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Zhang XF, Wu HY, Liang XW, Chen JL, Li J, Zhang S, Liu Z. Deep-learning-based radiomics of intratumoral and peritumoral MRI images to predict the pathological features of adjuvant radiotherapy in early-stage cervical squamous cell carcinoma. BMC Womens Health 2024; 24:182. [PMID: 38504245 PMCID: PMC10949581 DOI: 10.1186/s12905-024-03001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Surgery combined with radiotherapy substantially escalates the likelihood of encountering complications in early-stage cervical squamous cell carcinoma(ESCSCC). We aimed to investigate the feasibility of Deep-learning-based radiomics of intratumoral and peritumoral MRI images to predict the pathological features of adjuvant radiotherapy in ESCSCC and minimize the occurrence of adverse events associated with the treatment. METHODS A dataset comprising MR images was obtained from 289 patients who underwent radical hysterectomy and pelvic lymph node dissection between January 2019 and April 2022. The dataset was randomly divided into two cohorts in a 4:1 ratio.The postoperative radiotherapy options were evaluated according to the Peter/Sedlis standard. We extracted clinical features, as well as intratumoral and peritumoral radiomic features, using the least absolute shrinkage and selection operator (LASSO) regression. We constructed the Clinical Signature (Clinic_Sig), Radiomics Signature (Rad_Sig) and the Deep Transformer Learning Signature (DTL_Sig). Additionally, we fused the Rad_Sig with the DTL_Sig to create the Deep Learning Radiomic Signature (DLR_Sig). We evaluated the prediction performance of the models using the Area Under the Curve (AUC), calibration curve, and Decision Curve Analysis (DCA). RESULTS The DLR_Sig showed a high level of accuracy and predictive capability, as demonstrated by the area under the curve (AUC) of 0.98(95% CI: 0.97-0.99) for the training cohort and 0.79(95% CI: 0.67-0.90) for the test cohort. In addition, the Hosmer-Lemeshow test, which provided p-values of 0.87 for the training cohort and 0.15 for the test cohort, respectively, indicated a good fit. DeLong test showed that the predictive effectiveness of DLR_Sig was significantly better than that of the Clinic_Sig(P < 0.05 both the training and test cohorts). The calibration plot of DLR_Sig indicated excellent consistency between the actual and predicted probabilities, while the DCA curve demonstrating greater clinical utility for predicting the pathological features for adjuvant radiotherapy. CONCLUSION DLR_Sig based on intratumoral and peritumoral MRI images has the potential to preoperatively predict the pathological features of adjuvant radiotherapy in early-stage cervical squamous cell carcinoma (ESCSCC).
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Grants
- 20211800500322 CHINA,Guangdong Sci-tech Commissoner
- 20211800500322 CHINA,Guangdong Sci-tech Commissoner
- 20211800500322 CHINA,Guangdong Sci-tech Commissoner
- 20231800935742 CHINA,Dongguan City Social Science and Technology Development (Key) Project
- 20231800935742 CHINA,Dongguan City Social Science and Technology Development (Key) Project
- 20231800935742 CHINA,Dongguan City Social Science and Technology Development (Key) Project
- 20231800935742 CHINA,Dongguan City Social Science and Technology Development (Key) Project
- 20221800902092 CHINA,Dongguan City Social Science and Technology Development Project
- 20221800902092 CHINA,Dongguan City Social Science and Technology Development Project
- 20221800902092 CHINA,Dongguan City Social Science and Technology Development Project
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Affiliation(s)
- Xue-Fang Zhang
- Radiotherapy department, Cancer center, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
- Dongguan Key Laboratory of Precision Diagnosis and Treatment for Tumors, Dongguan, 523059, Guangdong, People's Republic of China
| | - Hong-Yuan Wu
- Radiotherapy department, Cancer center, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
- Dongguan Key Laboratory of Precision Diagnosis and Treatment for Tumors, Dongguan, 523059, Guangdong, People's Republic of China
| | - Xu-Wei Liang
- Radiotherapy department, Cancer center, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
- Dongguan Key Laboratory of Precision Diagnosis and Treatment for Tumors, Dongguan, 523059, Guangdong, People's Republic of China
| | - Jia-Luo Chen
- Radiotherapy department, Cancer center, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
- Dongguan Key Laboratory of Precision Diagnosis and Treatment for Tumors, Dongguan, 523059, Guangdong, People's Republic of China
| | - Jianpeng Li
- Radiology Department, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
| | - Shihao Zhang
- Pathology Department, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China
| | - Zhigang Liu
- Radiotherapy department, Cancer center, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), No.78 Wandaonan Road, Dongguan, 523059, Guangdong, People's Republic of China.
