph node status(PFS:HR 0.144,p=0.015;OS:HR 0.092,p=0.015)is an independent prognostic factor for 5-year OS and PFS.Sixty-five patients with cervical cancer were treated with radiation therapy.The 3-year PFS was 65.1%,and the 3-year OS was 69.0%.Multivariate analysis showed that pelvic lymph node status significantly affected patients with PFS(HR 0.269;p=0.040).Completion of brachytherapy increased the PFS by 10.84 times(p=0.000)and increased the OS by 4.09 times(p=0.026)of cervical cancer patients.A total of 57 patients(43.0%)developed severe hematologic toxicity(grade 3 and above),with incidence in radical radiotherapy group up to 60%.The incidence of acute severe intestinal toxicity was 2.9%,and that of advanced severe intestinal toxicity(grade 2 and above)was 3.5%.In the postoperative adjuvant radiotherapy group,multivariate analysis showed that concurrent chemotherapy(HR,0.176;p=0.047)and Hb<120 g/L(HR 2.641;p=0.050)before radiotherapy significantly increased the incidence of acute severe hematologic toxicity;The acute intestinal toxicity(HR,0.137;p=0.024)was an independent risk factor for the development of advanced intestinal toxicity.In patients with cervical cancer treated with radical radiotherapy,multivariate analysis only showed complete brachytherapy has a tendency to increase the incidence of severe acute hematologic toxicity(HR,0.122;p=0.073).Conclusion:This retrospective study showed that the overall outcomes and toxicities of IMRT for patients with cervical cancer in our hospital is comparable to global data.In the analysis of prognosis factors and risk factors affecting toxicities,it was found that there was still significant associations between some characteristics of patients and outcomes.This suggests that in the future therapy process,we will strengthen and improve the pre-treatment evaluation and select the optimal treatment plan,and record the treatment-related toxicity in detail for future treatment management and research. |
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