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Wang W, Liu X, Meng Q, Zhang F, Hu K. Comparisons of survivals and toxicities between young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy. Taiwan J Obstet Gynecol 2019; 58:364-369. [PMID: 31122526 DOI: 10.1016/j.tjog.2018.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the survivals and toxicities of young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS Patients with cervical cancer treated with radiotherapy or CCRT between January 2010 and December 2015 in our institute were reviewed. A dose of 50.4 Gy in 28 fractions was delivered to the pelvis with intensity modulated radiation therapy. In addition, a dose of 30-36 Gy in 5-7 fractions was prescribed to point A with brachytherapy. Weekly cisplatin was the first-line regimen of concurrent chemotherapy. Comparisons were made between patients in the young group (<60 years) and those in the elderly group (≥70 years) with multivariate analysis and propensity score matching. RESULTS There were 991 patients in the young group and 70 patients in the elderly group. The median follow-up period was 30.2 months. In multivariate analysis, age was an independent factor of overall survival (OS, hazard ratio, HR 1.99, p = 0.014), but it was not significant in predicting disease-free survival (DFS, HR 1.41, p = 0.179) and cancer-specific survival (CSS, HR 1.38, p = 0.332). After propensity score matching, 64 pairs of patients were selected. The 3-year OS, DFS, and CSS rates in the young and elderly groups were 86.5% and 73.9% (p = 0.280), 74.6% and 75.4% (p = 0.744), and 87.9% and 81.7% (p = 0.967), respectively. Significant differences between the young and elderly groups were observed in grade 3 and above chronic toxicities (2.9% and 8.6%, p = 0.027) and grade 3 and above chronic gastrointestinal toxicities (2.4% and 8.6%, p = 0.009). CONCLUSION After definitive radiotherapy or CCRT, the DFS and CSS of elderly patients with cervical cancer were similar to those in young patients. Elderly patients experienced more chronic toxicities than did young patients.
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Affiliation(s)
- Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Kobayashi D, Okonogi N, Wakatsuki M, Miyasaka Y, Kiyohara H, Ohno T, Kato S, Nakano T, Kamada T. Impact of CT-based brachytherapy in elderly patients with cervical cancer. Brachytherapy 2019; 18:771-779. [PMID: 31506225 DOI: 10.1016/j.brachy.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Three-dimensional image-guided brachytherapy (3D-IGBT) has become the standard therapy for patients with cervical cancer. However, in this population, the impact of 3D-IGBT in elderly individuals remains unknown. This study assessed the efficacy of 3D-IGBT for elderly patients with cervical cancer. METHODS AND MATERIALS We performed a retrospective chart review of 105 consecutive patients with cervical squamous cell carcinoma aged ≥70 years who received radiotherapy alone between January 2001 and September 2014. All patients were treated with external beam radiotherapy and high-dose-rate intracavitary brachytherapy. We assessed the treatment outcomes in all patients. We then compared outcomes between two groups: patients treated by changing the Point A dose at brachytherapy (Group A, n = 71) and those treated with 3D-IGBT at least twice (Group B, n = 34). RESULTS The median followup period was 59 (range, 6-203) months; the median age was 77 years. The 5-year local control and cause-specific survival rates were 89% and 78%, respectively. The 5-year cumulative rates of late toxicities of the rectum and bladder of Grade ≥3 were 2.0% and 4.2%, respectively. No statistically significant differences were observed in the local control and cause-specific survival rates, or in the incidence of rectal toxicities between groups. The 3-year cumulative rates of urinary toxicity of Grade ≥1 were 20.4% and 6.9% in Group A and Group B, respectively (p = 0.035). CONCLUSION In elderly patients with cervical cancer, 3D-IGBT could be performed safely and effectively and contributed to decreasing urinary toxicity incidence rates.