- Dongguan Key Laboratory of Precision Diagnosis and Treatment for Tumors, Dongguan, 523059, Guangdong, People's Republic of China.
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Ikeda M, Shida M, Shigeta S, Nagase S, Takahashi F, Yamagami W, Katabuchi H, Yaegashi N, Aoki D, Mikami M. The trend and outcome of postsurgical therapy for high-risk early-stage cervical cancer with lymph node metastasis in Japan: a report from the Japan Society of Gynecologic Oncology (JSGO) guidelines evaluation committee. J Gynecol Oncol 2021; 32:e44. [PMID: 33825359 PMCID: PMC8039172 DOI: 10.3802/jgo.2021.32.e44] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The Japan Society of Gynecologic Oncology published the first guidelines for the treatment of cervical cancer in 2007. The aim of this research was to evaluate the influence of the introduction of the first guideline on clinical trends and outcomes of patients with early-stage cervical cancer who underwent surgery. METHODS This analysis included 9,756 patients who were diagnosed based on the pathological Tumor-Node-Metastasis (pTNM) classification (i.e., pT1b1, pT1b2, pT2b and pN0, pN1, pNX) and received surgery as a primary treatment between 2004 and 2009. Data of these patients were retrospectively reviewed, and clinicopathological trends were assessed. The influence of the introduction of the guideline on survival was determined by using a competing risk model. RESULTS For surgery cases, the estimated subdistribution hazard ratio (HR) by the competing risk model for the influence of the guideline adjusted for age, year of registration, pT classification, pN classification, histological type, and treatment methods was 1.024 (p=0.864). Following the introduction of the first guideline in 2007, for patients with lymph node metastasis, the use of chemotherapy (CT) as a postsurgical therapy increased, whereas that of concurrent chemoradiotherapy (CCRT)/radiotherapy (RT) decreased (p<0.010). For pN1 cases, the estimated subdistribution HR by the competing risk model for the influence of the guideline was 1.094 (p=0.634). There was no significance in the postsurgical therapy between CT and CCRT/RT (p=0.078). CONCLUSIONS Survival of surgical cases was not improved by the introduction of the guidelines. It is necessary to consider more effective postsurgical therapy for high-risk early-stage cervical cancer.
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Affiliation(s)
- Masae Ikeda
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
| | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Fumiaki Takahashi
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
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Huang H, Feng YL, Wan T, Zhang YN, Cao XP, Huang YW, Xiong Y, Huang X, Zheng M, Li YF, Li JD, Chen GD, Li H, Chen YL, Ma LG, Yang HY, Li L, Yao SZ, Ye WJ, Tu H, Huang QD, Liang LZ, Liu FY, Liu Q, Liu JH. Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:361-369. [PMID: 33443541 DOI: 10.1001/jamaoncol.2020.7168] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors. Objective To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer. Design, Setting, and Participants After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018. Interventions Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively. Main Outcomes and Measures The primary end point was the rate of disease-free survival (DFS) at 3 years. Results A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT. Conclusions and Relevance In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer. Trial Registration ClinicalTrials.gov Identifier: NCT00806117.
