Analysis of Clinical Effect of Concurrent Chemo/radiotherapy in the Treatment of Advanced Cervical Cancer

ZHENG,Wufeng

【Abstract】The study aimed to analyze the efficacy and adverse effects of concurrent chemo/radiotherapy in the treatment of advanced cervical cancer,and the efficacy and safety of concurrent chemo/radiotherapy were evaluated to standardize the treatment.First of all,retrospective analysis was carried out,and 30 cases of advanced cervical cancer treated in hospitals from 2013 to 2018 were included in the study.30 cases of concurrent chemo/radiotherapy were included in the synchronous group,and 30 cases of radical radiotherapy alone were included in the radiotherapy group.The results showed that the CR rate and remission rate in the synchronous group were 43.3%and 93.3%,which were higher than those in the radiotherapy group(26.7%and 80.0%).The 3-year survival rate of the synchronous group was 80.0%,which was higher than that of the radiotherapy group,with a statistically significant difference(P<0.05).There was no significant difference in 3-year all-cause mortality,5-year survival and 5-year all-cause mortality between the two groups.The tumor-free survival time in the synchronous group was(24.4±8.2)months,which was higher than that in the radiotherapy group(17.0±8.5)months,and the difference was statistically significant(P<0.05).Therefore,compared with radiotherapy alone,concurrent chemo/radiotherapy in the treatment of advanced cervical cancer can improve the 3-year survival rate and prolong the tumor-free survival time.However,it did not increase 5-year survival rate,and bone marrow suppression and gastrointestinal reactions were increased.

【Keywords】Cervical cancer;Concurrent chemo/radiotherapy;Radical radiotherapy alone;Survival rate

1. Introduction

In recent years,due to population aging and changes in social environment,the infection rate of high-risk human papillomavirus(HPV)is on the rise,and the in-cidence of cervical cancer is on the rise.The treatment methods of cervical cancer mainly include surgery,chemoradiotherapy,biological therapy,etc.Radiother-apy is also a treatment method for pigs with advanced cervical cancer,but the overall survival rate of patients is still less than 50%[1-2].Chemotherapy alone cannot effectively prevent the spread and metastasis of the tumor.In recent years,chemotherapy has been increas-ingly valued in the treatment of cervical cancer.The commonly used drugs are cisplatin and paclitaxel,etc.A large number of analysis of Meta shows that concur-rent chemo/radiotherapy can significantly improve the survival rate and prolong the survival time of advanced cervical cancer[3-4].However,concurrent chemo/radio-therapy would increase the physical burden of patients and reduce tolerance of patients,and the risk of adverse reactions were increased.The symptoms caused by adverse reactions bring physical discomfort to patients and affect their confidence in treatment and compliance[5].The study tried to analyze the efficacy and adverse reactions of concurrent chemoradiotherapy in the treat-ment of advanced cervical cancer,summarizing and evaluating the efficacy and safety of concurrent chemo-radiotherapy,so as to provide basis for the application of therapy.

2.Materials and Methods

2.1 Subjects

A retrospective analysis was conducted to study pa-tients with advanced cervical cancer treated in hospitals from 2013 to 2018.A total of 30 patients with an aver-age age of(52.4±6.4)years were included in the syn-chronous group,aged 43-63 years.The tumor size was(4.4±1.2)cm.Pathological types were 20 cases of ade-nocarcinoma and 10 cases of squamous cell carcinoma.Clinical stage were 16 cases in stage II and 14 cases in stage III.Radical radiotherapy alone was used in 30 patients,including the radiotherapy group,aged 44-65 years old(53.2±6.2 years old on average).The tumor size was(4.2±1.5)cm.Pathological types were adeno-carcinoma in 26 cases and squamous cell carcinoma in 4 cases.Clinical stage were 15 cases in stage II and 15 cases in stage III.There was no statistically significant difference in age,stage,tumor size and pathological type between the two groups.

2.2 Inclusion and Exclusion Criteria

Inclusion criteria[6]:1.Patients with clinical diagnosis and initial treatment.Patients receiving concurrent chemo-radiotherapy or simple radical treatment.3.With complete clinical data,patients with FIGP stage II-III were diag-nosed.4 Patients with informed consent.

2.3 Methods

C/D medical linear accelerator of Varian and the KXO analog locator were used for conventional pelvic radia-tion,three-dimensional conformal radiotherapy,and CT analog positioning.The clinical target area included the primary tumor of uterus,cervix and vagina as well as the lymph node area and its surrounding tissues.The dose was 180-200cGy/time,5 times a week,and the Dt was 300cGy/15-17 times.SSD irradiation of the pelvic cavity before and after the four fields,a single time of 180-200cGy.

