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Gouveia AG, Viani GA, Bratti VF, Marta GN, Hanna SA, Jacinto AA, Silva MS, Hamamura AC, Rosa AA, Castilho MS, Carson L, Hopman WM, Sullivan R, Booth CM, Aggarwal A, Hanna TP, Moraes FY. Challenges in building radiotherapy capacity: A longitudinal study evaluating eight years of the Brazilian radiotherapy expansion plan. J Cancer Policy 2024; 39:100459. [PMID: 38029960 DOI: 10.1016/j.jcpo.2023.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In 2012, the Brazilian government launched a radiotherapy (RT) expansion plan (PER-SUS) to install 100 linear accelerators. This study assesses the development of this program after eight years. METHODS Official reports from the Ministry of Health (MoH) were reviewed. RT centres projects status, timeframes, and cost data (all converted to US dollars) were extracted. The time analysis was divided into seven phases, and for cost evaluation, there were five stages. The initial predicted project time (IPPT) and costs (estimated by the MoH) for each phase were compared between the 18 operational RT centres (able to treat patients) and 30 non-operational RT centres using t-tests, ANOVA, and the Mann-Whitney U. A p-value < 0.05 indicates statistical significance. RESULTS A significant delay was observed when comparing the IPPT with the overall time to conclude each 48 RT centres project (p < 0.001), with considerable delays in the first five phases (p < 0.001 for all). Moreover, the median time to conclude the first 18 operational RT centres (77.4 months) was shorter compared with the 30 non-operational RT centres (94.0 months), p < 0.001. The total cost of 48 RT services was USD 82,84 millions (mi) with a significant difference in the per project median total cost between 18 operational RT centres, USD1,34 mi and 30 non-operational RT centres USD2,11 mi, p < 0.001. All phases had a higher cost when comparing 30 non-operational RT centres to 18 operational RT centres, p < 0.001. The median total cost for expanding existing RT centres was USD1,30 mi versus USD2,18 mi for new RT services, p < 0.0001. CONCLUSION After eight years, the PER-SUS programs showed a substantial delay in most projects and their phases, with increased costs over time. POLICY SUMMARY Our findings indicate a need to act to increase the success of this plan. This study may provide a benchmark for other developing countries trying to expand RT capacity.
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Affiliation(s)
- Andre G Gouveia
- Department of Oncology, Division of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Gustavo A Viani
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Vanessa F Bratti
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil
| | - Samir A Hanna
- Department of Oncology, Division of Radiation Oncology, Sírio Libanes Hospital, São Paulo, Brazil
| | - Alexandre A Jacinto
- Radiation Oncology Department, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Mauricio S Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria; and Clínica de Radioterapia de Santa Maria, Brazil
| | - Ana C Hamamura
- Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Arthur A Rosa
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiotherapy Department Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
| | - Marcus S Castilho
- Radiotherapy Department of the Felicio Rocho Hospital, Belo Horizonte, MG, Brazil; President, Brazilian Radiotherapy Society - SBRT, Brazil
| | - Laura Carson
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Wilma M Hopman
- Kingston General Health Research Institute; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, Global Oncology Group, King's College London, London, UK
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ajay Aggarwal
- Department of Oncology, Queen's University, Kingston, ON, Canada; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada; Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
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Shen X, Li L, He Y, Lv X, Ma J. EIF5A2 Is Involved in the Biological Process of Cervical Cancer Cells through AGR2. Pharmacology 2022; 107:376-385. [PMID: 35640539 DOI: 10.1159/000524017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervical cancer is a severe malignant tumor that endangers the health of women worldwide. Eukaryotic initiation factor-5A2 (EIF5A2) expression has been reported to be increased in cervical cancer and correlates with prognosis. An attempt was made in this paper to explore the impact and potential mechanisms of EIF5A2 in the cell biology of cervical cancer. METHODS We first knocked down EIF5A2 in cervical cancer cells. Then, we examined the proliferation, migration, invasion, and apoptosis of these cells by cell counting kit 8, wound healing, Transwell, and terminal deoxynucleotidyl transferase dUTP nick-end labeling assays. Cells were processed with different concentrations of cisplatin to observe their sensitivity to cisplatin. Next, the relationship between EIF5A2 and anterior gradient 2 (AGR2) was verified by co-immunoprecipitation. Following AGR2 overexpression, the biological processes of these cells were examined. RESULTS EIF5A2 knockdown inhibited cell proliferation, migration, and invasion, and it promoted apoptosis and enhanced the sensitivity to cisplatin in cervical cancer cells. Additionally, AGR2 expression was positively correlated with EIF5A2, and its overexpression alleviated the reduction in proliferation, migration, and invasion of cervical cancer cells induced by EIF5A2 knockdown. Overexpression of AGR2 also reduced apoptosis and their sensitivity to cisplatin in EIF5A2-knockdwon cervical cancer cells. CONCLUSION EIF5A2 knockdown inhibited the biological process of cervical cancer cells through modulation of AGR2. The in-depth investigation of the molecular mechanism of EIF5A2 in cervical cancer cells provides new strategies for the prevention and treatment of clinical malignancies.