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Affiliation(s)
- He Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan-Ling Feng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ting Wan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan-Na Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-Ping Cao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yong-Wen Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Xiong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Min Zheng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan-Fang Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun-Dong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guan-Di Chen
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hu Li
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | | | - Li-Guo Ma
- Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hong-Ying Yang
- Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li Li
- Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Shu-Zhong Yao
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei-Jun Ye
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hua Tu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qi-Dan Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li-Zhi Liang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fu-Yuan Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qing Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ji-Hong Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Mori T, Makino H, Okubo T, Fujiwara Y, Sawada M, Kuroboshi H, Tsubamoto H, Murakoshi H, Motohashi T, Kitawaki J, Ito K. Multi-institutional phase II study of neoadjuvant irinotecan and nedaplatin followed by radical hysterectomy and the adjuvant chemotherapy for locally advanced, bulky uterine cervical cancer: A Kansai Clinical Oncology Group study (KCOG-G1201). J Obstet Gynaecol Res 2018; 45:671-678. [PMID: 30575239 DOI: 10.1111/jog.13885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/24/2018] [Indexed: 11/30/2022]
Abstract
AIM A multi-institutional phase II trial was conducted to determine the efficacy and toxicity of neoadjuvant chemotherapy with irinotecan and nedaplatin followed by radical hysterectomy and adjuvant chemotherapy for locally advanced, bulky stage IB2-IIB cervical cancer. METHODS Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2-II, bulky type (>4 cm in diameter) squamous cell carcinoma of the uterine cervix were enrolled. Irinotecan (60 mg/m2 ) was administered intravenously on days 1 and 8 and nedaplatin (80 mg/m2 ) was also administered on day 1 of every 21-day cycle. After two cycles of chemotherapy, a radical hysterectomy was performed. Until 6 weeks after the surgery, three to five cycles of the regimen were added as adjuvant chemotherapy. The primary endpoint was the 2-year relapse-free survival rate. The response rates and toxicities were evaluated as secondary endpoints. RESULTS Thirty-two patients from seven institutions were enrolled in this study. The median age was 48 years (range 25-75 years). The average follow-up period was 37.8 months (15-71 months). Twenty-three patients completed the regimen as planned. The objective response rate (complete response + partial response) for the neoadjuvant chemotherapy regimen was 81.2%. The 2-year and 5-year relapse-free-survival rates were 87.5% and 78.8%, respectively. The incidence of grade 3/4 neutropenia was 6.3% and 34.4% during neoadjuvant and adjuvant treatment, respectively. All other toxicities were well tolerated. CONCLUSION Our treatment showed efficacy and tolerability for patients with locally advanced, bulky stage IB2-IIB cervical cancer. This suggests that treatment has the potential to improve the prognosis compared to concurrent chemo-radiotherapy.
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Affiliation(s)
- Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroshi Makino
- Department of Obstetrics and Gynecology, Gifu University, Gifu, Japan
| | - Tomoharu Okubo
- Department of Obstetrics and Gynecology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yoichiro Fujiwara
- Department of Obstetrics and Gynecology, Kyoto City Hospital, Kyoto, Japan
| | - Morio Sawada
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Haruo Kuroboshi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Homare Murakoshi
- Department of Obstetrics and Gynecology, Chibune General Hospital, Osaka, Japan
| | - Takashi Motohashi
- Department of Obstetrics and Gynecology, Kuwana City Medical Center, Kuwana, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kimihiko Ito
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan
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Takekuma M, Shimokawa M, Nishio S, Omi H, Tabata T, Takei Y, Nasu K, Takahashi Y, Toyota S, Ichikawa Y, Arakawa A, Ito F, Tsubamoto H, Mori T, Hirashima Y, Ito K. Phase II study of adjuvant chemotherapy with paclitaxel and nedaplatin for uterine cervical cancer with lymph node metastasis. Cancer Sci 2018; 109:1602-1608. [PMID: 29575254 PMCID: PMC5980304 DOI: 10.1111/cas.13577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/19/2018] [Accepted: 03/11/2018] [Indexed: 12/11/2022] Open
Abstract
The purpose of this phase II trial was to assess the efficacy and toxicity of paclitaxel and nedaplatin (TN) as the initial postoperative adjuvant chemotherapy for uterine cervical cancer with lymph node metastases (LNM). Patients with FIGO stage IB1-IIA2 squamous cell carcinoma of the uterine cervix were enrolled. Histological confirmation of LNM was mandatory. Intravenous paclitaxel at 175 mg/m2 and nedaplatin at 80 mg/m2 were administered every 28-day cycle, of which there were 5 cycles after radical hysterectomy. Sixty-two patients were enrolled in the study from November 2011 to July 2015. Their median age was 48.5 years (range 28-64). The median tumor diameter was 37 mm (5-64). Overall, 30 patients (48.4%) had 1 metastatic lymph node, 11 (17.7%) had 2, 3 (4.8%) had 3, 5 (8.1%) had 4, and 13 (21.0%) had 5 or more. With a median follow-up of 45.7 months (range 23.4-69.5), the 2-year relapse-free survival and 2-year overall survival rates were 79.0% (90% CI, 69.0%-86.2%) and 93.5% (95% CI, 83.7%-97.5%), respectively. Almost all adverse events were relatively mild. Grade 3-4 adverse events (NCI-CTC ver. 4.0) that occurred in 5% or more of patients were neutropenia (60.7%) and infection (6.6%). The proportion of patients who completed 5 cycles of treatment was 90.3%. Postoperative adjuvant chemotherapy with TN for cervical cancer with LNM was demonstrated to be an effective and feasible treatment. A phase III trial is warranted to compare this with concurrent chemoradiotherapy.
