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Zhou Y, Wang W, Tang J, Hu K, Zhang F. Comparison of outcomes between early-stage cervical cancer patients without high-risk factors undergoing adjuvant concurrent chemoradiotherapy and radiotherapy alone after radical surgery. BMC Cancer 2024; 24:548. [PMID: 38689248 PMCID: PMC11061922 DOI: 10.1186/s12885-024-12284-9] [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: 08/07/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE For patients with early-stage cervical cancer without high-risk factors, there is no consensus regarding the optimal postoperative treatment regimen and whether postoperative concurrent radiochemotherapy (CCRT) is superior to radiotherapy (RT) alone. PATIENTS AND METHODS The medical records of patients with stage I-IIA cervical cancer, who underwent radical surgery and postoperative RT or CCRT between June 2012 and December 2017, were retrospectively reviewed. Patients with any high-risk factors, including positive pelvic lymph node(s), positive resection margin(s), and parametrial invasion, were excluded. Patients with large tumors (≥ 4 cm), deep stromal invasion (≥ 1/2), and lymphovascular space involvement were categorized as the intermediate-risk group. Patients without intermediate-risk factors were categorized as the low-risk group. RESULTS A total of 403 patients were enrolled and divided into 2 groups according to postoperative treatment: RT alone (n = 105); and CCRT (n = 298). For risk stratification, patients were also divided into 2 groups: intermediate-risk (n = 350); and low-risk (n = 53). The median follow-up was 51.7 months. Patients in the intermediate-risk group and those with multiple intermediate-risk factors were more likely to undergo CCRT. For patients who underwent RT alone or CCRT in the intermediate-risk group, 5-year overall survival (OS) rates were 93.4% and 93.8% (p = 0.741), and 5-year disease-free survival (DFS) rates were 90.6% and 91.4%, respectively (p = 0.733). Similarly, for patients who underwent RT alone or CCRT in the low-risk group, the 5-year OS rates were 100.0% and 93.5% (p = 0.241), and 5-year DFS rates were 94.4% and 93.5%, respectively (p = 0.736). Adjuvant CCRT or RT were not independent risk factors for either OS or DFS. Patients who underwent CCRT appeared to develop a higher proportion of grade ≥ 3 acute hematological toxicities than those in the RT group (44.0% versus 11.4%, respectively; p < 0.001). There was no significant difference in grade ≥ 3 chronic toxicities of the urogenital and gastrointestinal systems between the CCRT and RT groups. CONCLUSION There was no significant difference in 5-year OS and DFS rates between patients with early-stage cervical cancer without high-risk factors undergoing postoperative CCRT versus RT alone. Patients who underwent CCRT appeared to develop a higher proportion of grade ≥ 3 acute hematological toxicities than those who underwent RT alone.
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Affiliation(s)
- Yuncan Zhou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Tang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kinjo Y, Matsuura Y, Ohguri T, Aoyama Y, Murakami M, Hoshino K, Harada H, Ueda T, Kurita T, Kagami S, Yoshino K. Retrospective analysis of prognosis using the Gynecology Oncology Group score of stage IB‑IIA node negative uterine cervical cancer after radical hysterectomy and trachelectomy. Mol Clin Oncol 2022; 16:105. [PMID: 35620209 PMCID: PMC9112379 DOI: 10.3892/mco.2022.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/08/2022] Open
Abstract
There is currently controversy regarding the criteria for low and intermediate risk of cervical cancer (CC) after surgery. In the present study, the Gynecology Oncology Group (GOG) score was used to detect intermediate risk. Adjuvant radiotherapy was applied in the case of a GOG score >120. The present study aimed to evaluate the validity of the recurrence risk classification using the GOG score for stage IB-IIA node-negative CC. All cases of stage IB-IIA node-negative CC who underwent radical surgery between February 2007 and December 2015 were retrospectively reviewed. The GOG scores were determined from clinical and pathological findings and accordingly, subjects were divided into 4 groups: A, ≤40; B, >40 and ≤70; C, >70 and ≤120; and D, >120. Overall survival (OS) and recurrence-free survival (RFS) curves were generated using the Kaplan-Meier method. The log-rank test produced an estimated P-value by comparing the OS and RFS of group A (low-score group) with those of others. The present study included 61 patients (mean age, 47.82 years; age range, 22-76 years) and the median follow-up was 79 (39-149) months. Of these, 60 patients were observed for at least 60 months. During the follow-up period, the OS and RFS rates of group C were 94.7 and 84.2%, respectively, while those of group D were 100 and 91.7%, respectively; the OS and RFS of groups A and B were 100%. Log-rank tests for all OS and RFS indicated no significant differences compared to group A. It was indicated that a GOG score ≤70 does not require adjuvant therapy; however, a GOG score >70 requires consideration of adjuvant therapy based on the risk factors which constitute the score.