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Affiliation(s)
- Daijiro Kobayashi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Simotsuke-city, Tochigi, Japan
| | - Yuhei Miyasaka
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Kamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Amouzegar Hashemi F, Vesgari Kiasari Z, Kalaghchi B, Aghili M, Gholami S, Mansouri S, Moalej S, Maddah Safaei A. Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer. Asian Pac J Cancer Prev 2019; 20:2039-2043. [PMID: 31350963 PMCID: PMC6745200 DOI: 10.31557/apjcp.2019.20.7.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Brachytherapy in treatment of endometrial cancer patients is growing and therefore, evaluation of more feasible schedule has become of great importance. The purpose of current study was to evaluate the complications of accelerated short course high dose rate intravaginal brachytherapy (HDR IVB), a new brachytherapy approach which is a more feasible treatment option in developing countries. Method: From 2017 to 2018, 54 patients diagnosed with endometrial cancer and FIGO stages IA to IIB who underwent total abdominal hysterectomy with a bilateral salpingo-oophorectomy were enrolled in present study. They were treated with a total dose of 25 Gy in 5 fractions which was prescribed daily. A dose of 5 Gy was prescribed at a depth of 0.5 cm in the upper third and middle third of vagina. Adverse effects related to organs at risk consist of bladder, vagina and rectum were documented based on the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). Results: The accelerated short course HDR IVB was well tolerated and no grade 3 or higher toxicities was reported for patients during the follow up period. There were no chronic rectal toxicities and only one patient showed chronic urinary toxicities. However, the incidence rate of vaginal toxicities at the end of 4-month and 8-month follow up periods was higher than acute toxicities and significantly lower in elderly group compared to younger group. Conclusion: Overall, the accelerated HDR IVB was safe and was well tolerated in endometrial cancer patients and the incidence rate of undue complications were equal, if not less, in elderly patients compared to the younger ones.
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Affiliation(s)
- Farnaz Amouzegar Hashemi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zakieh Vesgari Kiasari
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bita Kalaghchi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahdi Aghili
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soraya Gholami
- Physics Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Mansouri
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. ,Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | | | - Afsaneh Maddah Safaei
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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You KY, Peng HH, Jiang YH, Bi ZF, Qiu XS. Selective use of concurrent chemotherapy in elderly cervical cancer patients treated with definitive radiotherapy: experience from two institutions. Cancer Manag Res 2019; 11:4815-4823. [PMID: 31213903 PMCID: PMC6549403 DOI: 10.2147/cmar.s190025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/15/2019] [Indexed: 12/09/2022] Open
Abstract
Background: Whether concurrent chemotherapy could bring about better oncological outcomes in elderly patients receiving definitive radiotherapy is still unknown. So, the purpose of this study was to find out whether it is essential for elderly patients to undergo concurrent chemotherapy. Methods: We performed a retrospective study of 246 elderly cervical cancer patients who were treated with definitive radiotherapy or chemo-radiation between August 2004 and August 2015. All patients were divided into two groups according to whether they were receiving concurrent chemotherapy or not. Overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival, and distant metastasis-free survival (DMFS). Results: The 5-year OS in the radiotherapy and chemo-radiation groups were 72.89% and 82.25%, respectively. A significant difference was found between the two groups (P=0.016). The 5-year DFS in the radiotherapy and chemo-radiaton groups were 58.19% and 75.52%, respectively, also with a significant difference between the two groups (P=0.028). Further subgroup analysis showed that in patients with negative lymph nodes, there were no differences in both OS and DFS between patients who did and did not receive concurrent chemotherapy. However, in patients with positive lymph nodes, patients who received concurrent chemotherapy acquired better OS and DFS than those who did not. Multivariable analysis showed that concurrent chemotherapy was an independent predictor of DFS and DMFS. Conclusion: Concurrent chemotherapy could improve oncological outcomes in elderly cervical cancer patients with positive lymph nodes, but not in those with negative lymph nodes.
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Affiliation(s)
- Kai-Yun You
- Department of Radiation Oncology, SunYat-Sen Memorial Hospital, SunYat-Sen University
| | - Hai-Hua Peng
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510075, People's Republic of China
| | - Yan-Hui Jiang
- Department of Radiation Oncology, SunYat-Sen Memorial Hospital, SunYat-Sen University
| | - Zhuo-Fei Bi
- Department of Radiation Oncology, SunYat-Sen Memorial Hospital, SunYat-Sen University
| | - Xing-Sheng Qiu
- Department of Radiation Oncology, SunYat-Sen Memorial Hospital, SunYat-Sen University
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Hata M. Radiation therapy for elderly patients with uterine cervical cancer: feasibility of curative treatment. Int J Gynecol Cancer 2019; 29:622-629. [PMID: 30630886 DOI: 10.1136/ijgc-2018-000077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
As the average lifespan lengthens worldwide, and the older adult population increases, the number of elderly patients with uterine cervical cancer is increasing. Because intensive and invasive treatments, including surgery, are frequently unacceptable in elderly patients, cancer treatments for these patients must be carefully considered. Elderly patients have undergone radiation therapy as less-invasive curative treatment, and it has been shown to be safe and effective for local control of cervical cancer in this population, even among patients aged ≥80 years treated with curative radiation doses. Although concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer, it is unclear whether the addition of chemotherapy to radiation therapy prolongs survival in elderly patients. Elderly patients treated with curative radiation therapy for cervical cancer might develop more therapy-related gastrointestinal and hematological toxicities and insufficiency fractures compared with younger patients. However, advanced techniques of radiation therapy (eg, intensity-modulated radiation therapy and volumetric modulated arc therapy with photons, charged-particle radiation therapy with protons and carbon ions in external-beam radiation therapy, and image-guided adaptive brachytherapy) can minimize radiation-induced toxicities and thus make curative treatment safer and more effective for elderly patients with uterine cervical cancer.
