| Objective: This study aims to explore the curative effect of surgical treatment,postoperative chemoradiotherapy and radical chemoradiotherapy for cervical stump carcinoma,and to clarify the related factors of prognosis of cervical stump carcinoma,so as to provide the basis for personalized treatment for cervical stump carcinoma.Methods: From October 1,2010 to January 1,2020,58 patients with cervical stump carcinoma who completed radical surgery or radical chemoradiotherapy in the second hospital of Jilin University were selected,and their information were analyzed retrospectively.All patients were confirmed by pathology,including 12 patients treated with surgical treatment,14 patients with postoperative combined chemoradiotherapy,and32 patients with radical chemoradiotherapy.In surgical treatment group,radical hysterectomy,bilateral adnexectomy and pelvic lymphadenectomy were performed.In the postoperative chemoradiotherapy group,the external radiation dose of PTV was 46.8Gy～50Gy,1.8Gy～2Gy/F,5F/Week,combined with brachytherapy.The prescription dose of HR-CTV was 10Gy/2F.Platinum sensitization chemotherapy was synchronized during radiotherapy,and 4 ～ 6 cycles of chemotherapy were sequential after radiotherapy.In the radical radiotherapy and chemotherapy group,the external dose of PTV was 46.8Gy～50Gy,1.8Gy～2Gy/F,5F/Week,and GTVnd was added to 60 Gy simultaneously;the prescription dose of HR-CTV combined with brachytherapy was 30～36Gy/5～6F,synchronous platinum sensitization chemotherapy,and sequential chemotherapy for 4～6 cycles after radiotherapy.The therapeutic effect was evaluated according to RECIST standard,the acute toxicity was evaluated according to CTCAE standard,and the late toxicity was evaluated according to RTOG/EORTC standard.SPSS26.0 software was used for statistical analysis,Kaplan-Meier method was used to draw survival curve for analysis,Log-Rank method was used for univariate analysis,and statistically significant variables were included in Cox-regression model for multivariate analysis(p<0.05 means the difference was statistically significant).1.Results: The overall 1-year survival rate was 96.5%,3-year survival rate was 82.7%,5-year survival rate was 68.9%.The 1-year,3-year and 5-year survival rates of operation group were 100%,83.3% and 75% respectively;the 1-year,3-year and 5-year survival rates of postoperative combined chemoradiotherapy group were 100%,71.4% and 64.3%respectively;the 1-year,3-year and 5-year survival rates of radical chemoradiotherapy group were 93.7%,87.5% and 68.7%respectively.2.Log Rank test showed that FIGO stage and pathological type of tumor were related to 5-year survival rate of disease,Cox Regression analysis showed that FIGO stage and pathological type of tumors were related to 5-year survival rate of disease FIGO stage and pathological type were independent prognostic factors of cervical stump carcinoma.3.In the radical radiotherapy and chemotherapy group,26patients(81.3%)achieved CR one month after treatment,6patients(18.7%)achieved PR,the total effective rate was(CR + PR)100%.30 patients(93.4%)had HR-CTV D90 ≥ 85 Gy,27 patients(84.4%)had HR-CTV D90 ≥ 87 Gy,the bladder D2 cc was 78.45 ± 5.2Gy,rectum D2 cc was 67.32 ± 5.6Gy,sigmoid D2cc was 65.27 ± 5.1Gy.Conclusion:1.FIGO stage and histopathological type are independent prognostic factors of cervical stump carcinoma.Early stage(IA～IIA)patients and squamous cell carcinoma have good prognosis,advanced stage(IIA～IVA)and non squamous cell carcinoma have poor prognosis.2.Early patients with cervical stump cancer can choose radical surgery.Patients with high risk factors and multiple medium risk factors after surgery should be combined with adjuvant chemotherapy to improve tumor control and prolong survival.3.Radical radiotherapy and chemotherapy is the effective treatment for patients with locally advanced cervical stump carcinoma.The combination of three-dimensional intensitymodulated radiotherapy and individualized three-dimensional brachytherapy in our department is expected to further improve the therapeutic effect of locally advanced cervical stump carcinoma and reduce radiation damage. |