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Affiliation(s)
- Yasuyuki Kinjo
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Yusuke Matsuura
- Department of Nursing of Human Broad Development, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Takayuki Ohguri
- Department of Radiology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Yoko Aoyama
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Midori Murakami
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Kaori Hoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Hiroshi Harada
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Taeko Ueda
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Tomoko Kurita
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Seiji Kagami
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka 807‑8555, Japan
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Zhang H, Yu R, Zhang L, Wang R, Xiao L. Chemotherapy versus chemoradiotherapy for FIGO stages IB1 and IIA1 cervical squamous cancer patients with lymphovascular space invasion: a retrospective study. BMC Cancer 2022; 22:202. [PMID: 35193525 PMCID: PMC8864837 DOI: 10.1186/s12885-022-09309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the impact of different adjuvant therapy on IB1 and IIA1 stage cervical squamous cell cancer patients with lymphovascular space invasion. It also aimed to analyze the relationship between lymphovascular space invasion and other clinical pathological characteristics on IB1 and IIA1 stage cervical squamous cell cancer patients. Methods This retrospective observational study collected data of FIGO stages IB1 and IIA1 squamous cervical cancer patients at the First Affiliated Hospital of Chongqing Medical University between 2014 and 2018. A correlation analysis between lymphovascular space invasion and other clinical or pathological factors was conducted. Prognosis analysis of patients with lymphovascular space invasion were performed to assess associations between clinical-pathological characteristics and survival. Results A total of 357 women were identified including 110 (30.8%) with lymphovascular space invasion, 247 (69.2%) without lymphovascular space invasion. Both middle 1/3 cervical stromal invasion (p = 0.000) and deep 1/3 cervical stromal invasion (p = 0.000) were independently associated with lymphovascular space invasion. Among lymphovascular space involved women, tumor differentiation (P = 0.001) and postoperative therapy (P = 0.036) had a significant influence on disease recurrence. Multivariate analysis showed that lymph node metastasis (P = 0.017), poorer tumor differentiation (P = 0.036) and postoperative chemotherapy alone (P = 0.021) can increase the risk of tumor relapse. Conclusion Our study suggested that the presence of deep stromal invasion independently increases the risk of lymphovascular space invasion. Compared with chemotherapy, chemoradiotherapy seems to improve progression-free survival in squamous cervical cancer patients with lymphovascular space invasion.
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Affiliation(s)
- Hao Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rao Yu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rong Wang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lin Xiao
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Kim H, Kim MW, Jeong YIL, Yang HS. Redox-Sensitive and Folate-Receptor-Mediated Targeting of Cervical Cancer Cells for Photodynamic Therapy Using Nanophotosensitizers Composed of Chlorin e6-Conjugated β-Cyclodextrin via Diselenide Linkage. Cells 2021; 10:cells10092190. [PMID: 34571839 PMCID: PMC8465130 DOI: 10.3390/cells10092190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to fabricate a reactive oxygen species (ROS)-sensitive and folate-receptor-targeted nanophotosensitizer for the efficient photodynamic therapy (PDT) of cervical carcinoma cells. Chlorin e6 (Ce6) as a model photosensitizer was conjugated with succinyl β-cyclodextrin via selenocystamine linkages. Folic acid (FA)-poly(ethylene glycol) (PEG) (FA-PEG) conjugates were attached to these conjugates and then FA-PEG-succinyl β-cyclodextrin-selenocystamine-Ce6 (FAPEGbCDseseCe6) conjugates were synthesized. Nanophotosensitizers of FaPEGbCDseseCe6 conjugates were fabricated using dialysis membrane. Nanophotosensitizers showed spherical shapes with small particle sizes. They were disintegrated in the presence of hydrogen peroxide (H2O2) and particle size distribution changed from monomodal distribution pattern to multimodal pattern. The fluorescence intensity and Ce6 release rate also increased due to the increase in H2O2 concentration, indicating that the nanophotosensitizers displayed ROS sensitivity. The Ce6 uptake ratio, ROS generation and cell cytotoxicity of the nanophotosensitizers were significantly higher than those of the Ce6 itself against HeLa cells in vitro. Furthermore, the nanophotosensitizers showed folate-receptor-specific delivery capacity and phototoxicity. The intracellular delivery of nanophotosensitizers was inhibited by folate receptor blocking, indicating that they have folate-receptor specificity in vitro and in vivo. Nanophotosensitizers showed higher efficiency in inhibition of tumor growth of HeLa cells in vivo compared to Ce6 alone. These results show that nanophotosensitizers of FaPEGbCDseseCe6 conjugates are promising candidates as PDT of cervical cancer.