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Affiliation(s)
- Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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Park JH, Kim YS, Ahn SD, Choi EK, Shin SS, Kim YT, Kim YM, Kim JH, Yi SY, Nam JH. Concurrent Chemoradiotherapy or Radiotherapy Alone for Locally Advanced Cervical Cancer in Elderly Women. TUMORI JOURNAL 2018. [DOI: 10.1177/548.6516] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate the efficacy and toxicity of concurrent chemoradiotherapy or radiotherapy alone in elderly patients with locally advanced cervical carcinoma (stage IB2-IVA). Methods and study design We retrospectively reviewed the medical records of 105 women aged ≥65 years who received radiotherapy (group I, n = 61) or concurrent chemoradiotherapy (group II, n = 44). Patients received a median dose of 76.4 Gy to point A, including 30-35 Gy of high-dose intracavity brachytherapy. The concurrent chemoradiotherapy group received platinum-based chemotherapy. Results The median follow-up was 65 months for surviving patients. There was no significant difference in compliance to radiotherapy between the two groups. Most acute toxicities were hematologic; acute hematologic and gastrointestinal toxicity were significantly more common in group II. Five-year overall survival and cancer-specific survival rates were, respectively, 53.5% and 66.6% in group I and 61.8% and 68.8% in group II. Performance status, comorbidity index, tumor size, and stage were independent prognostic factors for overall survival, whereas stage was the only prognostic factor for cancer-specific survival. Conclusions The analysis showed no benefit of concurrent chemoradiotherapy with respect to overall survival and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. Free full text available at www.tumorionline.it
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Affiliation(s)
- Jin-hong Park
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young Seok Kim
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seung Do Ahn
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Eun Kyung Choi
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Soo Shin
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young-Tak Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Yong-Man Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Jong-Hyeok Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Seoul, Korea
| | - Joo-Hyun Nam
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
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Torgeson A, Boothe D, Poppe MM, Suneja G, Gaffney DK. Disparities in care for elderly women with endometrial cancer adversely effects survival. Gynecol Oncol 2017; 147:320-328. [DOI: 10.1016/j.ygyno.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Wang W, Hou X, Yan J, Shen J, Lian X, Sun S, Liu Z, Meng Q, Wang D, Zhao M, Qiu J, Hu K, Zhang F. Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 2017; 17:510. [PMID: 28764676 PMCID: PMC5540340 DOI: 10.1186/s12885-017-3503-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial. We retrospectively analyzed the efficacy and tolerance of radical radiotherapy (RT) or CCRT in elderly cervical cancer patients and performed comparisons between them. METHODS We retrospectively analyzed the elderly cervical cancer patients (≥70 years old) treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5-7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel. RESULTS Seventy-three patients were eligible for this study. Twenty-one(28.8%) and 52(71.2%) patients suffered with FIGO stage IB-IIA and IIB-IVA disease, respectively. Twenty-four (32.9%) patients received CCRT. The median duration of follow-up was 32.4 months (4.8-118.8 months). The 3-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were 64.9%, 67.8% and 66.5%, respectively. By multivariate analysis, CCRT was a significant predictive factor of OS(p = 0.023, 95% confidence interval [CI]: 1.172-8.860), CSS(p = 0.031, 95% CI: 1.131-13.908)and DFS(p = 0.045, 95% CI: 1.023 ~ 6.430). The 3-year OS of patients received RT and CCRT were 54.3% and 83.1%, CSS were 56.8% and 87.1%, DFS were 57.6% and 83.3%. There was no treatment related death. Grade 3-4 acute hematological, gastrointestinal and urinary toxicity incidences were 31.5%, 19.1% and 12.3%, respectively. For grade 3-4 chronic gastrointestinal and genitourinary toxicities, the incidences were 4.1% and 2.7%, respectively. Compared with RT, CCRT was related with high grade 3-4 hematological toxicity (16.3% and 62.5% respectively, p < 0.001), respectively. However, acute nonhematological toxicity and chronic toxicity were not significantly different. CONCLUSION Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.
