• X X Du, H Yang, H J Zhang, L A Li, W S Fan, and Y G Meng.
• Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China.
• Zhonghua Fu Chan Ke Za Zhi. 2017 Oct 25; 52 (10): 679-686.

AbstractObjective: To compare the dose, clinical efficacy and acute adverse reactions of intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) combined with three-dimensional brachytherapy (3D-BT) in the treatment of concurrent radiotherapy and chemotherapy for advanced stage cervical cancer patients. Methods: Data collection was performed from January 2011 to November 2015 in Chinese PLA General Hospital and Inner Mongolia Cancer Hospital. All 89 patients with advanced stage (Ⅱ b-Ⅲ b) cervical cancer were treated by pelvic radiotherapy and concurrent chemotherapy, 46 cases of them received IMRT and 3D-BT (IMRT group) , 43 cases received 3D-CRT and 3D-BT (3D-CRT group) , along with cisplatin chemotherapy. The dose accumulation of external beam radiotherapy and 3D-BT was calculated by deformable image registration to analyze clinical efficacy, acute adverse reactions and prognosis of the two groups. Results: (1) Dose of radiotherapy: planning target volume (PTV) coverage of IMRT group and 3D-CRT group were respectively (95.4±4.7)% and (95.1±5.1)%, without significant differences (t=0.289, P=0.773). Compared with the patients treated with 3D-CRT, the volumn receiving at least 30 Gy (V(30)), V(50) of rectum, colon, bladder and small intestine and V(20) of bone marrow in the IMRT group were significantly decreased (P<0.05). Regarding the combined dose, the maximum dose (D(max)) and the minimum dose received by the most exposed 2 cm(3) volume of the analyzed organ (D(2CC)) of rectum, colon, bladder and small intestine of IMRT group were significantly lower than those of 3D-CRT group (P<0.05). (2) Short-term efficacy: the effective rate of IMRT and 3D-CRT group were respectively 93% (43/46) and 91% (39/43), with no significant differences (χ(2)=0.237, P=0.626). (3) Acute adverse reactions: compared with 3D-CRT, IMRT could significantly reduce grade 1-2 acute toxicity in gastrointestinal [63%(29/46) vs 84%(36/43)], genitourinary [17%(8/46) vs 37%(16/43)] and hematologic [57%(26/46) vs 79%(34/43)] system (all P<0.05). There were no significant differences of grade 3 acute adverse reactions of gastrointestinal, genitourinary and hematologic system between two groups (all P>0.05). No grade 4 acute adverse reactions were observed. (4) Prognosis: the overall survival rate at 1, 2-year of IMRT and 3D-CRT group were respectively 95.6%, 89.1% and 93.1%, 86.1%. The progression-free survival rateat 1, 2-year of IMRT and 3D-CRT group were 91.1%, 89.1% and 88.4%, 86.1%, respectively. There were no significant differences in overall survival rate and progression-free survival rate between two groups (P>0.05). Conclusions: Compared with 3D-CRT, IMRT combined with 3D-BT has dosimetry advantages based on dose accumulation algorithms by deformable image registration. IMRT could ensure clinical efficacy and significantly reduce the incidence rate of acute toxicities.

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