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Affiliation(s)
- Howard Kim
- Department of Medicine, Graduate School, Dongguk University, Gyeongju 38067, Korea;
| | - Mi Woon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dongguk University, Gyeongju 38067, Korea;
| | - Young-IL Jeong
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Gyeongnam 50612, Korea
- The Institute of Dental Science, Chosun University, Gwangju 61452, Korea
- Correspondence: (Y.-I.J.); (H.S.Y.)
| | - Hoe Saeng Yang
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Gyeongju 38067, Korea
- Correspondence: (Y.-I.J.); (H.S.Y.)
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Cao L, Wen H, Feng Z, Han X, Zhu J, Wu X. Role of adjuvant therapy after radical hysterectomy in intermediate-risk, early-stage cervical cancer. Int J Gynecol Cancer 2020; 31:52-58. [PMID: 33303568 DOI: 10.1136/ijgc-2020-001974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Adjuvant treatment remains a controversial issue for intermediate-risk cervical cancer. The aim of this study was to compare the prognosis of patients who underwent no adjuvant treatment, pelvic radiotherapy alone, or concurrent chemoradiotherapy after radical hysterectomy for intermediate-risk, early-stage cervical cancer. METHODS Patients with stage IB1-IIA2 (FIGO 2009) cervical squamous cell carcinoma treated with radical hysterectomy and pelvic lymph node dissection, with negative lymph nodes, surgical margins, or parametria, who had combined intermediate risk factors as defined in the Gynecologic Oncology Group trial (GOG-92; Sedlis criteria) were included in the study. Recurrence-free survival and disease-specific survival were compared. RESULTS Of 861 patients included in the analysis, 85 patients received no adjuvant treatment, 283 patients were treated with radiotherapy, and 493 patients with concurrent chemoradiotherapy. After a median follow-up of 63 months (IQR 45 to 84), adjuvant radiotherapy or concurrent chemoradiotherapy was not associated with a survival benefit compared with no adjuvant treatment. The 5-year recurrence-free survival and corresponding disease-specific survival were 87.1%, 84.2%, 89.6% (p=0.27) and 92.3%, 87.7%, 91.4% (p=0.20) in the no adjuvant treatment, radiotherapy alone, and concurrent chemoradiotherapy groups, respectively. Lymphovascular space invasion was the only independent prognostic factor for both recurrence-free survival and disease-specific survival. Additionally, significant heterogeneity exists in Sedlis criteria: higher risk of relapse (HR=1.88; 95% CI 1.19 to 2.97; p=0.007) and death (HR=2.36; 95% CI 1.41 to 3.95; p=0.001) occurred in patients with lymphovascular space invasion and deep 1/3 stromal invasion compared with no lymphovascular space invasion, middle or deep 1/3 stromal invasion, and tumor diameter ≥4 cm. CONCLUSIONS Radical hysterectomy alone without adjuvant treatment may achieve a favorable survival for patients with intermediate-risk cervical cancer as defined by Sedlis criteria. Criteria for adjuvant treatment in patients without high risk factors need to be further evaluated.
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Affiliation(s)
- Lijie Cao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Wen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zheng Feng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaotian Han
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jun Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China .,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Zhu J, Lou R, Ji S, Wu G, Chen Q, Hu Q, Zhao Y, Cai D, Gu K. Weekly versus triweekly cisplatin-alone adjuvant chemoradiotherapy after radical hysterectomy for stages IB-IIA cervical cancer with risk of recurrence. Anticancer Drugs 2020; 32:203-209. [PMID: 33186140 DOI: 10.1097/cad.0000000000001018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Weekly and triweekly cisplatin-alone concomitant chemoradiotherapy regimens after radical surgery were compared in stages IB-IIA cervical cancer with intermediate- or high-risk factors to identify the better therapeutic regimen. We retrospectively analyzed patients with stages IB-IIA cervical cancer who received radical hysterectomy followed by concurrent adjuvant chemoradiotherapy to compare the efficiency between weekly and triweekly regimen groups. We evaluated between-group differences in survival, recurrence, compliance, and adverse effects. A total of 217 patients were included in this study (triweekly group vs. weekly group; 97 vs. 120). The mean follow-up was 47.2 months. The 5-year disease-free survival (DFS) was 84.4% or 76.5% for patients treated with triweekly cisplatin chemotherapy or the weekly regimen, respectively (P = 0.110). The 5-year overall survival (OS) was 82.4 and 78.6% for the same treatment groups, respectively (P = 0.540). The DFS of the patients with pelvic lymph node metastasis were marginally better in triweekly regimen group compared with the weekly group (P = 0.031). Grades 3-4 leukopenia was significantly more common in the triweekly group (P = 0.028). The weekly cisplatin chemotherapy group experienced the same therapeutic effect as the triweekly cisplatin-alone chemotherapy group but with less toxicity. However, triweekly cisplatin regimen reduced the recurrence in patients with pelvic lymph node metastasis.