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Affiliation(s)
- Weiping Wang
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xiaorong Hou
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Junfang Yan
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jie Shen
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xin Lian
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shuai Sun
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhikai Liu
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Qingyu Meng
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Dunhuang Wang
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Mei Zhao
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jie Qiu
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ke Hu
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Fuquan Zhang
- Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
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Beriwal S, Klopp A, Mell L. Defining Prognostic Biomarkers and Optimal Adjuvant Treatment for Gynecologic Cancer. Int J Radiat Oncol Biol Phys 2017; 98:1-4. [DOI: 10.1016/j.ijrobp.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 10/19/2022]
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Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy — A propensity score-matched study. Gynecol Oncol 2017; 145:277-283. [DOI: 10.1016/j.ygyno.2017.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 01/23/2023]
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Venkatesulu BP, Mallick S, Rath GK. Patterns of care of cervical cancer in the elderly: A qualitative literature review. J Geriatr Oncol 2017; 8:108-116. [DOI: 10.1016/j.jgo.2016.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/03/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022]
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12
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Caires IQDS, Souza KT, Negrão MV, de Oliveira JA, Barroso-Sousa R, de Lima RCA, Hoff PMG, Diz MDPE. Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly? Eur J Obstet Gynecol Reprod Biol 2015; 192:86-9. [PMID: 26182837 DOI: 10.1016/j.ejogrb.2015.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical cancer (CC) is the second most common cancer in Brazilian women, and approximately 10% of cases occur in elderly patients (pts). In this age group, disease is usually diagnosed in more advanced stages and oncological therapies are usually less intensive, due to comorbidities and impaired performance status. METHODS Retrospective analysis of pts ≥65 years old with CC admitted at a Brazilian University Cancer Center from August 2008 to February 2012. We performed a descriptive analysis of baseline performance status (PS), disease stage (FIGO), histology, body mass index (BMI), treatment received and overall survival, using the Kaplan-Meier method. RESULTS 900 medical records were analyzed and 75 pts (8%) fulfilled the inclusion criteria. Median age was 73.4 years old (±5.5 years). Squamous cell carcinoma (SCC) was the most common histology (71 pts, 94.7%). 67 (89.3%) had PS 0 or 1 and 52 pts (69.3%) were eutrophic (BMI 18.5-25 kg/m(2)). At presentation, disease staging consisted of 18 pts (24%) stage I, 35 pts (46.7%) stage II, 8 pts (10.7%) stage III, 12 pts (16%) stage IVa and 2 pts (2.7%) stage IVb. 24 pts (32%) underwent surgery (hysterectomy, adnexectomy, pelvic and paraaortic lymphadenectomy). Adjuvant treatment with radiotherapy (RT) was performed in 13 pts (total dose of external RT in pelvis ranged from 39.6 to 45 Gy, parametrial boost ranged from 14 to 20 Gy and 4 inserts from 7 to 7.5 Gy of brachytherapy); 8 of them received concomitant platinum-based chemotherapy (CT). 30 pts underwent definitive CRT, 17 definitive RT, 1 palliative CT and 3 best supportive care. In the CRT group, 18 pts received cisplatin (CDDP 40 mg/m(2)/w/6w) and 12 carboplatin (AUC 2/w/6w). During definitive CRT, treatment was discontinued in 39% of pts who received CDDP and 25% of pts who received carboplatin, all due to treatment toxicities. CDDP was associated with more nefrotoxicity (5 pts, 28%) than carboplatin (1 pt, 8.3%). The CDDP group also presented more radiodermatitis and stroke. However, myelosuppression and diarrhea were similar in both groups. After a 26.1-month follow-up, median OS was not reached. CONCLUSIONS Despite advanced age, more than 60% of pts underwent complete CRT treatment. Thus, age should not be the only factor to guide therapeutic decisions in CC. Carboplatin was better tolerated than CDDP in CRT group, but prospective trials are necessary to evaluate the best treatment option in this population.
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Affiliation(s)
- Inacelli Queiroz de Souza Caires
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil.
