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Advances in Radiotherapy
& Nuclear Medicine CCRT plus nimotuzumab for cervical cancer

regarded as an independent adverse prognostic factor
of cervical cancer and an indicator to predict the poor
efficacy of RT and chemotherapy for cervical cancer [18,19] .
A number of studies have confirmed that nimotuzumab
monotherapy or combined with RT and chemotherapy is
well tolerated in the treatment of various advanced solid
tumors without increasing adverse reactions, and could
improve efficacy,whether EGFR overexpression is positive
or negative [20-24] .
Compared to three-dimensional conformal RT, IMRT
has been associated with significantly fewer toxicities.
A retrospective cohort study found that the incidence
of Grade 2 acute gastrointestinal reaction was 45%, and
the incidence of Grade 3 or higher acute gastrointestinal
reactions was only 2% . One prospective study found
[25]
Figure 3. Overall survival of patients.
that the incidence of Grade 3 acute intestinal reactions was
5.6% . Gandhi et al. reported that patients experienced
[26]
metastasis was not known. Five patients died during the Grade 2 and 3 acute gastrointestinal toxicities at rates of
follow-up period. 31.8% and 4.5%, respectively, while acute genitourinary
[27]
4. Discussion toxicities were 23.8% and 0%, respectively . Erpolat
et al. reported that the incidence rates of acute anemia,
Over the past 20 years, CRT has always been the standard leukopenia, neutropenia, and thrombocytopenia of
treatment for Stages IB2–IVA of cervical cancer. Despite Grade 2 or higher were 27%, 53%, 24.5%, and 4.5%,
the reported significant improvement in DFS and OS respectively . Pelvic extended-field RT with IMRT
[28]
associated with a combination of CRT, some patients did not significantly increase the incidence of adverse
still showed disease progression. The 5-year survival rate reactions. In one study, 20 patients received 45 Gy RT of
of patients with recurrence was only 3.2–13% . The pelvic extended-field, and 33 patients with positive lymph
[11]
improvement in EBRT technology and the emergence of nodes received 50–65 Gy locally . About 49% of patients
[29]
new drugs has been the focus of attention. Advances in received concurrent chemotherapy. The gastrointestinal
EBRT techniques have improved the accuracy of treatment. reactions were evaluated in 46 patients: The incidence
Image-guided IMRT and image-guided brachytherapy are of acute toxicities of Grade 3 or higher characterized by
increasingly being used in clinical practice. diarrhea, nausea, and vomiting was 6.5%. The incidence
The RetroEMBRACE multicenter cohort study of late toxicities of Grade 3 or higher, characterized
showed that for IIB and IIIB stage patients who received by incomplete small intestinal obstruction and upper
image-guided EBRT, the 3-year local control (LC) rates and lower digestive tract hemorrhage, was 6.5%. In a
were 93% and 79%, respectively, and the 5-year OS rate retrospective study of IB2–IVA cervical cancer patients,
was 65%. Although the results were better than those of 96 patients were treated with prophylactic sub-renal vein
previous studies, whether the study truly shows that the RT (PSRVRT), and among them, 84 received PSRVRT
[30]
curative effect is better than that of traditional low-dose combined with concurrent chemotherapy . No Grade 4
RT combined with chemotherapy remains to be further toxicities were reported in the patients. The incidence rates
investigated . of Grade 2 acute gastrointestinal and urogenital reactions
[12]
were 30.2% and 9.4%, respectively. The incidence rates
The application of cytotoxic drug therapy for cervical
cancer has entered a plateau stage. The efficacy of other of Grade 3 leukopenia, Grade 3 thrombocytopenia, and
Grade 3 anemia were 39.6%, 6.2%, and 16.7%, respectively.
chemotherapy drugs combined with concurrent RT was The incidence of Grade 3 anemia was higher than that in
not better than that of the single regimen of cisplatin, and
multi-drug combinations might cause more toxic and the pelvic RT group. The incidence of late gastrointestinal
side effects . Molecular targeted drugs provide a new reactions was 4.2%. No Grade 3 genitourinary tract
[13]
approach to tumor treatment. However, currently, only reaction was observed.
bevacizumab is recommended for metastatic cervical In this study, we innovatively used a treatment regimen
cancer treatment . EGFR overexpression has been comprising image-guided IMRT and two-dimensional
[14]
reported in 70–90% of cervical cancer cases [15-17] . It was HDR brachytherapy combined with concurrent cisplatin

Volume 1 Issue 1 (2023) 5 https://doi.org/10.36922/arnm.0408