To assess the safety and efficacy of simultaneous integrated boost (SIB) or late course accelerated boost (LCAB) with external beam radiotherapy (EBRT) to the vaginal cuff for high risk cervical cancer patients after radical hysterectomy. Between October 2009 and January 2012, patients with high risk cervical cancer who had undergone radical surgery followed by EBRT to the vaginal cuff were enrolled. Patients were treated with either intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with SIB (arm A) or IMRT/VMAT to the pelvis followed by LCAB (arm B) to vaginal cuff. In arm A, the pelvic and boost doses were 50.4 Gy and 60.2 Gy in 28 fractions, respectively. In arm B, pelvic irradiation to 50 Gy in 25 fractions followed by a boost of 9 Gy in 3 fractions were delivered. Chemotherapy was given concurrently. Overall, 80 patients were analyzed in this study (42 in arm A, 38 in arm B). In arm A and B, median follow-up was 37 and 32 months, respectively. The 3-year disease-free survival and overall survival in arms A vs B were 88.7% vs. 93.4% (p = 0.89), and 91.8% vs.100% (p = 0.21), respectively. The 3-year local-regional control and distant failure were 97.6% vs. 100% (p = 0.34), and 4.8% vs. 5.3% (p = 0.92), respectively. Grade 3–4 acute leukopenia and dermatitis were seen in 11 (26.2%) and 8 (19.0%) patients in Arm A, vs. 7 (17.8%) and 6 (15.8%) patients in Arm B, respectively (p > 0.05). Only Grade 1–2 chronic gastrointestinal (GI) and genitourinary (GU) toxicities were observed. Our results indicate that both SIB and LCAB to vaginal cuff for high risk cervical cancer patients after radical hysterectomy are associated with excellent survival, local control and low toxicity.

Background: The study was aimed to explore the expression of hypoxia-inducible factor-1α (HIF-1α) and p53 protein, as well as their correlation with clinicopathological features and survival in non-small cell lung carcinoma (NSCLC) patients. Methods: The overexpression of HIF-1α and p53 alteration was detected by immunohistochemistry in 50 paraffin-embedded tumor samples from NSCLC patients who received pulmonary surgery and seven benign lung lesion tissue samples. In addition, the correlation between HIF-1α or p53 protein overexpression and clinicopathological features as well as their relationship with epidermal growth factor receptor (EGFR) overexpression was examined by the chi-squared test, while Kaplan-Meier survival analysis was applied to explore their prognostic value. Results: The results showed that HIF-1α and p53 protein overexpression in NSCLC was remarkably higher than that in benign lung lesion tissue, with a positive rate of 40% and 42%, respectively. HIF-1α overexpression had an unfavorable impact on radiotherapy (P=0.047) and patient survival (P=0.002). However, multivariate analysis showed that HIF-1α was not an independent prognostic factor. There was a significant correlation between the overexpression of HIF-1α and tumor size (P=0.005), nodal metastasis (P=0.014) and pathological stage (P=0.023), while p53 overexpression was only significantly associated with the differentiation level. No correlation was found between p53 overexpression and survival. Conclusions: Both HIF-1α and p53 protein levels played a crucial role in participating in oncogenesis, and HIF-1α might be a risk factor for survival and a biological marker relevant to radioresistance. However, p53 had no prognostic value for survival.