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Affiliation(s)
- Jiahao Zhu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Rui Lou
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
| | - Gang Wu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Qingqing Chen
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
| | - Qunchao Hu
- Department of Radiation Oncology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Yutian Zhao
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Dongyan Cai
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Ke Gu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
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Akilli H, Tohma YA, Bulut AN, Karakas LA, Haberal AN, Kuscu UE, Ayhan A. Comparison of no adjuvant treatment and radiotherapy in early-stage cervical carcinoma with intermediate risk factors. Int J Gynaecol Obstet 2020; 149:298-302. [PMID: 32246761 DOI: 10.1002/ijgo.13147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/15/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the results of receiving no adjuvant treatment (NAT) or radiotherapy after radical hysterectomy in patients with International Federation of Gynecology and Obstetrics 2018 Stage IB1-IB3 cervical cancer with intermediate risk factors. METHODS A retrospective cohort study was conducted at Baskent University School of Medicine's Department of Gynecology and Obstetrics in Ankara, Turkey between January 1, 2008, and December 31, 2016. In total, 134 women with at least two intermediate risk factors (positive LVSI, deep stromal invasion, and tumor size ≥4 cm) were included in the study. Patients were divided into two groups: NAT and radiotherapy. RESULTS There were 66 patients in the NAT group and 68 in the radiotherapy group. The median follow-up time was 61.05 months. The 5-year overall survival (OS) rates were similar in both groups (84.1% vs 82.9%, respectively; P=0.57), while the 5-year disease-free survival (DFS) rates were 80.2% and 78.2% in the NAT and radiotherapy groups, respectively (P=0.25). Most importantly, both groups had similar local recurrence rates: 8 (12.1%) in the NAT group and 9 (13.2%) in the radiotherapy group (P=0.82). Multivariant analyses showed that the only independent risk factor for recurrence was tumor size ≥4 cm with a hazard ratio of 2.4 (95% confidence interval 1.12-5.24; P=0.02). CONCLUSION Adjuvant treatment improved neither DFS nor local recurrence rates.
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Affiliation(s)
- Huseyin Akilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
| | - Yusuf A Tohma
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey
| | - Ayça N Bulut
- Department of Obstetrics and Gynecology, City Hospital, Kayseri, Turkey
| | - Latife Atasoy Karakas
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey
| | - Asuman N Haberal
- Department of Pathology, Baskent University School of Medicine, Ankara, Turkey
| | - Ulku E Kuscu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
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Li M, Hu M, Wang Y, Yang X. Adjuvant chemoradiotherapy versus radiotherapy in cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 238:1-6. [DOI: 10.1016/j.ejogrb.2019.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/17/2019] [Accepted: 04/28/2019] [Indexed: 01/23/2023]
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Tong J, Yu H, Li J, Zhou J, Ma X, Yang J. Short-term recurrence and distant metastasis following robotic-assisted radical hysterectomy with pelvic lymphadenectomy and chemoradiotherapy for a stage IB1 cervical adenocarcinoma: A case report and literature review. Medicine (Baltimore) 2019; 98:e15387. [PMID: 31027131 PMCID: PMC6831419 DOI: 10.1097/md.0000000000015387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Postoperative concurrent chemoradiotherapy (CCRT) is considered the standard treatment for patients with early stage cervical cancer with positive pelvic nodes, yet many patients with high-risk factors treated with CCRT still suffered from distant metastasis. PATIENT CONCERNS A 48-year-old woman presented with abnormal vaginal bleeding for 5 months. Thin prep liquid-based cytology test revealed low-grade squamous intraepithelial lesion and the human papillomavirus test (type 58) was positive. Magnetic resonance imaging showed a mass measuring 17 × 15 mm, located predominantly in the posterior lip of uterine cervix. Colposcopy biopsy reported adenocarcinoma of the cervix. DIAGNOSIS Cervical adenocarcinoma stage IB1. INTERVENTIONS A robotic-assisted radical hysterectomy with pelvic lymphadenectomy was performed followed by postoperative CCRT. OUTCOMES Distant metastasis was occurred shortly after postoperative CCRT and the patient died 9 months from initial diagnosis. LESSONS In cases of new nodule in bones, lower abdominal distension and bloating occurring shortly after CCRT in early stage cervical adenocarcinoma, clinicians should bear in mind that recurrence should be considered. Development of more effective treatment to improve the survival outcomes of patients with postoperative metastasis is needed.
