Intensity Modulated Radiation Therapy or 3D Conformal Radiation Therapy Combined with Brachytherapy and Concurrent Chemoradiotherapy in Advanced Cervical Cancer: A Retrospective Multicenter Study.

Abstract

A restrospective study in multicenter was carried out to summary the last 15 years’ experience of Intensity Modulated Radiation Therapy (IMRT) or 3D Conformal Radiotherapy(3D-CRT) combined with brachytherapy and concurrent chemoradiothearpy in advanced cervical cancer in China. A total of 1,962 patients with FIGO stage IB2-IVA cervical cancer from 17 Chinese tertiary hospitals were enrolled in from Dec 2014 to Jan 2000. Inclusion Criteria also included ： 1） with external beam by IMRT or 3D-CRT, 2） with 2D or 3D bracytherapy by tandem and ovoid placed simultaneously, 3) KPS≥60, 4） 18∼70 years old. Overall survival rates(OS), progression-free survival(PFS), local control rates(LC) were analyzed with Kaplan-Meier methods. The effects of treatment techniques and patterns on the prognosis were analyzed with Cox regression and Kaplan-Meier methods. Of the 1,962 patients, 52.04%% patients had FIGO IIB disease and 35.42% patients had FIGO IIIB disease. 95.39% patients had squamous cell carcinoma. VMAT/TOMO, Fix field IMRT(FF-IMRT),3D-CRT used for external beam radiotherapy were 27.62%,34.40%,37.97%. 2D intracavitary， 3D intracavitary combined with or without implant used for brachytherapy were 57.65%,42.35%, and 89.41% patients prescribed with target volume in 3D brachytherapy. Cisplatin weekly chemotherapy was used in 74.57% patients, chemotherapy before and after radiotherapy were 20.69%,18.86%. The median follow-up time was 43.64 months, and the longest follow-up time was 11.2 years. The 3-year and 5-year OS were 86.70%, 80.80%, respectively. The median PFS time was 38.57 months, 3-year and 5-year PFS rates were 80.8%, 77.4%. The 3-year and 5-year LC rate were 93.7%,92.6%, and the median survival time from recurrence was 9.9 months. 3.06% patients had chronic Grade 3-4 gastrointestinal toxicities and 2.90% patients had chronic Grade 3-4 genitourinary toxicities. Stage and pathology were independent prognostic factors, prognostic of adenocarcinoma with stage more than IIA2 was poorer compared to squamous cell carcinoma particularly. In addition, no statistical difference of OS, DFS, LC were found between IMRT and 3D-CRT, and between 2D and 3D brachytherapy. Chemotherapy before radiotherapy was not observed survival advantage significantly (p=0.580). Application of IMRT and 3D-CRT combined combined with brachytherapy and concurrent chemoradiothearpy in advanced cervical cancer had achieved good effect in China. But application of new modes such as IMRT, 3D brachtherapy, chemotherapy before radiotherapy were not observed survival advantage compared to traditional mode.