Comparison Of Acute Adverse Reactions And Short-Term Efficacy Between Intensity Modulated Radiotherapy And Conventional Pelvic Field Radiotherapy For Middle And Advanced Cervical Cancer

Objective:To compare the short-term efficacy,acute adverse reactions,incidence of perimenopausal symptoms,and the rate of decreased quality of sexual life in patients with middle and advanced cervical cancer using intensity-modulated radiotherapy(IMRT)and conventional pelvic field radiotherapy.MethodsA total of 87 patients with the FIGO clinical stage ofⅡB-ⅣA cervical cancer who were treated at Changzhou Cancer Hospital from January 2015 to December 2017were selected and received standard treatment of external radiotherapy and intracavitary radiotherapy.Intensive radiotherapy and conventional pelvic field radiotherapy,inform patients of the two radiotherapy treatment modes and treatment costs,and patients choose external radiotherapy methods according to their own conditions.46 cases received conventional four-field pelvic radiotherapy,which comprised 45 Gy given in 25 fractions.41 cases received IMRT:a dose of 46～50 Gy for planning target volume(PTV),54～60 Gy for gross tumor volume(GTVnd)simultaneously integrated boosted in 25-28 fractions.After 30 Gy in vitro exposure,192Ir afterloading brachytherapy of 6～7 Gy/fraction was performed,with a total dose of 25～36 Gy.During radiotherapy,patients received nedaplatin(NDP)40mg/m~2,ivgtt,weekly,for 4～6 weeks.Short-term efficacy,1-year survival rate,local recurrence,metastasis,and acute adverse reactions,as well as dosimetry of target volume and normal tissue were observed in both groups.Results:There was no difference in clinical data between the two groups of patients.Short-term efficacy,1-year survival rate,local recurrence and metastasis rate had no significant difference between groups(P>0.05).The proportion of grade 0 and grade I myelosuppression in IMRT group was significantly higher than that in conventional group,while the proportion of grade II,III and IV myelosuppression was lower than that in conventional group(P<0.05);The detection rate of grade I gastrointestinal reaction had no significant difference between groups(P>0.05),while the IMRT group had higher grade 0 gastrointestinal reaction rate and grade 0 urinary system reaction rate as well as lower grade II gastrointestinal reaction rate and grade I urinary system reaction rate than those of conventional group(P<0.05).The detection rates of grade 0,grade I and grade II skin response in IMRT group were lower than those in conventional group(P<0.05).The sexual life quality decrease,perimenopausal symptom and Kupperman score showed no significant difference between groups(P>0.05).The mean CTV dose,maximum dose,45gy irradiation volume and PTV average dose in IMRT group were higher than those in conventional group(P<0.05);In all dose levels,the radiation volume of rectum,bladder,bone marrow and femoral head(20Gy)in IMRT group was significantly lower than that in conventional group(P<0.05),while the radiation volume under a dose of 30 Gy showed no significant difference between groups(P>0.05)Conclusion:1.Intensity modulated radiation therapy and conventional pelvic field radiotherapy after radical resection of cervical cancer has similar short-term efficacy.2.The incidence of adverse reactions induced by intensity-modulated radiation therapy is significantly lower than that of conventional pelvic field radiotherapy.3.Intensity modulated radiation therapy is superior to conventional pelvic field radiotherapy in protecting the surrounding normal tissues and organs.