CLINICAL RESULTS OF CERVIX CANCER USING VARIOUS TECHNOLOGIES IN RADIATION THERAPY

Abstract

Background: clinical results of patients with cervical cancer (CC) who treated with different methodological approaches of radiotherapy (RT) in the transforming from conventional to conformal RT and brachytherapy (BT).
 Purpose: to evaluate long-term results of treatment, locoregional and distant control.
 Methods: 137 patients with CC IIb - IIIb in 2013-2016 were analysed: 70 (51%) - conventional gamma therapy and brachytherapy (BT) with two-dimensional planning (2D) 60Сo alone or in combination with cisplatin 40 mg/m2 two groups of n=35. The total dose (TD) for point A 75.08 0.57 Gy, point B 57.9 0.43 Gy. In 67 (49%) with conform radiotherapy following BT with three-dimensional planning (3D) 192Ir alone or in combination with cisplatin 40 mg/m2 - two groups n = 35 and 32, respectively. TD CTV-HR D90 95.0 Gy 0.67 EQD2.
 Results: 3 and 5-year overall survival with 3D RT versus 2D RT was 84.6 4.5% and 63.1 6.0%; 84.6 4.5% versus 56.1 6.0%, respectively (p = 0.030). It was revealed that modern technologies are important in improving overall survival with image-guided RT: 88.2 6.6% of patients are alive for 3 years versus 59.0 8.4%, respectively (p=0.027). The use of chemoradiotherapy (CRT) showed an advantage of 3-year event-free survival in groups with 2D RT - 67.9 8.4% versus 55.2 8.6% (p = 0.042) in 3D RT - no statistically significant differences. Locoregional control was higher in the 3D RT groups at 3 years follow-up: 97.0 2.9% versus 82.9 5.3%, p = 0.050. CRT allows to reduce the number of local failures in the pelvis in the follow-up period up to 6 months, regardless of the RT technologies. The number of relapses and metastases in pelvis is lower in 3D RT - 3.0 2.1% versus 2D - 15.7 4.4% (p = 0.05). The frequency of metastases did not show statistically significant differences: 2D RT - 5.7 2.8% versus 3D RT - 9.0 3.5% (p 0.05).
 Conclusion: the study proves the improvement of local control in the treatment of cervical cancer in cases of conformal RT and 3D BT.