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Affiliation(s)
- Munetaka Takekuma
- Department of Gynecologic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Kyusyu Cancer Center, Fukuoka, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideo Omi
- Department of Obstetrics and Gynecology, Iwate Medical University Hospital, Iwate, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, Japan
| | - Yoshiyuki Takahashi
- Department of Obstetrics and Gynecology, Okinawa Chubu Hospital, Okinawa, Japan
| | - Shinji Toyota
- Department of Obstetrics and Gynecology, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshikazu Ichikawa
- Department of Obstetrics and Gynecology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Atsushi Arakawa
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Fuminori Ito
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Hyogo, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuyuki Hirashima
- Department of Gynecologic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kimihiko Ito
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Hyogo, Japan
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Takekuma M, Kasamatsu Y, Kado N, Kuji S, Tanaka A, Takahashi N, Abe M, Hirashima Y. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I-II cervical cancer: A review. J Obstet Gynaecol Res 2017; 43:617-626. [PMID: 28190285 DOI: 10.1111/jog.13282] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/10/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Abstract
The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical significance, while patients allocated to the RT group did experience an increase in severe toxicities compared with the NFT group. This could be why many physicians are reluctant to treat patients with this approach, although guidelines recommend RT for patients with intermediate-risk factors. With regard to toxicities, postoperative RT would be problematic because the organs in the pelvis targeted by RT have already been damaged by radical surgery. To reduce the toxicities, intensity-modulated radiotherapy would best be used worldwide. Further improvement in adjuvant therapy will come from enhanced definition of prognostic risk factors, better patient selection, and refinements in both local and systematic therapies.
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Shu T, Zhao D, Li B, Wang Y, Liu S, Li P, Zuo J, Bai P, Zhang R, Wu L. Prognostic evaluation of postoperative adjuvant therapy for operable cervical cancer: 10 years' experience of National Cancer Center in China. Chin J Cancer Res 2017; 29:510-520. [PMID: 29353973 DOI: 10.21147/j.issn.1000-9604.2017.06.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics (FIGO) Ib-IIa cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months. Results Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival (DFS) of 92.1% and 5-year overall survival (OS) of 95.0%. In multivariate analysis, differentiation of G3 (P<0.05), lymph node metastasis (LNM, P<0.05) and lymphovascular space invasion (LVSI, P<0.05) were independent predictors for OS, while LNM (P<0.05), deep stroma invasion (DSI, P<0.05) and LVSI (P<0.05) were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma (SCC) was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamous carcinoma (AC/ASC), differentiation was the independent predictor of OS (P<0.05); and LVSI of DFS (P<0.05). Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy (CCRT, n=195), radiotherapy (RT, n=24), and chemotherapy (CT, n=17). Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT (P=0.118), with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant. Conclusions LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival. CCRT+CT outperformed CCRT in high-risk patients. For patients with single non-high-risk factor, the role of adjuvant therapy needs to be further discussed.