| | - Karla Teixeira Souza
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Marcelo Vailati Negrão
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Julia Andrade de Oliveira
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Romualdo Barroso-Sousa
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Rafael Caires Alvino de Lima
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Paulo Marcelo Gehm Hoff
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Maria del Pilar Estevez Diz
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
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Yanazume Y, Yanazume S, Iio K, Yonekura R, Kojima N, Uchida N, Koriyama C, Douchi T. Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer. J Obstet Gynaecol Res 2015; 40:1725-32. [PMID: 24888940 DOI: 10.1111/jog.12387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
AIM Incomplete brachytherapy is a major risk factor for recurrence. However, high-dose-rate intracavitary brachytherapy has not been assessed adequately in elderly patients with invasive cervical cancer. The present study investigated the clinical importance of intracavitary brachytherapy and risk factors of incomplete intracavitary brachytherapy in elderly patients with cervical cancer. MATERIAL AND METHODS Subjects were 76 patients aged 70-89 years old with invasive cervical cancer. All subjects were recruited between January 1997 and September 2010, and were planning to receive external beam radiation therapy followed by high-dose-rate intracavitary brachytherapy. Survival rates and the incidence of complications were compared between the 70s and 80s age groups. Risk factors for recurrence in elderly patients were evaluated using multivariate analysis, and risk factors for impractical intracavitary brachytherapy were also estimated. RESULTS No significant differences were observed in 3-year progression-free survival rates or the incidence of complications in the two age groups. Cox multivariate analysis showed that histology (non-squamous cell carcinoma), incomplete intracavitary brachytherapy, and lymph node swelling were significant prognostic factors for recurrence. Impractical application was the major reason for incomplete treatment. Multiple logistic regression analysis revealed that a previous history without vaginal births (P = 0.016) was an independent risk factor for the impractical application, independent of tumor diameter ≥ 4 cm (P = 0.007). CONCLUSIONS Incomplete intracavitary brachytherapy decreased the survival rates of elderly patients. Larger tumors and patients without a history of vaginal births were the two major causes of impractical intracavitary brachytherapy, which may be fatal, especially in elderly patients with bulky tumors.
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Affiliation(s)
- Yumi Yanazume
- Department of Obstetrics and Gynecology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
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Abstract
The foregoing, it is hoped, has provided at least a taste of the past, present, and future in the use of RT for the elderly population. Based on many ongoing studies, it becomes clear that the radiation oncology world has come to recognize the geriatric population’s ability to tolerate, and perhaps even thrive from, a course of RT, when it is offered appropriately. In the final analysis, it has become clear that no simple age cutoff can substitute for clinical acumen and a thorough assessment of patients’ general health before the best treatment regimen can be chosen. One need only follow the trend both in American and in European trials (the RTOG and the EORTC) to appreciate the acceptance that has taken hold that there need not be an age cutoff so much as a set of clinical criteria, including performance status and other assessments of function and comorbidity, prior to patient enrollment in anational trial. With such an outlook, we eagerly anticipate the results from these trials and look forward to implementing them in our treatment of young and old patients alike.
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Affiliation(s)
- Benjamin Rosenbluth
- Department of Radiation Oncology, Holy Name Medical Center, Teaneck, NJ 07666, USA.
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16
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Clinical aspects of the management of elderly women diagnosed with gynecologic malignancies: Treatment decisions and choices. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity. Arch Gynecol Obstet 2010; 284:1007-14. [PMID: 21116639 PMCID: PMC3171672 DOI: 10.1007/s00404-010-1777-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/11/2010] [Indexed: 11/22/2022]
Abstract
Purpose To examine the preliminary survival outcomes and treatment-related toxicity for elderly patients with cervical cancer treated with radiotherapy (RT). Methods Forty patients ≥75 years old with cervical cancer who were treated with RT were evaluated. Of these 40 patients, 25 were classified as FIGO stage I or II and 15 as stage III or IVA. Thirty-five patients were treated with radical RT (RRT), and five were treated with surgery plus adjuvant RT (S + ART). External beam radiotherapy combined with high-dose-rate intracavitary brachytherapy was performed on 31 patients who were treated with RRT and on 2 patients who were treated with S + ART because of positive vaginal surgical margins. The patients’ median age was 78 years (range 75–89 years). Concurrent chemotherapy (CCT) was performed on five patients (RRT: 3, S + ART: 2). Results The median follow-up period was 20 months (range 1–85 months). Only one patient could not complete RT. The 3-year overall and disease-specific survival (OS and DSS) rates for all patients were 58 and 80%, respectively. Five patients experienced Grade 3 acute toxicity; two were treated with RRT (2/35), and three were treated with S + ART (3/5, 2 of them with CCT). Two patients experienced Grade 3 late toxicity; one was treated with RRT (1/35, with CCT) and the other was treated with S + ART (1/5). No Grade 4 or higher toxicity was experienced. Conclusions RRT for elderly patients with cervical cancer is generally effective and safe, but severe toxicity may occur with more aggressive treatment modalities.
