Objective： To observe the clinical value of three dimensional conformal radiation therapy （3D-CRT） followed by radical surgery and discuss the best radiation technique for cervical cancer patients after radical hys...Objective： To observe the clinical value of three dimensional conformal radiation therapy （3D-CRT） followed by radical surgery and discuss the best radiation technique for cervical cancer patients after radical hysterectomy. Methods： From February 2003 to June 2006, 115 stage Ⅰ-Ⅲa uterus cervix cancer patients received postoperation radiotherapy in our department after radical surgery. They were randomly divided into two groups. There were 81 patients in 3D-CRT group and 74 patients in traditional radiation group. According to FIGO, there were 45 in stage Ⅰ, 77 in stage Ⅰa, 31 in stage Ⅱb, 2 in stage Ⅲa. Pathological examination confirmed that 148 cases had squamous carcinoma and 7 cases had adenocarcinoma. The target volume included supravaginal portion, the cervical stump, paracervical tissue, common iliac lymph nodes, intemal and extemal lilac lymph nodes, obturator and sacral lymph nodes. For 3D-CRT group we designed four-field or two-fields rotating irradiation in the left-right and the anterior-posterior direction. For traditional radiation group we designed two-field, anterior-posterior, at opposed lateral directions. The radiation dose ranged from 48-50 Gy. Stage lib patients with a cervical stump recurrence received postoperative boost radiation by 8-10 Gy. Results： There were no significant difference in 0.5-year, 1-year, 1.5-year, 2-year local control rate between 3D-CRT group and traditional radiation group （P 〉 0.05）. The occurrence of early and late complications was significant lower in 3D-CRT group than that in traditional radiation group （P 〈 0.05）. There was significant difference in gastrointestinal reaction and urinary system reaction between the two groups （P 〈 0.05）. In postoperation radiotherapy 3D-CRT was superior compared with traditional two-field radiation at opposed lateral direction. Conclusion： 3D-CRT is superior compared with traditional radiation. Four-field rotating irradiation in 3D-CRT has advantages of dose focusing, even dose distribution and cause less side effects and complications. The side-field and cervical stump-targeted boost irradiation are apparent advantages of 3D-CRT.展开更多
Objective： The aim of this study was to explore the difference of long-term prognosis of different treatment regimens in patients with stage IB2, IIA2 cervical Cancer. Methods： From August 1995 to September 2005, ra...Objective： The aim of this study was to explore the difference of long-term prognosis of different treatment regimens in patients with stage IB2, IIA2 cervical Cancer. Methods： From August 1995 to September 2005, radical hysterectomy was chosen as primary treatment regimen for 122 patients （group A）, 85 patients underwent radical hysterectomy after ef- fective neoadjuvant therapy （group B）, and 98 patients received surgery after ineffective preoperative therapy （group C）. All patients received postoperative therapy. Results： Atotal of 305 patients were analyzed. The maximum diameter of tumor was largest in group B, while the pathological risk factors （cervical infiltration, positive surgical margins） were in the lowest propor- tion. The 5-year mortality rate and relapse rate of group B were the highest, and the overall survival （OS） and progression-free survival （PFS） were the shortest （P 〈 0.05）. No significant difference of long-term survival was found in group C and group A. No difference was found in the surgical of three groups. Large tumor more than 5.5 cm had higher effective ratio of treatment than those 5.5 cm or less. Patients received effective preoperative radiotherapy had better long-term prognosis than those received chemotherapy or radiochemotherapy. Conclusion： neoadjuvant treatment using for patients with IB2, IIA2 cervical cancer is effective in reducing risk factors of pathological, but it could not improve the long-term survival. The indications of adjuvant therapy after surgery should be reconsidered. Those tumors of diameter 5.5 cm or less response poor to neoadjuvant treatment, and no improvement of survival was found, so direct surgical treatment is suggested for these patients. Radiotherapy is a better choice of preoperative treatment.展开更多
Objective： The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy （IMRT） with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer...Objective： The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy （IMRT） with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods： For a cohort of 10 patients, bone marrow-sparing IMRT and routine IMRT planning were designed. The prescribed dose was 45 Gy/1.8 Gy/25f, 95% of the planning target volume received this dose. Doses were computed with a commercially available treatment planning system （TPS） using convolution/superimposition （CS） algorithm. Plans were compared according to dose-volume histogram （DVH） analysis in terms of planning target volume （PTV） homogeneity and conformity indices （HI and CI） as well as organs at risk （OARs） dose and volume parameters. Results： Bone marrow-sparing IMRT had an vantages over routine IMRT in terms of CI, but inferior to the latter for HI. Compared with routine IMRT, V5, Vl0, V20, V30, V40 of pelvic bone marrow of bone marrow-sparing IMRT reduced by 1.81%, 8.61%, 31.81%, 29.50%, 28.29%, respectively. No statistically significant differences were observed between bone marrow-sparing IMRT and routine IMRT in terms of small bowel, bladder and rectum. Conclusion： For patients with cervical cancer after hysterectomy, bone marrowsparing IMRT reduced the pelvic bone marrow volume irradiated at all dose levels and might be conducive to preventing the occurrence of acute bone marrow toxicity.展开更多
Objective： To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer. Methods： 162 cervical cancer p...Objective： To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer. Methods： 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy. The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy. External irradiation used ^60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of ＂B＂ point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used ^192lr, the dose of ＂A＂ point was 5-15 Gy. Results： The 5-year survival rate of preoperative combined radiotherapy group was 78.0% （71/91）, preoperative intracavitary radiotherapy group 64.9% （24/37）, and postoperative radiotherapy group 35.3% （12/34）. Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference （P 〈 0.05）. The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% （32/91）, 32.4% （12/37）, 38.2% （13/34）, respectively, and the differences were not statistically significant （P 〉 0.05）. Conclusion： The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.展开更多
