Effects Of Different Forms Of Adjuvant Chemotherapy On The Efficacy And Prognosis Of Radiotherapy For Locally Advanced Cervical Cancer

BackgroundCervical cancer is the most common gynecological malignancy.According to WHO statistics,in 2020,there were an estimated 604 127 new cases of cervical cancer and 341831 deaths worldwide,ranking fourth among female malignant tumors in the world,and the incidence of cervical cancer in Chinese women is increasing year by year.At present,the standard treatment for locally intermediate and advanced cervical cancer is platinumbased concurrent chemoradiotherapy,but the recurrence rate and mortality rate are still high.ObjectiveThis study aimed to explore the effect of different forms of adjuvant chemotherapy on the efficacy of radical radiotherapy for locally advanced cervical cancer and the severity of toxic side effects,so as to guide the selection of clinical individualized treatment regimens,in order to obtain better clinical efficacy,reduce the incidence of complications of radiotherapy and chemotherapy,and screen for risk factors related to cervical cancer prognosis.MethodsA retrospective analysis of 164 patients with locally advanced cervical cancer from January 2015 to May 2019 was conducted.According to the different treatment options,the patients were divided into the concurrent group,sequential group,platinum-based weeklytherapy group and mixed group,and the patients in the four groups received the same radical radiotherapy.The concurrent group was using platinum + paclitaxel during radiotherapy;The sequential group was adjuvant chemotherapy with platinum + paclitaxel before or after radiotherapy;Platinum-based weeklytherapy group is treated with platinum per week during radiotherapy;Mixed group treatment was adjuvant platinum + paclitaxel chemotherapy before or after radiotherapy initiation or end,and platinum-based weeklytherapy adjuvant chemotherapy during radiotherapy.The differences in complete response rate(CRR),objective response rate(ORR),5-year progression-free survival(PFS),overall survival(OS),and adverse effects were compared between groups,and univariate and multivariate Cox regression analysis were used to explore the risk factors affecting PFS and OS.ResultsIn this study,the CRR of patients in the concurrent group was significantly higher than that in the platinum-based weeklytherapy group and the mixed group(P<0.05).There were no significant differences in the incidence and severity of myelosuppression,digestive adverse reactions and liver and kidney function impairment between the four groups.Univariate regression analysis showed that lymph node metastasis before treatment,the hemoglobin concentration before treatment was <95g/L,tumor residue after treatment,SCCA and CEA levels were still higher than normal values after treatment,which had a significant impact on the prognosis of patients.Multivariate COX regression analysis showed that lymph node metastasis,SCC level remained higher than normal after treatment,and tumor diameter did not change or increase after treatment were independent risk factors for PFS.Lymph node metastasis and no change or increase in tumor diameter after treatment are independent prognostic factors for OS.ConclusionThe efficacy of platinum combined with paclitaxel in concurrent chemoradiotherapy is considerable,which can significantly improve the complete response rate without significantly increasing the toxic side effects of chemoradiotherapy,which is worthy of further clinical promotion.After treatment,tumor regression should be evaluated,including but not limited to imaging tests and tumor indicators(mainly SCCA),and guide the need for follow-up supplemental therapy,close follow-up,timely detection of recurrence and timely treatment,so as to improve the prognosis of patients.