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Laurentius T, Altendorf-Hofmann A, Camara O, Runnebaum IB, Wendt TG. Impact of age on morbidity and outcome of concurrent radiochemotherapy in high-risk FIGO stage I to IVA carcinoma of the uterine cervix following laparoscopic surgery. J Cancer Res Clin Oncol 2010; 137:481-8. [PMID: 20473526 PMCID: PMC3036825 DOI: 10.1007/s00432-010-0903-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate the impact of age on treatment-related acute morbidity, on modifications of drug doses and radiotherapy and on disease-free and overall survival in non-elderly and elderly with high-risk cervical cancer treated with concurrent radiochemotherapy following laparoscopic surgery. Methods One hundred and two patients with high-risk FIGO I – IVA cervical cancer (77 non-elderly [<60 years] and 25 elderly [≥60 years]) were treated by radical hysterectomy with lymphadenectomy (n = 91) and postoperative radiochemotherapy or radical radiochemotherapy alone after laparoscopic lymph node dissection (n = 11) patients received five to six cycles of cis-platin, 40 mg/sqm weekly, given concurrently to pelvic radiotherapy of 45–50.4 Gy in 5–6 weeks. Paraaortic radiotherapy with 45 Gy was performed when laparoscopic staging revealed paraaortic node metastases. Acute morbidity was prospectively scored weekly. Toxicity-related protocol violations (treatment breaks or dose reduction) were related with age, 5-year overall survival (OS) and progression-free survival (PFS) rates. Results Clinical stages and histologic subtypes were equally distributed. Grade 3/4 leukopenia, anemia, diarrhea and nausea occurred more frequently in the elderly. 16 (22%) non-elderly and 6 (25%) elderly needed a modification of drug dose. 10/77 (13%) non-elderly patients and 11/25 (44%) of the elderly needed an unscheduled treatment break (p = 0.002). OS and PFS were not different between age groups. The 5-year OS rate was 47 ± 6% for non-elderly patients and 45 ± 10% for the elderly. Patients with/without treatment breaks had a 5-year OS rate of 39 ± 11%/48 ± 6%. The 5-year PFS rate is 49 ± 6% for non-elderly patients and 47 ± 11% for the elderly. Patients with/without treatment breaks had a 5-year PFS probability of 50 ± 12%/48 ± 6%. FIGO stage retains its prognostic significance irrespective of age. Conclusions Concurrent radiochemotherapy caused slightly higher acute toxicity with increasing age. Adjustment of treatment intensity was more frequent in the elderly but did not result in detrimental outcome figures.
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Magné N, Mancy NC, Chajon E, Duvillard P, Pautier P, Castaigne D, Lhommé C, Morice P, Haie-Meder C. Patterns of care and outcome in elderly cervical cancer patients: A special focus on brachytherapy. Radiother Oncol 2009; 91:197-201. [DOI: 10.1016/j.radonc.2008.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 07/02/2008] [Accepted: 08/27/2008] [Indexed: 01/03/2023]
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Delgado FG, Martínez E, Céspedes MA, Bravo MM, Navas MC, Cómbita Rojas AL. Increase of human papillomavirus-16 E7-specific T helper type 1 response in peripheral blood of cervical cancer patients after radiotherapy. Immunology 2008; 126:523-34. [PMID: 18778290 DOI: 10.1111/j.1365-2567.2008.02912.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
It has been suggested that tumour cell lysis by gamma-radiation induces a tumoral antigen release eliciting an immune response. It is not clear how a specific immune response in cervical cancer patients is developed after radiotherapy. This study is an attempt to investigate the role of the human papillomavirus type 16 (HPV-16) E7-specific T helper response before and after radiotherapy. Lymphocytes were isolated from 32 cervical cancer patients before and after radiotherapy and from 16 healthy women. They were stimulated for 12 hr with autologous HPV-16 E7-pulsed monocyte-derived dendritic cells or directly with HPV-16 E7 synthetic peptides: E7(51-70), E7(65-84) and E7(79-98). The cells were stained for CD4, CD69, intracellular interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) cytokines and analysed by flow cytometry. A specific CD4(+) CD69(+) IFN-gamma(+) immune response against HPV-16 E7(79-98) peptide was observed in 10 of 14 patients (71.4%) after treatment, compared with 4 of 14 (28.5%) before radiotherapy (P = 0.039); however, this response was not associated with a successful clinical response. Before treatment, 5 of 31 patients showed a HPV-16 E7(79-98)-specific T helper type 2 (Th2) response. Interestingly, this response was significantly associated with a decrease in disease-free survival (P = 0.027). These results suggest that a Th2-type cellular response could be useful as a predictor of recurrence and poor prognosis. An increase of the HPV-specific immune response was observed after radiotherapy; however, it is not enough to control completely the disease after treatment. Our results support that the E7-specific T-cell IFN-gamma response in cervical cancer patients, rather than reflecting the host's capability of controlling tumour growth, might be an indicator for disease severity.