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Affiliation(s)
- Jinfei Tong
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Hailan Yu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jianqiong Li
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jiena Zhou
- Zhibu Town Health Center, Zhuji, Zhejiang Province, China
| | - Xudong Ma
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jianhua Yang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
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Sun HY, Tang Q, Chen JH, Lv XJ, Tu YQ, Yan DD. Cisplatin concurrent chemoradiotherapy vs adjuvant radiation in stage IB/IIA cervical cancer with intermediate risk factors, treated with radical surgery: a retrospective study. Onco Targets Ther 2018; 11:1149-1155. [PMID: 29563803 PMCID: PMC5846308 DOI: 10.2147/ott.s158214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine if postoperative cisplatin concurrent chemoradiotherapy (CCRT) improves the outcome in stage IA/IIB cervical cancer patients with intermediate risk factors, when compared with radiation therapy (RT) alone, and identify the potential eligible populations for this treatment. Patients and methods We reviewed medical records of 1,240 patients with stage IA/IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in our hospital between January 2008 and December 2011. Of the 1,240 patients, 436 displayed 1 or more intermediate risk factors. Of these, we screened 306 patients who underwent RT only or CCRT. We analyzed the effects of CCRT on survival and prognosis. Results The 5-year progress-free survival (PFS) in the CCRT group was superior to that in the RT-only group (96.0% vs 89.0%, respectively; P=0.031). The 5-year overall survivals (OSs) were not different between the 2 groups (P=0.141). Compared with RT-only group, CCRT did not improve PFS or OS in patients with 1 risk factor, large tumor size, or deep stromal invasion (P>0.05). Compared with RT-only group, CCRT improved PFS (97.9% vs 82.8%; P=0.017) but did not increase OS (97.9% vs 89.7%; P=0.109) in patients with lymphovascular space invasion plus deep stromal invasion/large tumor size. OS (92.3% vs 70.6%; P=0.048) and PFS (92.3% vs 64.7%; P=0.020) in the CCRT group were superior to those in the RT-only group with 3 risk factors. Compared with RT-only group, CCRT was an independent prognostic factor for favorable PFS (hazard ratio [HR] =0.238; 95% CI =0.0827-0.697, P=0.009) and OS (HR =0.192; 95% CI =0.069-0.533, P=0.002). Conclusion Postoperative CCRT improved survival in stage IA/IIB cervical cancer patients with intermediate risk factors. Patients with 2 or more intermediate risk factors, including lymphovascular space invasion, may benefit from CCRT.
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Affiliation(s)
- Hai-Yan Sun
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qiu Tang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian-Hong Chen
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiao-Juan Lv
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ye-Qiang Tu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ding-Ding Yan
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
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Zhao D, Qiu H, Zhang H, Hong L, Zhang G, Xie C. Treatment results of adjuvant pelvic radiotherapy after radical hysterectomy for low-risk Stage IB1-IIA cervical cancer. Jpn J Clin Oncol 2018; 47:1024-1030. [PMID: 28973662 DOI: 10.1093/jjco/hyx127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of the present retrospective analysis was to determine the effectiveness of pelvic radiotherapy (RT) as postoperative adjuvant therapy for low-risk cervical cancer. Methods Between June 2003 and April 2011, the clinical data of 225 International Federation of Gynecology and Obstetrics (FIGO) Stage IB1-IIA cervical cancer patients with low-risk factors were retrospectively reviewed, to analyze the relationship between adjuvant pelvic RT after radical hysterectomy and tumor recurrence or the patients' survival. Results The 5-year overall survival (OS) of 225 patients was 91.2% and 5-year disease-free survival (DFS) was 84.5%. The 5-year DFS and local regional disease-free survival was significantly better for patients in the RT group compared with that in the non-RT group (5-year DFS, 91.2% vs. 77.1%, P = 0.006; 5-year local regional disease-free survival 94.6% vs. 79.0%, P = 0.001). There were no statistically significant differences in the 5-year OS (92.9% vs. 89.4%, P = 0.371) and distant metastasis-free survival (96.4% vs. 96.5%, P = 0.887) between the two groups. Grade 3-4 treatment-related acute and late toxicities were not significantly different between the two groups. Subgroup analysis shows the 5-year DFS of RT alone, chemotherapy (CT) alone, non-RT/CT, RT and CT was, respectively, 90.5%, 62.9%, 81.4%, 92.5% separately (P = 0.002). The 5-year OS was not significantly different (91.6% vs. 78.2% vs. 92.9% vs. 96.9%, P = 0.887) between the four groups. Performing univariate analysis, postoperative CT was the only significant risk factor for DFS. Conclusions Our results indicate that postoperative adjuvant pelvic RT has a tendency to improve DFS especially local regional disease-free survival for FIGO Stage IB1-IIA cervical cancer patients with low-risk factors, without increased Grade 3-4 treatment-related acute and late toxicities, but non-standard CT is harmful to the prognosis (DFS) of these patients.