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Affiliation(s)
- Tong Shu
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dan Zhao
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yating Wang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuanghuan Liu
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Pingping Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jing Zuo
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ping Bai
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rong Zhang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Ye Y, Xu W, Zhong W, Li Y, Wang C. Combination treatment with dihydrotanshinone I and irradiation enhances apoptotic effects in human cervical cancer by HPV E6 down-regulation and caspases activation. Mol Cell Biochem 2011; 363:191-202. [DOI: 10.1007/s11010-011-1171-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 11/23/2011] [Indexed: 12/30/2022]
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Hosaka M, Watari H, Kato T, Odagiri T, Konno Y, Endo D, Mitamura T, Kikawa S, Suzuki Y, Sakuragi N. Clinical efficacy of paclitaxel/cisplatin as an adjuvant chemotherapy for patients with cervical cancer who underwent radical hysterectomy and systematic lymphadenectomy. J Surg Oncol 2011; 105:612-6. [PMID: 22065519 DOI: 10.1002/jso.22136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 09/21/2011] [Accepted: 10/13/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to compare the clinical efficacy of paclitaxel/cisplatin (TP) as an adjuvant chemotherapy to adjuvant radiotherapy (RT) after radical hysterectomy and systematic lymphadenectomy for patients with cervical cancer. METHODS A total of 125 patients with early-stage cervical cancer, who underwent radical hysterectomy, and received adjuvant therapy due to recurrent risk factors were retrospectively analyzed. Forty-nine patients were treated with RT, and 32 received paclitaxel/cisplatin (TP) for three to six cycles at 4-week interval. Survival and postoperative complications were compared between two modalities. RESULTS There was no significant difference of 3-year disease-free survival between two groups (P = 0.23), while significantly better 3-year overall survival in TP group than RT group (P = 0.02). Seven of 32 patients (21.9%) treated with adjuvant TP, 16 of 49 patients (32.7%) treated with RT showed disease recurrence. Median of survival time after recurrence in RT group and TP group was 8.5 months, 12.0 months, respectively. Postoperative bowel obstruction was significantly more frequent in the RT group compared to the TP group (P = 0.01). CONCLUSIONS Postoperative chemotherapy using TP might be more beneficial for survival than adjuvant RT and can reduce postoperative complications for cervical cancer patients treated with radical hysterectomy.
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Affiliation(s)
- Masayoshi Hosaka
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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11
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Hosaka M, Watari H, Mitamura T, Konno Y, Odagiri T, Kato T, Takeda M, Sakuragi N. Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Int J Clin Oncol 2010; 16:33-8. [PMID: 20842404 DOI: 10.1007/s10147-010-0123-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Lymph node metastasis (LNM) is known to be the most important prognostic factor in cervical cancer. We analyzed the number of positive lymph nodes and other clinicopathological factors as prognostic factors for survival in node-positive patients with cervical cancer. METHODS Node-positive cervical cancer patients (n = 108) who underwent radical hysterectomy and systematic lymphadenectomy in Hokkaido University Hospital from 1982 to 2002 were enrolled. Clinicopathological data including age, stage, histologic subtype, and the number of LNM sites were collected. The main outcome was the overall survival (OS) rate for Stage Ib-IIb patients treated with surgery and postoperative radiotherapy. RESULTS The 5-year OS rate of patients with 1 positive node was 93.3%, that for 2 nodes was 77.3%, for 3 nodes it was 33.3%, and for 4 or more it was 13.8%. The OS rate of patients with 1 or 2 LNM sites was significantly better than that for patients with more than 2 LNM sites. The OS rate of patients with adenocarcinoma (Ad) (28.6%) was significantly lower than that for patients with other histologic subtypes (squamous cell carcinoma; 66.7%, adenosquamous carcinoma; 75.0%, p = 0.0003). Multivariate analysis revealed that >2 LNM sites and Ad were independent prognostic factors for survival. The 5-year OS rate of patients with 1 or 2 LNM sites was 86.8%, a more favorable prognosis than the OS rates in other reports. CONCLUSION More than two LNM sites and adenocarcinoma were independent prognostic factors for node-positive patients with cervical cancer.
