Objective To explore the efficacy, safety, and prognostic factors of intensity modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy (3D-CRT) combined with intracavitary posterior radiotherapy for medium-term and advanced cervical cancer. Methods Retrospectively analyze the clinical data of 104 patients with medium-term and advanced cervical cancer who were treated in the radiotherapy department of our hospital from September 2015 to March 2017. According to the different radiotherapy techniques, they were divided into the IMRT combined with intracavitary posterior radiotherapy group (n = 52) and the 3D-CRT combined with intracavitary posterior radiotherapy group (n = 52). Observe and compare the short-term efficacy, occurrence of adverse reactions and overall survival rate of the two groups. The clinicopathological characteristics of the survival group and the death group were compared, and univariate analysis and multiple logistic regression models were used to analyze the relationship between the clinicopathological characteristics and the patient’s prognosis. Results The total effective rate of IMRT combined with intracavitary posterior radiotherapy group was 96.15%, which was higher than that of 3D-CRT combined with intracavitary posterior radiotherapy group (88.46%), but the difference was not statistically significant (p > 0.05). The incidence of digestive system injury, thrombocytopenia, and radiation proctitis in the IMRT combined intracavitary posterior radiotherapy group was lower than that of the 3D-CRT combined intracavitary posterior radiotherapy group, and the differences were statistically significant (p < 0.05). The prognosis and survival of the two groups of patients were similar, and the difference was not statistically significant (p > 0.05). Pathological classification, clinical stage, and lymph node metastasis are independent influencing factors of 3-year prognosis in patients with medium-term and advanced cervical cancer (p < 0.05). Conclusion IMRT combined with intracavitary posterior radiotherapy is equivalent to 3D-CRT combined with intracavitary posterior radiotherapy, but it can reduce the incidence of adverse reactions in patients with medium-term and advanced cervical cancer, and has higher safety. Pathological typing, clinical staging, Lymph node metastasis were independent factor affecting the prognosis of patients. In clinical treatment, IMRT combined with intracavitary posterior radiotherapy is more recommended as a treatment plan for patients with medium-term and advanced cervical cancer.

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Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy Combined with Intracavitary Posterior Radiotherapy for the Treatment of Medium-Term and Advanced Cervical Cancer: Efficacy, Safety and Prognostic Factors

Abstract Introduction: Cervical cancer with lymph node metastasis (LNM) has a poor prognosis, but the prognosis of patients varies among individuals to a great extent and depends on diverse factors. This study attempted to develop and externally validate a prognostic model based on risk factors to predict the probability of survival of patients with cervical cancer with LNM. Methods A population-based cohort with 4238 participants diagnosed with cervical cancer with LNM between 2000 and 2016 from the Surveillance, Epidemiology, and End Results database was used to select prognostic variables for inclusion in our model. Model performance was validated internally and externally using the concordance index (C-index), areas under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration curves, and decision curve analyses (DCA). Kaplan–Meier survival curve was used to validate the risk stratification capability of the established model. Results Prognostic factors included marital status, age, pathological subtype, clinical stage, tumor size, surgical treatment, radiotherapy, and chemotherapy (all P &lt; .05). The C-index (0.736, 0.727, and 0.701 for the training, internal validation, and external validation cohorts) and AUC values of the 3- and 5-year ROC curves (0.781 and 0.777 for the training cohort, 0.78 and 0.759 for the internal validation cohort, and 0.728 and 0.74 for the external validation cohort) demonstrated the satisfactory discrimination and excellent accuracy of the nomogram. Calibration plots showed the favorable agreement between the predicted and observed probabilities, and DCA indicated good clinical benefits. The nomogram-based risk stratification successfully discriminated patients into low-, intermediate-, and high-risk populations. Conclusion An easy-to-use online website of the dynamic nomogram was provided which could help predict overall survival of cervical cancer with LNM. 

A novel prognostic model for cervical cancer patients with lymph node metastases: based on SEER database and an independent cohort

Cervical cancer is the fourth most common cancer in women, and it is divided into 2 main histological types: squamous cell carcinoma and adenocarcinoma. Extension of disease as well as the presence of metastases define the prognosis of patients. Accurate tumor staging at diagnosis is essential for adequate planning for treatment. There are several classifications of cervical cancer, and the most used are FIGO and TNM, which help classify the patient and guide the treatment. Imaging has a pivotal role in classifying patients, and MRI plays a decision-maker role both for diagnosis and for treatment planning. In this paper we highlight the role of MRI, alongside guidelines classification, in patients with different stages of cervical tumors. 

Role of MRI in the Assessment of Cervical Cancer

The prognostic factors in 384 patients with FIGO 2014 stage IB cervical cancer: What is the role of tumor size on prognosis?

In this study, we aimed to investigate the role of systemic immune‐inflammation index (SII) and other inflammatory parameters in the diagnosis of placenta accreta spectrum (PAS) and its histological subtypes.

Ediz Karatas Sahin

Papers

The prognostic factors in 384 patients with FIGO 2014 stage IB cervical cancer: What is the role of tumor size on prognosis?

Systemic immune‐inflammation index to predict placenta accreta spectrum and its histological subtypes