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Affiliation(s)
- Deying Zhao
- Department of Medical Oncology, Huanggang Central Hospital
| | - Hui Qiu
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China
| | - Hui Zhang
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China
| | - L Hong
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China
| | - Gong Zhang
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China
| | - Conghua Xie
- Department of Radiation & Medical Oncology, Zhongnan Hospital of Wuhan University; Cancer Clinical Study Center of Hubei Province; Hubei Key Laboratory of Tumor Biological Behavior, Hubei, China
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Lan ML, Yu X, Xiao H, Zhou P, Hu N, Liu Y, Wang G. Comparison of chemoradiotherapy with and without brachytherapy as adjuvant therapy after radical surgery in early-stage cervical cancer with poor prognostic factors: An observational study. Medicine (Baltimore) 2017; 96:e8384. [PMID: 29145247 PMCID: PMC5704792 DOI: 10.1097/md.0000000000008384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to determine whether the addition of intracavitary brachytherapy (ICBT) to chemoradiotherapy (CRT) improves outcome in patients with cervical cancer and poor prognostic factors. Patients with stage IB to IIA cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy between August 2008 and December 2014 were retrospectively registered in this study. All patients received external beam radiation therapy (EBRT) + chemotherapy, and some patients additionally received ICBT. EBRT consisted of 45 to 50.4 Gy delivered to the standard pelvic field in 25 to 28 fractions. Chemotherapy consisted of 2 to 4 courses of weekly cisplatin-based treatment. ICBT was delivered in 1 to 3 insertions. Ninety-seven of 163 patients received CRT, and 66 patients additionally received ICBT. During a median follow-up period of 33 months, recurrence was detected in 38 patients. The 3-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates did not differ significantly between patients who did and did not receive ICBT. In subgroup analyses, fewer recurrences were seen in patients with at least 1 high-risk factor who received ICBT than in those who did not, with a significant (62%) reduction in the risk of progression or death (hazard ratio 0.384, 95% confidence interval 0.151-0.978, P = .045). The difference in OS between the CRT and CRT + ICBT subgroups was marginal (P = .064). The addition of ICBT to CRT after radical surgery significantly improves LRC and DFS rates in women with cervical cancer and at least 1 high-risk factor.
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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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Li L, Song X, Liu R, Li N, Zhang Y, Cheng Y, Chao H, Wang L. Chemotherapy versus radiotherapy for FIGO stages IB1 and IIA1 cervical carcinoma patients with postoperative isolated deep stromal invasion: a retrospective study. BMC Cancer 2016; 16:403. [PMID: 27387204 PMCID: PMC4936260 DOI: 10.1186/s12885-016-2447-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background The adjuvant treatment for patients with isolated stromal invasion after radical hysterectomy and pelvic lymph node dissection (PLND) in FIGO stage IB1 and IIA1 cervical carcinoma has not been established. This study assessed the survival outcomes and recurrent patterns in this particular group of patients treated with chemotherapy or radiation-based adjuvant therapy. Methods The records 133 IB1 and IIA1 postoperative cervical carcinoma patients with histopathology-confirmed isolated deep stromal invasion (DSI) without any other unfavorable pathological finding between June 2010 and March 2013 were analyzed. Sixty-five patients received postoperative adjuvant four to six cycles of cisplatin-based chemotherapy (CT group) and Sixty-eight received postoperative received postoperative adjuvant radiotherapy (RT group). Treatment-related toxicities were evaluated and disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and statistical significance was determined using the log-rank test. Results With a median follow-up of 33.7 months (range 10–62 months), RT group had a significantly improved in DFS rate (P = 0.044), but there was no significant difference in overall survival (P = 0.437). Upon further analysis, patients with outer 1/3 to full-thickness invasion in chemotherapy group exhibited significantly higher recurrence rates compared to the radiotherapy group. Leukocytopenia, nausea and vomiting were the most frequent short-term complications of chemotherapy, whereas colitis/proctitis and cystitis were more frequent in the radiotherapy group (P = 0.000 respectively). No significant differences were found regards to other acute toxicities, including hemoglobin, platelets and ALT/AST, colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively). Fewer late severe side effects in the chemotherapy group were observed compared with the radiation group and significant differences were found at colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively). Conclusion Compared to chemotherapy alone, postoperative RT to FIGO stages IB1 and IIA1 cervical carcinoma patients with isolated DSI can reduce risk of recurrence and with acceptable morbidity.