On the basis of three-dimensional conformal radio therapy,4500 cGy was increased 7-8 times,once a day,5 times a week.Intracavity retrofitting treatment,the dose at point A was 600 cGy/time,the cumulative dose was 3000-3600 cGy/5-6 times or 3600-4200 cGy/6-7 times.The dose could be appropriately increased in patients with large tumor volume,and the treatment began after the end of in vitro irradiation.Cisplatin regimen was used for chemotherapy,and 30 mg/m2 of cisplatin were intravenous drip to patients once a week ford 3 to 6 times in total.On the day of radiotherapy,patients were given active antiemetic and rehydra-tion therapy.Blood routine examination and liver and kidney function examination were carried out before treatment.Blood routine examination once a week after treatment.

2.4 Observation Indicator

Short-term efficacy and long-term survival were ob-served.

2.5 Curative Effect of Standard

According to RECIST criteria,the short-term efficacy was evaluated as complete response(CR),partial response(PR),stabilization disease(SD),and progression disease(PD),with CR+PR as remission and CR+PR+SD as con-trol.

2.6 Follow-up Visits

After treatment,the patients were followed up every 3 months in the first to second year,and every 6 months in the third year.Then,long-term efficacy was evaluated and survival indicators,overall survival rate(OS),disease-free survival rate and time were calculated.

2.7 Statistical Tests

Excel was used to record data,and SPSS 20.0 statisti-cal software was used for calculation.was used to reflect the measurement data,and n or%were used to reflect the counting data.The Comparison between the two groups was performed by theχ2 test or Fisher accuracy test,with P<0.05 indicating that the difference was statistically sig-nificant.

3.Results and Discussion

3.1 Short-term Treatment Effect of Two Group

As shown in Table 1,the CR rate and remission rate in the synchronous group were higher than those in the radiotherapy group,and the differences were statistically significant(P<0.05).

Table1.Comparisonofshort-termefficacybetweensynchronousgroupandradiotherapygroup(n)

Curativeeffect	Synchronousgroup		Radiotherapygroup
	Case	Treatmentefficiency(%)	Case	Treatmentefficiency(%)
CR	13	43.3	8	26.7
PR	15	50.0	16	53.3
SD	2	6.7	10	16.7
PD	0	0.0	1	3.3
Ease	28	93.3	24	80.0
Control	30	100.0	29	93.7

3.2 Long-term Treatment Effect of Two Group

As shown in Table 2,the 3-year survival rate of the synchronous group was higher than that of the radiother-apy group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the 3-year all-cause mortality,5-year survival rate and 5-year all-cause mortality between the two groups.The tumor-free survival time of the synchronous group was(24.4±8.2)months,which was higher than that of the ra-diotherapy group(17.0±8.5)months,and the difference was statistically significant(P<0.05).

Table 2.Comparison of long-term prognosis between synchronous group and radiotherapy group(n)

Project	Synchronousgroup		Radiotherapygroup
	Case	Percentage(%)	Case	Percentage(%)
3-yearsurvival	24	80.0	18	60.0
3-yearall-cause mortality	6	20.0	9	30.0
5-year survival	12	40.0	8	26.7
5-yearall-cause mortality	16	53.3	21	70.0

4.Discussion

There are many factors influencing the prognosis of neck cancer,and the treatment obviously has a signifi-cant influence on the prognosis.The study showed that the CR rate and remission rate of the concurrent chemo/radiotherapy group were 43.3%and 93.3%higher than those of the radiotherapy group(26.7%and 80.0%respec-tively),with statistically significant differences(P<0.05),suggesting that the chemo/radiotherapy can improve the short-term efficacy.Concurrent chemo/radiotherapy can inhibit the repair of DNA damage induced by radiother-apy and reduce tumor volume.At the same time,it can also reduce the ratio of radiosensitive hypoxic oxygen to improve the hypoxic condition,controlling the tumor cycle and increasing the tumor radiotherapy sensitivity,and the possibility of cross-tolerance was reduced.Zhang et al.conducted a meta-analysis on 10 literatures,and the results showed that the overall survival rate[RR=1.17,95%CI(1.10-1.24)]and the total effective rate[RR=1.24,95%CI(1.16-1.33)]of the two methods were statistically significant(P<0.05)[7-8].

In terms of long-term prognosis,it is generally believed that concurrent chemoradiotherapy can prolong the total survival time and the tumor-free survival time of patients.The study showed that the 3-year survival rate and tu-mor-free survival time in the synchronous group were 80.0%and 24.4±8.2 months,respectively,which were higher than those in the radiotherapy group(60.0%and 17.0±8.5 months,respectively),with statistically signifi-cant differences(P<0.05).In addition,the results showed that there was no significant difference in 3-year all-cause mortality,5-year survival rate or 5-year all-cause mortality between the two groups.The difference in 3-year survival rate was statistically significant(P<0.05),suggesting that with the extension of time,patients did not benefit sig-nificantly from concurrent chemoradiotherapy,and there were many factors affecting long-term prognosis.Reports showed that 3-year survival rate was correlated with tu-mor size,type and lymph node metastasis[9-10].

5.Conclusion

In conclusion,concurrent chemo/radiotherapy in the treatment of advanced cervical cancer can improve the 3-year survival rate and prolong the tumor-free survival time.However,it did not increase 5-year survival rate,and bone marrow suppression and gastrointestinal reac-tions were increased.

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