Individualized Precise Radiotherapy With the Guidance of Radiosensitivity of Locally Advanced Cervical Cancer
Individualized Precise Radiotherapy With the Guidance of Radiosensitivity of Locally Advanced Cervical Cancer
Cisplatin-based chemoradiation (CCRT) has been considered as the standard care for patients
 with locally advanced cervical cancer (LACC). Nevertheless, increasingly more radio-resistant
 tumors still recur. IMRT including Rapid-Arc have obvious advantage in the dose distribution
 and organ protection, and positron emission tomography (PET) with F-18 fluorodeoxyglucose
 (FDG) and Comet analysis have good sensitivity for detecting sites and radiosensitivity of
 disease. These may be helpful to individualized CCRT of LACC.

 Three hundred LACC patients are enrolled in the study, who were with FIGO stages IB2-IVA and
 had no para-aortic lymphadenopathy (>10 mm) assessed by PET-CT or MRI. All the patients
 received definitive radiotherapy consisting of external beam whole pelvic RT and HDR-ICBT.
 The cumulative linear quadratic equivalent dose (EQD2) was 70-75Gy prescribed at point A.
 Cisplatin 30 mg/m2 weekly was administered concurrently for 5 courses. 2-4 cycles TP (Taxol
 135 mg/m2, D1 and DDP 25 mg/m2, D1-3) regimen sequential chemotherapy were performed if
 complete response (CR) not achieved according to magnetic resonance imaging (MRI) or PET-CT
 after CCRT. Hypothesis of the study is that CCRT and sequential chemotherapy is safe. Based
 on FDG-PET/CT and Comet assay, higher doses can be safely delivered individually to accurate
 tumor volume, while the doses to bladder and rectum are relative low. Comet and
 FDG-PET/CT-guided IMRT including RapidArc may improve survival in terms of time to
 progression (TTP), progression-free survival (PFS) and overall survival (OS) and less
 treatment-related toxicity. The data will be observed and analyzed.
Cisplatin-based chemoradiation (CCRT) has been considered as the standard care for patients
 with locally advanced cervical cancer (LACC). Nevertheless, increasingly more radio-resistant
 tumors still recur. IMRT including Rapid-Arc have obvious advantage in the dose distribution
 and organ protection, and positron emission tomography (PET) with F-18 fluorodeoxyglucose
 (FDG) and Comet analysis have good sensitivity for detecting sites and radiosensitivity of
 disease. These may be helpful to individualized CCRT of LACC. IMRT including RapidArc could
 be considered as a treatment selection for LACC patients, and it aims to improve the degree
 of target coverage, to protect organ at risk (OARs) and healthy tissue sparing compared to
 other RT solutions and to reduce significantly the treatment time as to RapidArc. Several
 studies have indicated that FDG-PET/CT increases the accordance between biopsies and
 delineated tumor volume and has the potential to positively impact the course of treatment.
 The Comet assay is attractive as a potential clinical test of tumour radiosensitivity. During
 radiotherapy, accurately defining disease areas is critical to avoid unnecessary irradiation
 of normal tissue. Based on FDG-PET/CT and Comet assay, higher doses can be safely delivered
 individually to accurate tumor volume, while the doses to bladder and rectum are relative
 low.

 Three hundred LACC patients are enrolled in the study, who were with FIGO stages IB2-IVA and
 had no para-aortic lymphadenopathy (>10 mm) assessed by PET-CT or MRI. All the patients
 received definitive radiotherapy consisting of external beam whole pelvic RT and HDR-ICBT.
 The cumulative linear quadratic equivalent dose (EQD2) was 70-75Gy prescribed at point A.
 Cisplatin 30 mg/m2 weekly was administered concurrently for 5 courses. 2-4 cycles TP (Taxol
 135 mg/m2, D1 and DDP 25 mg/m2, D1-3) regimen sequential chemotherapy were performed if
 complete response (CR) not achieved according to magnetic resonance imaging (MRI) or PET-CT
 after CCRT. Hypothesis of the study is that CCRT and sequential chemotherapy is safe. Comet
 and FDG-PET/CT-guided IMRT including RapidArc may improve survival in terms of time to
 progression (TTP), progression-free survival (PFS) and overall survival (OS) and less
 treatment-related toxicity. The data will be observed and analyzed.
Inclusion Criteria:

 1. Age : 18-70 years old;

 2. Histology or cytology confirmed cervical squamous cell carcinomas;

 3. 2009 FIGO stage includesⅠB2, ⅡA2, ⅡB-ⅣA;

 4. Performance status(PS): 0-1;

 5. Peripheral blood meet the following conditions: neutrophil count > 2.0 * 109/L, white
 blood cell count > 4.0 * 109/L, the platelet count > 100.0 * 109/L;

 6. Liver and kidney function meet the following conditions: bilirubin < 1.5 mg/dl, AST
 and ALT < 2 times the upper limit of normal serum creatinine < 1.5 mg/dl, creatinine
 clearance > 50 ml/min;

 7. Signed informed consent before treatment.

 Exclusion Criteria:

 1. There is no definite pathological diagnosis;

 2. Clinical or imaging examination revealed distant metastases;

 3. Pelvic had received radiotherapy;

 4. Patients can't attend the study because of the associated with other diseases;

 5. Patients can't sign the informed consent because of mental disorders, mental
 disorders;

 6. Uncontrolled active infection;

 7. No follow-up.