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Affiliation(s)
- Masayoshi Hosaka
- Department of Gynecology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
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Yamashita T, Katayama H, Kato Y, Nishiwaki K, Hayashi H, Miyokawa N, Sengoku K. Management of pelvic lymph nodes by sentinel node navigation surgery in the treatment of invasive cervical cancer. Int J Gynecol Cancer 2009; 19:1113-8. [PMID: 19820378 DOI: 10.1111/igc.0b013e3181a83d65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Diagnosis of lymph node metastasis is a critical issue in the treatment of cervical cancer. Many studies describing sentinel node navigation surgery (SNNS) for examination of node status have been reported in the past decade. In this study, the feasibility of node status diagnosis by SNNS, including intraoperative frozen section diagnosis, in patients with early and advanced cervical cancer was evaluated. PATIENTS AND METHODS Fifty-eight cervical cancer patients with early and advanced stage disease were enrolled. All patients were treated with backup pelvic lymphadenectomy after SNNS. To detect sentinel lymph nodes (SLNs), radioactive material and/or blue dye were used as tracers. Lymph nodes confirmed as SLNs were immediately sent to pathologists and diagnosed by frozen section intraoperatively. RESULTS A total of 118 and 16 SLNs were pathologically investigated in early and advanced stage cervical cancer, respectively. The detection rate of SLNs in the early and advanced stages was 94.7% and 66.7%, respectively, whereas the detection rate using 1 or 2 tracers was 62.5% and 90%, respectively. The false-negative rate and negative predictive value was 0% and 100% for all stages. Pathological diagnosis by frozen section was completed within 30 minutes in all cases. CONCLUSIONS Our data demonstrate that SNNS in cervical cancer is a promising procedure for patients with early stage (up to Ib1) disease, especially patients with small tumor diameter (<2.0 cm). However, SNNS raises several points for discussion before it can be established as a practical clinical procedure or as part of a subsequent radical hysterectomy.
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Affiliation(s)
- Tsuyoshi Yamashita
- Department of Obstetrics and Gynecology, Asahikawa Medical College, Midorigaoka-higashi 2-1-1-1, Asahikawa, Japan.
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Li XL, Meng QH, Fan SJ. Adenovirus-mediated expression of UHRF1 reduces the radiosensitivity of cervical cancer HeLa cells to gamma-irradiation. Acta Pharmacol Sin 2009; 30:458-66. [PMID: 19270723 DOI: 10.1038/aps.2009.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM An in vitro study was carried out to determine the effect of UHRF1 overexpression on radiosensitivity in human cervical cancer HeLa cells using adenovirus-mediated UHRF1 gene transfer (Ad5-UHRF1). METHODS Cell survival was evaluated using the clonogenic survival assay and the MTT assay; apoptosis and cell cycle distribution were monitored by flow cytometry. Protein levels were measured by Western blotting. Silencing XRCC4 expression was performed by transfection of small interfering RNA (siRNA). RESULTS Increased expression of UHRF1 by Ad5-UHRF1 significantly reduced the radiosensitivity of HeLa cells. The UHRF1-mediated radioresistance was correlated with increased DNA repair capability and increased expression of the DNA damage repair protein, XRCC4. Knocking down XRCC4 expression in the cells using XRCC4 siRNA markedly reduced the UHRF1-mediated radioresistance. CONCLUSION These results provide the first evidence for revealing a functional role of UHRF1 in human cervical cancer cells as a negative regulator of radiosensitivity.
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Kim HS, Park NH, Park IA, Park JH, Chung HH, Kim JW, Song YS, Kang SB. Risk factors for recurrence of vaginal intraepithelial neoplasia in the vaginal vault after laser vaporization. Lasers Surg Med 2009; 41:196-202. [DOI: 10.1002/lsm.20741] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Plesinac-Karapandzić V, Borojević N, Milosević Z, Marković B, Nikitović M, Plesinac S. [Postoperative radiotherapy of cervival carcinoma: treatment results and analysis of prognostic factors]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:195-200. [PMID: 20420020 DOI: 10.2298/aci0904195p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of the study was to evaluate the efficacy of postoperative radiotherapy (RT) and to investigate prognostic factors for early-stage cervical cancer patients. We reviewed the medical records of 162 cervical cancer patients treated by RT during 2003 year. RT included 30-45 Gy of external photons to pelvis in 12-25 fractions. Brachytherapy with 192Ir was delivered in 3-5 fractions to a dose of 27-32 Gy. The mean age was 49 years (range 27-71). Majority of patients 130 had Stage Ib. Radical hysterectomy with lymphadenectomy was performed in 122 pts. and simple hysterectomy in 40 pts. The 5-year actuarial overall survival (OS) for all patients was 92.6% and disease-free survival (DFS) was 90.9%.There was statistically significant differences in OS and DFS in pat. with positive vs. negative pelvic lymph nodes; tumor 4 cm vs. tumor < or = 4 cm; positive vs. negative surgical margin/residual tumor (p < 0.05). Late GIT complications were determined in 35.8% and UT in 12.3%. In conclusion, postoperative radiotherapy has achieved high-satisfactory survival with acceptable complications. The survival benefit was less evident among patients with positive lymph nodes, tumor > 4 cm and positive surgical margin/residual tumor.