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Affiliation(s)
- Félix Giovanni Delgado
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Columbia
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Goodheart M, Jacobson G, Smith BJ, Zhou L. Chemoradiation for invasive cervical cancer in elderly patients: outcomes and morbidity. Int J Gynecol Cancer 2008; 18:95-103. [PMID: 17466049 DOI: 10.1111/j.1525-1438.2007.00967.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Age may impact survival and treatment in cervical cancer patients. We sought to determine if treatment and survival were different in elderly patients and whether chemoradiation increased morbidity. We performed a retrospective chart review to identify patients treated with definitive radiation therapy at the University of Iowa Hospitals and Clinics between 1997 and 2001. Three hundred sixty-four patients had a new diagnosis of invasive cervical cancer, of which 150 patients were treated with radiation. We excluded patients treated postoperatively or with palliative intent, leaving 96 patients treated with definitive radiation therapy. Patients were divided into two age categories: elderly (>/=65) and nonelderly (<65). We compared these groups with respect to treatment received, morbidity, and survival. Sixty-nine (72%) women were less than 65 years old, and 27 (28%) women were greater than or equal to 65 years old. Chemoradiation was associated with decreased mortality (P < 0.01). The decrease in mortality did not differ between the two age cohorts (all causes: P = 0.66; cancer specific: P = 0.65), nor was there a difference in the complication rate due to chemoradiation (P = 0.70). Although elderly patients were more likely to be diagnosed with nonsquamous histologies (P < 0.01), their odds of receiving chemoradiation were 0.35 (95% CI: 0.13-0.90) times the odds for nonelderly. Elderly cervical cancer patients more often have nonsquamous histology and are likely to receive only radiation therapy compared to younger patients. Treatment with chemoradiation was associated with similar survival increases in both age cohorts. Complication rates between the two were similar. Chemoradiation should be considered in elderly patients with invasive cervical cancer.
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Affiliation(s)
- M Goodheart
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, Iowa, USA.
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Sakurai H, Suzuki Y, Nonaka T, Ishikawa H, Shioya M, Kiyohara H, Katoh H, Nakayama Y, Hasegawa M, Nakano T. FDG-PET in the detection of recurrence of uterine cervical carcinoma following radiation therapy—tumor volume and FDG uptake value. Gynecol Oncol 2006; 100:601-7. [PMID: 16257440 DOI: 10.1016/j.ygyno.2005.09.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 09/16/2005] [Accepted: 09/19/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE We evaluated the use of positron emission tomography (PET) with fluorine-18-labeled fluoro-2-deoxy-d-glucose (FDG) in follow-up study after radiation therapy in patients with uterine cervical carcinoma. MATERIALS AND METHODS Thirty-two studies in 25 patients were reviewed. Twenty patients were treated with external beam irradiation and intracavitary brachytherapy, and five with irradiation following initial surgery. Time from initial treatment to FDG-PET was 23.3 (5.2-88.0) months. Rationale for FDG-PET was the presence of symptoms in 6 patients, abnormal serum tumor marker values in 13, abnormal lesions on other diagnostic imaging modalities in 19, and patient request in 2. On visualization of a lesion, the maximum standardized uptake value (maxSUV) of the lesion was calculated, and values over 2.0 were classified as FDG-positive. Maximum tumor diameter and tumor volume in the corresponding disease were estimated by computed tomography (CT) or magnetic resonance imaging (MRI). RESULTS Sensitivity and specificity of FDG-PET in the detection of recurrent disease were 91.5% (43/47) and 57.1% (4/7), respectively. Four false-negative findings were seen for small lung metastases having a volume less than 1 cm3. Three false-positive cases were a localized pneumonitis, a benign pubic bone fracture, and a fibrosis after interstitial brachytherapy. Sensitivity for extrapelvic lymph node metastases was extremely high (100%); in contrast, sensitivity and specificity for lung and bone lesions were 75.0% (12/16) and 33.3% (1/3), respectively. Regarding tumor volume measurement, good correlation between maxSUV on FDG-PET and tumor volume was obtained (lung metastases, P = 0.03; extrapelvic nodes, P < 0.0001). Within this study, all corresponding lesions over 1 cm3 showed a maxSUV value greater than 2.0. CONCLUSION FDG-PET is a useful tool for the detection of extrapelvic lesions during the follow-up period after radiation therapy for cervical cancer. This study suggests that FDG uptake is associated with tumor volume, and FDG-PET has limitations in the detection of lesions less than 1 cm3 or microscopic disease. Careful diagnostic agreement between PET and CT/MRI for positive but benign lesions, such as inflammation and bone fracture, remains important.