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Affiliation(s)
- Lei Li
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China.
| | - XiaoYan Song
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - RuoNan Liu
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Nan Li
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Ye Zhang
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Yan Cheng
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - HongTu Chao
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - LiYing Wang
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
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Yang J, Yin J, Yan G, Huang D, Wang J. Postoperative chemoradiotherapy versus radiotherapy alone for cervical cancer: A systematic review and meta-analysis. J OBSTET GYNAECOL 2016; 36:641-8. [PMID: 26821995 DOI: 10.3109/01443615.2015.1134458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jialin Yang
- Radiotherapy Department, Sichuan Cancer Hospital, Chengdu, China
| | - Jun Yin
- Radiotherapy Department, Sichuan Cancer Hospital, Chengdu, China
| | - Gaoshu Yan
- Radiotherapy Department, Sichuan Cancer Hospital, Chengdu, China
| | - Dandan Huang
- Radiotherapy Department, Sichuan Cancer Hospital, Chengdu, China
| | - Jichuan Wang
- Radiotherapy Department, Sichuan Cancer Hospital, Chengdu, China
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Sun W, Wang T, Shi F, Wang J, Wang J, Hui B, Zhang Y, Lu J, Chen H, Liu Z. Randomized phase III trial of radiotherapy or chemoradiotherapy with topotecan and cisplatin in intermediate-risk cervical cancer patients after radical hysterectomy. BMC Cancer 2015; 15:353. [PMID: 25935645 PMCID: PMC4425857 DOI: 10.1186/s12885-015-1355-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/23/2015] [Indexed: 11/13/2022] Open
Abstract
Background In cervical cancer patients with intermediate-risk factors, the optimal adjuvant therapy is still controversial. We undertook a randomized trial (ClinicalTrials.gov Identifier: NCT01418859) to compare the efficacy and toxicity of concurrent chemoradiotherapy with topotecan and cisplatin with radiotherapy alone in intermediate-risk cervical cancer patients. Methods Eligible patients were randomly assigned to one of three treatment arms including arm A (radiotherapy only,RT), arm B(concurrent chemoradiotherapy only, CCRT), and arm C (concurrent chemoradiotherapy with following consolidation chemotherapy, CCRT + CT). All eligible patients completed external RT (IMRT or 3D-CRT), receiving 45-50Gy /25f uniformly to the pelvis. Concurrent chemotherapy regimen was topotecan 0.75 mg/m2 for days 1, 2 and 3, followed by cisplatin 25 mg/m2 for days 1, 2 and 3. Three cycles of consolidation chemotherapy regimen was topotecan 1.5 mg/m2 for days 1 and 2, and 0.75 mg/m2 for day 3; followed by cisplatin 25 mg/m2 for days 1, 2 and 3, repeated every 21 days. Adverse events of each group were investigated and compared. Results Thirty-nine patients enrolled onto the remaining regimens: 14 to RT, 15 to CCRT and 10 to CCRT + CT. Six patients (15.4%) did not complete the protocol treatment. Hematologic toxicity was more frequent and more severe in the CCRT and CCRT + CT arms compared with the RT arm. The incidence of grade 3-4 neutropenia was significantly different statistically between the RT, CCRT and CCRT + RT groups (15.4%, 46.7% and 100%, respectively; P = 0.002). Specially, three patients in CCRT + CT arm of all six patients who did not complete the protocol treatment discontinued planned therapy because of persistent grade 4 neutropenia. However, there were no significant differences in grade 3-4 non-hematologic toxicities between the three groups(all P > 0.05). Recurrence-free survival and overall survival of each group were not analyzed on account of a median follow-up of only 16 months. Conclusions Concurrent chemoradiotherapy with topotecan and cisplatin showed severe hematologic toxicity in intermediate-risk cervical cancer patients after radical hysterectomy. Thus, the study was closed ahead of schedule. Trial registration ClinicalTrials.gov Identifier: NCT01418859.
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Affiliation(s)
- Wenze Sun
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Tao Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Fan Shi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Jiquan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Juan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Beina Hui
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Yingbing Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Jinli Lu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Hongwei Chen
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Yanta District, Xi'an, 710061, China.
