Assessment of risk factors for delayed radiation toxicity by combined surgical and radiation treatment in patients with cervical cancer
Summary. Objective — to carry out comparative analysis of clinical and laboratory parameters of patients with cervical cancer with late radiation complications (LRC) and without delayed complications of radiation therapy after combined radiotherapy and surgery for. Маterials and methods. A retrospective analysis of 254 case histories of patients with malignant cervical tumors was performed. 122 case histories were selected, divided into two groups: main (59 patients) — patients with LRC after combination treatment, which included surgery and radiation therapy and control (63 patients) — patients without LRC after combination treatment. Results. It is established that the relative risk of developing LRC in patients after combined surgical and radiotherapy in the presence of concomitant pathology ≥3 systems is 3.1±0.28. The relative risk of development of LRC was highest in the background of diseases of the genitourinary system (2.2±0.19), blood system and hematopoietic organs (2.1±0.14), endocrine (2.1±0.14) and musculoskeletal system (2.0±0.16). The relative risk of delayed radiation toxicity in patients on the background of radio modification was 1.5±0.21. During combination therapy in patients with LRC, a statistically significant 5.4 (p=0.02) higher total protein level, 6.3% (p=0.3) bilirubin, 6.0% (p=0.09) aspartate aminotransferase and 18.6% (p=0.04) fibrinogen relative to control group. Conclusion. Reduction of the radiotherapeutic interval caused by the increase of radiosensitivity of normal tissues after surgical treatment is a prerequisite for the development of radiation complications.
- Vasilev L.A., Kostyuk I.P., Ivanov S.A., Kaprin A.D. (2019) Sovremennaya klassifikatsiya postluchevyih svischey organov malogo taza. Onkourologiya, 2(15): 118–123.
- Velsher L.Z., Matyakin E.G., Duditskaya T.K., Polyakov B.I. (2009) Onkologiya: uchebnik. GEOTAR-Media, Moskva, 512 s.
- Loran O.B., Sinyakova L.A., Guspanov R.I. (2019) Luchevyie povrezhdeniya organov mochevoy sistemyi pri onkoginekologicheskih zabolevaniyah. Med. inform. agentstvo, 120 s.
- Ovodenko D.L., Habas G.N., Makarova A.S. i dr. (2019) Sovremennyie metodyi lecheniya bolnyih mestnorasprostranennyim rakom sheyki matki. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 7(1): 68–74.
- Fuccio L., Guido A., Andreyev H.J. (2012) Management of intestinal complications in patients with pelvic radiation disease. Clin. Gastroenterol. Hepatol., 10(12): 1326–1334.
- Henson C.C., Andreyev H.J., Symonds R.P. et al. (2011) Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin. Oncol., 23(8): 552–557.
- Jacobsona L.K., Johnsonb M.B., Dedhiac R.D. et al. (2017) Impaired wound healing after radiation therapy: A systematic review of pathogenesis and treatment. JPRAS Open, 13: 92–105.
- Landoni F., Colombo A., Milani R. et al. (2017) Randomized study between radical surgery and radiotherapy for the treatment of stage IB-IIA cervical cancer: 20-year update. J. Gynecol. Oncol., 28(3): e34.
- Marth C., Landoni F., Mahner S. et al.; ESMO Guidelines Committee (2017) Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol., 28 (Suppl. 4): iv72–iv83.
- Pfaendler K.S., Wenzel L., Mechanic M.B., Penner K.R. (2015) Cervical cancer survivorship: long-term quality of life and social support. Clin. Ther., 37(1): 39–48.
- Piver M.S., Rutledge F., Smith J.P. (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet. Gynecol., 44(2): 265–272.
- Small W.Jr., Bacon M.A., Bajaj A. et al. (2017) Cervical cancer: a global health crisis. Cancer, 123(13): 2404–2412.
- Zar J.H. (2014) Biostatistical analysis. Prentice-Hall, Englewood, 960 р.