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Plesinac-Karapandzić V, Borojević N, Marković B, Stanković V, Vucković S, Plesinac S. [Implementation of 3D- CT based brachytherapy in the postoperative radiotherapy of cervical cancer: treatment technique and dose-volume parameters]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:201-207. [PMID: 20420021 DOI: 10.2298/aci0904201p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Intracavitary brachytherapy has an important roll in developing complications in postoperative radiotherapy of cervical cancer. 3D- CT based brachytherapy gives precisely estimating doses to organ at risk. In this study, we show our preliminary results in implementation of 3D-imaging based postoperative brachytherapy of cervical cancer: treatment technique and dose-volume parameters. During 2009 year, in 6 patients with early stage I-II of cervical cancer, brachytherapy treatment planning was based on the radiographs and CT imaging brachytherapy technique. Mean values of ICRU reference points of rectum was R max 4,2 Gy and bladder B max 4,5 Gy, while estimated volume-dose parameters D0.1 cm3 D1.0 cm D2.0 cm3 were presented with higher dose.Volume of organ at risk reflected the need for better bladder preparation. Our initial experience in performing CT-based brachytherapy, enabled us to introduce the characteristics of the parameters, assessment of their significance from the aspect of mutual relations applicators and organs at risk. Further analysis are needed, for monitoring the effects of 3D planning on complications.
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Hosaka M, Watari H, Takeda M, Moriwaki M, Hara Y, Todo Y, Ebina Y, Sakuragi N. Treatment of cervical cancer with adjuvant chemotherapy versus adjuvant radiotherapy after radical hysterectomy and systematic lymphadenectomy. J Obstet Gynaecol Res 2008; 34:552-6. [PMID: 18937708 DOI: 10.1111/j.1447-0756.2008.00739.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To compare the clinical efficacy focused on post-treatment morbidity between adjuvant chemotherapy (CT) and pelvic radiotherapy (RT) after radical hysterectomy for patients with cervical cancer. METHODS A total of 125 patients with cervical squamous cell carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy at Hokkaido University Hospital between 1991 and 2002 were enrolled in the study for retrospective analysis. Seventy patients with recurrent risk factors, including deep stromal invasion, lymph vascular space invasion, parametrial invasion, lymph node metastasis (LNM), and bulky tumor (>or=4 cm), received adjuvant therapy; 42 were treated with RT, and 28 were treated with CT. Almost all patients with multiple LNM received RT. Analyses were also performed on a subgroup of 50 patients without multiple LNM (23 RT, 27 CT). Clinical efficacy of post-treatment morbidity and survival was evaluated. RESULTS Because there were more patients with multiple LNM in the RT group, we analyzed disease-free survival in 50 patients without multiple LNM. The 3-year disease-free survival rate was 82.6% with RT and 96.3% with CT (P = 0.16). Postoperative bowel obstruction was significantly more frequent in the RT group versus the CT (P = 0.007) and no-therapy (P = 0.0026) groups. Urinary disturbance was also more frequent in the RT group than in the CT (P = 0.0016) and no-therapy (P = 0.089) groups. CONCLUSION CT has the equivalent therapeutic effect as RT with fewer postoperative complications for patients with intermediate risks. A prospective randomized trial is needed to compare CT combined with radical hysterectomy and pelvic lymphadenectomy to RT or chemoradiotherapy.
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Affiliation(s)
- Masayoshi Hosaka
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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