Clinical And Evidence-based Medicine Research On Radical Radiotherapy For Cervical Cancer

The prognostic factors of chemoradiotherapy for carcinoma of the uterine cervix:a systematic reviewObjective:investigating the prognostic factors of radical or adjuvant radiotherapy with or without concurrent chemotherapy for carcinoma of the uterine cervix.Methods:The literature published between January 1,1985 and December 31,2012 were searched in PubMed,Embase,Medline,Cochrane Library,EBMR,CBM,CJFD,and CNKI to identify the RCT were searched about the prognostic factors include clinical and pathologic poor prognostic factors:the FIGO stage,the Patients' age,deep cervical stromal invasion,tumor size>4 cm,nodal metastases,microscopic tumor in uterine parametrial tissues,histological texture,grade,haemoglobin level on Overall survival(OS),relapse-free survival(RFS),disease-specific survival(DSS)and pelvic control rate,Rates of local and distant recurrence and complications.The literature was screened according to the inclusive and exclusive criteria by two reviewers independtly,then the SPSS software was used for linear regression.Results:Simple linear regression showed that statistical significance between FIGO stage(F=57.672,P=0.000),residual size(F=29.129,P=0.000),nodal metastases(F=6.282,P=0.021),the number of chemotherapy between radiotherapy(F=14.371,P=0.001).Conclusions:More large and high quality randomized controlled study are required.optimal fractionation of high-dose-rate intracavitary brachytherapy for Carcinoma of the Uterine Cervix-A Meta AnalysisObjective:In order to determine whether an optimal HDR schedule model existed and to assess the efficacy and safety of the optimization of HDR brachytherapy schedule in the treatment of carcinoma of the cervix.Methods:The literature published between January 1,1990 and December 31,2012 were searched in PubMed,Embase,Medline,Cochrane Library,EBMR,CBM,CJFD,and CNKI to identify the RCT were searched about the effect of the difference between higher dose and lower dose per-fraction of HDR on overall survival rates,disease-specific survival rates,local control rates.Results:Three studies involving 359 patients met the inclusion criteria.In our meta-analysis to compare the difference between higher dose and lower dose per-fraction of HDR which generate different ruration(shorter and longer duration respectively),the pooled RRs were 1.01,95%CI:0.89-1.13;1.05,95%CI:0.86-1.28 for 3-years OS and 5-years OS respectively.pooled RRs were 1.07,95%CI:0.92-1.24;1.03,95%CI:0.81-1.32 for 3-years PFS and 5-years PFS respectively.For local control rates the RR was 1,29(95%CI 1.02 to 1.62)at three years;For local control rates the RR was 1.40(95%CI 1.13 to 1.73)at five years;with a RR of 1.39(95%CI 0.79 to 2.47)for local recurrence,1.31(95%CI 0.66 to 2.58)for distant metastasis,1.95(95%CI 1.15 to 3.31)for acute toxic in bladder and rectum,and 4.03(95%CI 1.37 to 11.79)for chornic toxic in bladder and rectum.Two review authors independently assessed potential trials for inclusion,and the RevMan 5.2 software was used for meta-analyses.Conclusions:This review showed no significant differences between H-HDR-and L-HDR-ICBT when considering OS,PFS,local control rate,recurrence,metastasis and treatment related complications for women with cervical carcinoma.Due to some potential advantages of H-HDR-ICBT(rigid immobilization,outpatient treatment,patient convenience,accuracy of source and applicator positioning,individualized treatment,shorter duration)we recommend the use of H-HDR-ICBT for advanced stages of cervix cancer.Efidence-based medical research on late course accelerated hyperfractionation radiothera py of cervical cancerObjective:To review published literature and perform a meta—analysis for assessing the eficacy and clinical value of late course accelerated hyperfractionation radiotherapy(LCHART)of cervical cancer.Methods:The literature published between January 1,1985 and December 31,2012 were searched in PubMed,Embase,Medline,Cochrane Library,EBMR,CBM,CJFD,and CNKI to search the effect of the difference between LCHART and conventional fractionation radiotherapy on overall survival rates,disease-specific survival rates,local control rates,acute and chronic toxic.Results:Four randomized controlled trials involving 747 patients were included,with 295 patients in LCHART group and 452 patients inconventional radiotherapy(CRT)group.The pooled OR=1.00,95%CI:0.58-1.75,p=0.99 for 3-years OS between LCHART and CRT;OR=0.70,95%CI:0.45-1.07,p=0.10 for 5-years OS between LCHART and CRT;OR=3.70,95%CI:1.13-12.09,p=0.03 for 3-years local control rate between LCHART and CRT;OR=2.51,95%CI:1.05-6.01,p=0.04 for 5-years local control rate between LCHART and CRT;OR=1.01,95%CI:0.56-1.82,p=0.96 for 3-years local reccurence rate between LCHART and CRT;OR=0.62,95%CI:0.11-3.55,p=0.59 for 5-years local reccurence rate between LCHART and CRT;OR=2.09,95%CI:0.36-11.95,p=0.41 for 3-years distant metastasis rate between LCHART and CRT;OR=2.41,95%CI:1.15-5.02,p=0.02 for 5-years distant metastasis rate between LCHART and CRT;OR=1.86,95%CI:0.93-3.72,p=0.08 for acute toxic;OR=0.60,95%CI:0.20-1.80,p=0.36 for chronic toxic,respectively.Conclusions:NPC LCHART increased 3-year local control rate as conpared with CRT.Intensity-modulated radiotherapy(IMRT)for carcinoma of the uterine cervix:A Meta AnalysisObjective:In order to determine and assess the efficacy and safety of the Intensity-modulated radiotherapy in the treatment of carcinoma of the cervix.Methods:The literature published between January 1,1990 and December 31,2012 were searched in PubMed,Embase,Medline,Cochrane Library,EBMR,CBM,CJFD,and CNKI to search the effect of the difference between IMRT and non-IMRT on overall survival rates,disease-specific survival rates,local control rates.A Meta-analysis was carried out using Review Manager 5.2.0 software.Results:In our meta-analysis to compare the difference between IMRT and non-IMRT,and pooled OS were(OR=1.51,95%CI:1.01-2.28,p=0.05);DFS(OR=1.37,95%CI:0.92-2.05,p=0.12);Pelvic rates(OR=0.93,95%CI:0.59-1.46,p=0.74);Chronic Hematologic toxicity(OR=0.76,95%CI:0.52-1.10,p=0.15);Chronic GI toxicity(OR=0.30,95%CI:0.18-0.50,p<0.00001);Chronic GU toxicity(OR=0.31,95%CI:0.17-0.57,p=0.0001);Acute GI toxicity(OR=0.12,95%CI:0.06-0.27,p<0.00001);Acute GU toxicity(OR=0.34,95%CI:0.16-0.73,p=0.006).Conclusions:This review showed no significant differences between OS and PFS,and showed significant differences between complications.