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Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors: A 13-Year Experience. Int J Gynecol Cancer 2013; 23:567-75. [DOI: 10.1097/igc.0b013e31828703fd] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesTo identify groups of patients who derive clinical benefit from postoperative adjuvant concurrent chemoradiotherapy (CCRT), we retrospectively investigated the survival outcomes of surgically treated early-stage cervical cancer patients.MethodsWe reviewed the medical records of 316 patients with FIGO stage IB1-IIB cervical cancer who had been treated with adjuvant radiotherapy (RT) (n = 124, RT group) or adjuvant CCRT (n = 192, CCRT group) after radical hysterectomy between January 1996 and December 2009. Of these, 187 patients displayed high-risk prognostic factors (high-risk group), and 129 displayed intermediate-risk prognostic factors (intermediate-risk group). Sixty patients with 1 intermediate-risk prognostic factor who received no adjuvant therapy were also identified and used as controls (NFT group). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.ResultsIn the high-risk group, adjuvant CCRT was significantly superior to RT alone with regard to recurrence rate, progression-free survival (PFS), and overall survival. In the intermediate-risk group, CCRT was superior to RT with regard to recurrence rate and PFS in patents with 2 or more risk factors. Among the patients with only 1 intermediate-risk factor, although no survival benefit of CCRT over RT was observed, addition of adjuvant treatment resulted in significantly improved PFS compared with the NFT group in patients with deep stromal invasion (log-rank, P = 0.012).ConclusionsPostoperative CCRT improved the prognosis of FIGO stage IB1-IIB cervical cancer patients in the high-risk group and patients who displayed 2 or more intermediate-risk factors. Patients who displayed deep stromal invasion alone also derived clinical benefit from adjuvant treatment.
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Marnitz S, Köhler C, Affonso RJ, Schneider A, Chiantera V, Tsounoda A, Vercellino F. Validity of Laparoscopic Staging to Avoid Adjuvant Chemoradiation following Radical Surgery in Patients with Early Cervical Cancer. Oncology 2012; 83:346-53. [DOI: 10.1159/000341659] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
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20 year experience of postoperative radiotherapy in IB-IIA cervical cancer patients with intermediate risk factors: impact of treatment period and concurrent chemotherapy. Gynecol Oncol 2011; 124:63-7. [PMID: 22004904 DOI: 10.1016/j.ygyno.2011.09.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 09/21/2011] [Accepted: 09/24/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the long-term clinical outcomes of adjuvant radiotherapy (RT) versus concurrent chemoradiotherapy (CCRT) in cervical cancer patients with intermediate risk factors. METHODS Between 1990 and 2010, 110 cervical cancer patients with 2 or more intermediate risk factors (deep stromal invasion, lymphovascular space invasion, and large tumor size) underwent adjuvant RT (n=56) or CCRT (n=54) following radical surgery. Because CCRT had been performed since 2000, patients were divided into 3 groups regarding treatment period and the addition of chemotherapy, RT 1990-1999 (n=39), RT 2000-2010 (n=17) and CCRT 2000-2010 (n=54). Majority of concurrent chemotherapeutic regimens were carboplatin and paclitaxel (n=48). RESULTS Five-year relapse-free survival (RFS) rates for RT 1990-1999, RT 2000-2010 and CCRT 2000-2010 were 83.5%, 85.6% and 93.8%, respectively. CCRT 2000-2010 had a significant decrease in pelvic recurrence (p=0.012) and distant metastasis (p=0.027). There were no significant differences in overall survival and RFS between RT 1990-1999 and RT 2000-2010. Acute grade 3 and 4 hematologic toxicities were more frequently observed in CCRT 2000-2010 (p<0.001). However, acute grade 3 and 4 gastrointestinal (GI) and chronic toxicities did not differ between the groups. CONCLUSIONS This study shows that the addition of concurrent chemotherapy to postoperative RT in cervical cancer patients with intermediate risk factors may improve RFS without increasing acute GI and chronic toxicities, although hematologic toxicities increased significantly.
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Ryu SY, Park SI, Nam BH, Cho CK, Kim K, Kim BJ, Kim MH, Choi SC, Lee ED, Lee KH. Is Adjuvant Chemoradiotherapy Overtreatment in Cervical Cancer Patients With Intermediate Risk Factors? Int J Radiat Oncol Biol Phys 2011; 79:794-9. [DOI: 10.1016/j.ijrobp.2009.11.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/27/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2010; 22:87-93. [DOI: 10.1097/gco.0b013e328335462f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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