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Affiliation(s)
- Xin Shen
- Department of Gastrointestinal Surgery, Xi'an Daxing Hospital, Xi'an, China
| | - Lingxia Li
- Department of Obstetrics & Gynecology, Fourth Military Medical University, Xi'an, China
| | - Yuanyuan He
- Department of Obstetrics & Gynecology, Fourth Military Medical University, Xi'an, China
| | - Xiaohui Lv
- Department of Obstetrics & Gynecology, Fourth Military Medical University, Xi'an, China
| | - Jiajia Ma
- Department of Obstetrics & Gynecology, Fourth Military Medical University, Xi'an, China
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Nguyen VT, Winterman S, Playe M, Benbara A, Zelek L, Pamoukdjian F, Bousquet G. Dose-Intense Cisplatin-Based Neoadjuvant Chemotherapy Increases Survival in Advanced Cervical Cancer: An Up-to-Date Meta-Analysis. Cancers (Basel) 2022; 14:cancers14030842. [PMID: 35159111 PMCID: PMC8834199 DOI: 10.3390/cancers14030842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Although neoadjuvant chemotherapy has become standard care for many locally advanced cancer sites, the benefit of neoadjuvant chemotherapy remains unclear for the treatment of locally advanced cervical cancer. With this meta-analysis, we set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Dose-intense cisplatin-based neoadjuvant chemotherapy followed by local therapy was significantly associated with a survival benefit in the treatment of locally advanced cervical carcinoma. Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Abstract Purpose: We set out to demonstrate the benefit of using dose-intense cisplatin-based neoadjuvant chemotherapy in terms of overall survival and progression-free survival. Methods: We searched through MEDLINE and Cochrane Library databases up to May 2021 to identify randomized clinical trials comparing the benefit of using cisplatin-based neoadjuvant chemotherapy followed by local treatment with local treatment alone for the treatment of locally advanced cervical cancer. The PRISMA statement was applied. Results: Twenty-two randomized clinical trials were retrieved between 1991 and 2019, corresponding to 3632 women with FIGO stages IB2-IVA cervical cancer. More than 50% of the randomized clinical trials were assessed as having a low risk of bias. There was no benefit of neoadjuvant chemotherapy on overall survival, but there was significant heterogeneity across studies (I2 = 45%, p = 0.01). In contrast, dose-intense cisplatin at over 72.5 mg/m2/3 weeks was significantly associated with increased overall survival (RR = 0.87, p < 0.05) with no heterogeneity across the pooled studies (I2 = 36%, p = 0.11). The survival benefit was even greater when cisplatin was administered at a dose over 105 mg/m2/3 weeks (RR = 0.79, p < 0.05). Conclusion: Even though radiotherapy combined with weekly cisplatin-based chemotherapy remains standard of care for the treatment of locally advanced cervical cancer, our meta-analysis makes it possible to consider the use of dose-intense cisplatin-based neoadjuvant chemotherapy when local treatment is suboptimal and opens perspectives for designing new clinical trials in this setting. Neoadjuvant chemotherapy could be proposed when surgery is local treatment instead of standard chemoradiotherapy for the treatment of locally advanced cervical cancer.
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Affiliation(s)
- Van Tai Nguyen
- National Cancer Hospital, Department of Medical Oncology 1, Hanoi 10000, Vietnam;
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
| | - Sabine Winterman
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
| | - Margot Playe
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service de Médecine Nucléaire, 93000 Bobigny, France;
| | - Amélie Benbara
- Assistance Publique Hôpitaux de Paris, Hôpital Jean Verdier, Service de Gynécologie—Obstétrique, 93140 Bondy, France;
| | - Laurent Zelek
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Université Sorbonne Paris Nord, 9 Avenue Jean Baptiste Clément, 93439 Villetaneuse, France
| | - Frédéric Pamoukdjian
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service de Médecine Gériatrique, 93000 Bobigny, France
| | - Guilhem Bousquet
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Service d’Oncologie Médicale, 93000 Bobigny, France; (S.W.); (L.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S942, Université de Paris-Université Sorbonne Paris Nord, 93000 Bobigny, France;
- Université Sorbonne Paris Nord, 9 Avenue Jean Baptiste Clément, 93439 Villetaneuse, France
- Correspondence:
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Mendez LC, Ravi A, Martell K, Raziee H, Alayed Y, Wronski M, Paudel M, Barnes E, Taggar A, Wong CS, Leung E. Comparison of CTV HR and organs at risk contours between TRUS and MR images in IB cervical cancers: a proof of concept study. Radiat Oncol 2020; 15:73. [PMID: 32252792 PMCID: PMC7137277 DOI: 10.1186/s13014-020-01516-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/18/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare CTVHR and OAR dimensions and inter-rater agreement between magnetic resonance (MR) and trans-rectal ultrasound (TRUS) images in IB cervical cancer patients. Methods IB cervical cancer patients treated with (chemo)radiotherapy plus MR-guided brachytherapy (BT) were prospectively enrolled in this study. Radiation oncologists contoured CTVHR and OARs in pre-BT MR images (MRI) and intra-operative TRUS images. These contours were subsequently compared in regard to volume and dimension. Contour inter-rater agreement analysis was also investigated using kappa index (KI). Stata 15.0 was used for statistical analysis and a p-value < 0.05 was considered statistically significant. Results TRUS CTVHR volumes were statistically smaller than the respective MRI contoured volumes. TRUS CTVHR thickness was found to be consistently smaller than MRI contours in all patients. No statistical difference was seen in width and height between the two different imaging modalities. MRI contours had a median KI of 0.66 (range: 0.56–0.77) while TRUS-based contours had a median KI of 0.64 (range: 0.47–0.77). Bladder and rectum had very satisfactory KI in both imaging modalities. Vaginal contours had moderate agreement in MR (0.52) and in TRUS images (0.58). Conclusion TRUS images allow good visualization of CTVHR and OARs in IB cervical cancer patients. Inter-rater contour variability was comparable between TRUS and MR images. TRUS is a promising modality on its own for image-guided BT.
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Affiliation(s)
- Lucas C Mendez
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Division of Radiation Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Ananth Ravi
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Martell
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hamid Raziee
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yasir Alayed
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Radiation Oncology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Matt Wronski
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moti Paudel
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elizabeth Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C S Wong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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