Abstract:
Objective: To explore the effect of late course three dimensional conformal radiotherapy (3DCRT) combined with chemotherapy on locally advanced cervical cancer in patients unsuitable for conven-tional intracavitary brachytherapy. Methods:Sixty-seven cervical cancer patients were randomly divided into two groups. The 31cases in the 3DCRT group received 3DCRT plus chemotherapy. The 36cases in the con-ventional group received conventional radiotherapy plus chemotherapy. In the 3DCRT group, a median total dose of 40Gy was administered for whole pelvic irradiation, using6 MV energy. The3DCRT plans were opti -mized to deliver 19Gy to the pelvic lymph nodes and local lesions, and then3DCRT boosted the total dose to the local cervical cancer lesion up to 70-75Gy. In the conventional group, after whole pelvic irradiation, the four-field technique was used to irradiate the parametrial tissue and regional nodes (a median dose of 20Gy),
and then intracavitary brachytherapy (30Gy/5 fraction) was performed. The total dose to the local cervical cancer lesions was 70Gy. All 67patients in the two groups received two cycles of chemotherapy concurrently with radiotherapy in the first week and the last week. Chemotherapy consisted of5-Fluorouracil (500 mg/m2/d) infusion on days 1-5 and cisplatin (30mg/d) infusion on days1-3. Results: The 1- and 2-year survival rates were93.5% and 90.3% in the 3DCRT group, and 83.3% and 72.2% in the conventional group, with no signifi-cant difference (P=0.198 and P=0.062 ). The 3-year survival rate was 87.1% in the 3DCRT group and 61.1% in the conventional group, with a significant difference ( P=0.017 ). The side effects in the two groups were simi -lar and well tolerated. The incidence of I-II grade rectal reaction and pelvic fibrosis was lower in the 3DCRT group than in the conventional group (P=0.000 and P=0.015 ). Conclusion:Late course 3DCRT combined with chemotherapy is an effective and feasible approach for treating cervical cancer and can significantly improve short term survival. It also has a lower incidence of late complications. A larger sample size and longer follow-up are warranted to further investigate the value of 3DCRT in the treatment of cervical cancer.