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Affiliation(s)
- Hideyuki Sakurai
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
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Geinitz H, Zimmermann FB, Thamm R, Schumertl A, Busch R, Molls M. 3D conformal radiation therapy for prostate cancer in elderly patients. Radiother Oncol 2005; 76:27-34. [PMID: 15990188 DOI: 10.1016/j.radonc.2005.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 04/05/2005] [Accepted: 06/05/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate if conformal radiation therapy for localized prostate cancer with doses of 70 Gy is well tolerated in patients aged 75 years or older, and if the side effects and the biochemical recurrence free (bNED) survival are comparable to younger patients. PATIENTS AND METHODS Eighty patients>or=75 years received definitive conformal radiotherapy for prostate cancer. Acute and late side effects as well as bNED survival (ASTRO criteria) were compared to 221 patients younger than 75 years who were treated during the same period of time. RESULTS Median dose to the prostate was 70 Gy in both groups. There were no significant differences in acute or late side effects between age groups. The frequency of grade III late symptoms was low and ranged between 0 and 4% for the evaluated symptoms irrespective of age group. Older patients had a better bNED survival than younger patients (bNED survival at 4 years: 76 vs. 61%, P=0.042). CONCLUSIONS High-dose conformal radiation therapy for prostate cancer is well tolerated in patients aged 75 years or older. In terms of bNED survival radiation treatment is at least as effective as it is for younger patients.
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Affiliation(s)
- Hans Geinitz
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technische Universität, München, Germany.
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Sakurai H, Niibe H, Suzuki M, Nakano T. A 104-year-old woman with advanced cervical carcinoma of the uterus. Gynecol Oncol 2004; 92:713-5. [PMID: 14766273 DOI: 10.1016/j.ygyno.2003.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment of elderly patient with advanced cancer includes considerable problems because of their limited life expectancy. CASE A 104-year-old woman with FIGO stage IIIB uterine cervical carcinoma treated with external beam radiotherapy and high dose-rate brachytherapy. After the treatment, the serum squamous cell carcinoma (SCC) antigen had fallen to normal level. She is now living 66 months after the treatment without recurrent symptoms. CONCLUSION In this specific case, the significance of this treatment is that the patient is surviving at the age of 109.
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Affiliation(s)
- Hideyuki Sakurai
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
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Brun JL, Stoven-Camou D, Trouette R, Lopez M, Chene G, Hocké C. Survival and prognosis of women with invasive cervical cancer according to age. Gynecol Oncol 2003; 91:395-401. [PMID: 14599872 DOI: 10.1016/s0090-8258(03)00501-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We assessed survival and compared clinical and pathological prognostic factors of women with invasive cervical cancer according to the age in order to define a cutoff point where screening should become useless. METHODS The survival of 308 women with invasive cervical cancer treated at Bordeaux University Hospital between 1976 and 1996 was evaluated on December 31, 2000. Kaplan-Meier survival curves calculated with regard to age were compared by the log-rank test. Prognostic factors were assessed according to age (cutoff 65 years) and included in a Cox model. Survival of women in our population within a particular age group was compared to survival of women of the same age range, using indirect standardization. RESULTS The 5-year survival rate of women under 65 (n = 221), between 65 and 74 (n = 56), and over 75 (n = 31) was 75%, 69%, 42%, respectively (P < 0.001). Compared to women under 65, women over 65 had a significantly lower Karnofsky performance status and a significantly more advanced clinical stage cancer involving vaginal bleeding. Age, gross cervical appearance, clinical vaginal involvement, histologic grade, and microscopic cervical and parametrial involvements were independent prognostic factors. Compared to women under 65, the risk of mortality was 1.3, 95% CI = 0.8-2.7, P = 0.189, for women aged 65-74, and 2.3, 95% CI = 1.1-3.9, P = 0.022, for women over 75. Mortality of women with invasive cervical cancer was significantly higher than that of women in the general population in the indirect standardization model (SMR = 1.9, 95% CI = 1.5-2.2), except beyond age 75. CONCLUSIONS Age was a significant prognostic factor in our study and advanced stages were significantly increased after 65. However, survival after 75 was not different from that of the population. These considerations address the question of the maintenance of screening between 65 and 75.
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Affiliation(s)
- Jean Luc Brun
- Department of Gynecology, University Hospital, Bordeaux, France.
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