CLINICO-MORPHOLOGICAL PROGNOSTIC FACTORS AS A BASIS OF POSTOPERATIVE IMAGE-GUIDED RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER PATIENTS UNDERGONE RADICAL SURGERY
342 patients with verified locally advanced cervical cancer were included after surgery, 246 pts. in research group (branch A - 152 pts. after primary surgery, branch B - 94 pts. after surgery with previous taxan-platinum based chemotherapy), 96 pts. - in retrospective control group. In whole, 20 different clinical and morphological parameters were picked out, analyzed with Cox multivariate regressive analyses and compared in two groups as significant factors for tumor progression. It was demonstrated that primary tumor volume over 30см 3 (HR 1,64, 95% CI 1,07-2,51, P=0,024); cervical stroma invasion over 1/3 (HR 1,60, 95% CI 1,11-2,31, P=0,011); uterine involvement with myometrium invasion over 5мм (HR 1,38, 95% CI 1,04-1,84, P=0,026); parametrium or vagina involvement (HR 1,86, 95% CI 1,23-2,82, P=0,003); 0-I Grade of therapeutic pathomorphosis after neoadjuvant radiotherapy (HR 1,54, 95% CI 1,03-2,31, P=0,036); positive resection margin (HR 1,81, 95% CI 1,35-2,41, P=0,002); tumor embolus in lymphatic and blood vessels (HR 1,79, 95% CI 1,19-2,68, P=0,005); lymph node metastases (HR 1,86, 95% CI 1,13-3,04, P=0,014); cytoreductive surgery (HR 2,01, 95% CI 1,28-3,16, P=0,002); heavy intraoperative bleeding with persistant anemia II-III (HR 1,49, 95% CI 1,15-1,95, P=0,003) significantly decrease the disease free survival (DFS) rates in control group, after conventional postoperative radiotherapy. The principles of postoperative radiotherapy dose and volume individual choice were formed according to individual predictive factors evaluation. Overall (OS) and DFS rates were evaluated in research group, after modified image-guided radiotherapy, and the significant survival improvement was shown in comparison with control group (60-month OS 74,0±2,9% vs 41,6±5,3%, DFS 71,9±4,6% vs 57,9±4,0% (Р<0,001), with 15% additional survival improvement in neoadjuvant chemotherapy patients. According to Cox multivariate analyses in research group, the negative influence of uterine or vagina 2/3 involvement, positive margin, lympho-vascular space invasion and obturator lymph node metastases was successfully overcome by individually planned modified postoperative radiotherapy while parametrium involvement, residual tumor of any size after surgery, ineffective neoadjuvant therapy still significantly decreased DFS rates.