文摘Objective： To observe the clinical value of three dimensional conformal radiation therapy （3D-CRT） followed by radical surgery and discuss the best radiation technique for cervical cancer patients after radical hysterectomy. Methods： From February 2003 to June 2006, 115 stage Ⅰ-Ⅲa uterus cervix cancer patients received postoperation radiotherapy in our department after radical surgery. They were randomly divided into two groups. There were 81 patients in 3D-CRT group and 74 patients in traditional radiation group. According to FIGO, there were 45 in stage Ⅰ, 77 in stage Ⅰa, 31 in stage Ⅱb, 2 in stage Ⅲa. Pathological examination confirmed that 148 cases had squamous carcinoma and 7 cases had adenocarcinoma. The target volume included supravaginal portion, the cervical stump, paracervical tissue, common iliac lymph nodes, intemal and extemal lilac lymph nodes, obturator and sacral lymph nodes. For 3D-CRT group we designed four-field or two-fields rotating irradiation in the left-right and the anterior-posterior direction. For traditional radiation group we designed two-field, anterior-posterior, at opposed lateral directions. The radiation dose ranged from 48-50 Gy. Stage lib patients with a cervical stump recurrence received postoperative boost radiation by 8-10 Gy. Results： There were no significant difference in 0.5-year, 1-year, 1.5-year, 2-year local control rate between 3D-CRT group and traditional radiation group （P 〉 0.05）. The occurrence of early and late complications was significant lower in 3D-CRT group than that in traditional radiation group （P 〈 0.05）. There was significant difference in gastrointestinal reaction and urinary system reaction between the two groups （P 〈 0.05）. In postoperation radiotherapy 3D-CRT was superior compared with traditional two-field radiation at opposed lateral direction. Conclusion： 3D-CRT is superior compared with traditional radiation. Four-field rotating irradiation in 3D-CRT has advantages of dose focusing, even dose distribution and cause less side effects and complications. The side-field and cervical stump-targeted boost irradiation are apparent advantages of 3D-CRT.
文摘Objective： The aim of this study was to explore the difference of long-term prognosis of different treatment regimens in patients with stage IB2, IIA2 cervical Cancer. Methods： From August 1995 to September 2005, radical hysterectomy was chosen as primary treatment regimen for 122 patients （group A）, 85 patients underwent radical hysterectomy after ef- fective neoadjuvant therapy （group B）, and 98 patients received surgery after ineffective preoperative therapy （group C）. All patients received postoperative therapy. Results： Atotal of 305 patients were analyzed. The maximum diameter of tumor was largest in group B, while the pathological risk factors （cervical infiltration, positive surgical margins） were in the lowest propor- tion. The 5-year mortality rate and relapse rate of group B were the highest, and the overall survival （OS） and progression-free survival （PFS） were the shortest （P 〈 0.05）. No significant difference of long-term survival was found in group C and group A. No difference was found in the surgical of three groups. Large tumor more than 5.5 cm had higher effective ratio of treatment than those 5.5 cm or less. Patients received effective preoperative radiotherapy had better long-term prognosis than those received chemotherapy or radiochemotherapy. Conclusion： neoadjuvant treatment using for patients with IB2, IIA2 cervical cancer is effective in reducing risk factors of pathological, but it could not improve the long-term survival. The indications of adjuvant therapy after surgery should be reconsidered. Those tumors of diameter 5.5 cm or less response poor to neoadjuvant treatment, and no improvement of survival was found, so direct surgical treatment is suggested for these patients. Radiotherapy is a better choice of preoperative treatment.
文摘Objective： The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy （IMRT） with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods： For a cohort of 10 patients, bone marrow-sparing IMRT and routine IMRT planning were designed. The prescribed dose was 45 Gy/1.8 Gy/25f, 95% of the planning target volume received this dose. Doses were computed with a commercially available treatment planning system （TPS） using convolution/superimposition （CS） algorithm. Plans were compared according to dose-volume histogram （DVH） analysis in terms of planning target volume （PTV） homogeneity and conformity indices （HI and CI） as well as organs at risk （OARs） dose and volume parameters. Results： Bone marrow-sparing IMRT had an vantages over routine IMRT in terms of CI, but inferior to the latter for HI. Compared with routine IMRT, V5, Vl0, V20, V30, V40 of pelvic bone marrow of bone marrow-sparing IMRT reduced by 1.81%, 8.61%, 31.81%, 29.50%, 28.29%, respectively. No statistically significant differences were observed between bone marrow-sparing IMRT and routine IMRT in terms of small bowel, bladder and rectum. Conclusion： For patients with cervical cancer after hysterectomy, bone marrowsparing IMRT reduced the pelvic bone marrow volume irradiated at all dose levels and might be conducive to preventing the occurrence of acute bone marrow toxicity.
文摘Objective： To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer. Methods： 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy. The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy. External irradiation used ^60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of ＂B＂ point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used ^192lr, the dose of ＂A＂ point was 5-15 Gy. Results： The 5-year survival rate of preoperative combined radiotherapy group was 78.0% （71/91）, preoperative intracavitary radiotherapy group 64.9% （24/37）, and postoperative radiotherapy group 35.3% （12/34）. Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference （P 〈 0.05）. The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% （32/91）, 32.4% （12/37）, 38.2% （13/34）, respectively, and the differences were not statistically significant （P 〉 0.05）. Conclusion： The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.
