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Schmid MP, Lindegaard JC, Mahantshetty U, Tanderup K, Jürgenliemk-Schulz I, Haie-Meder C, Fokdal LU, Sturdza A, Hoskin P, Segedin B, Bruheim K, Huang F, Rai B, Cooper R, van der Steen-Banasik E, Van Limbergen E, Pieters BR, Petric P, Ramazanova D, Ristl R, Kannan S, Hawaldar R, Ecker S, Kirchheiner K, Tan LT, Nout R, Nesvacil N, de Leeuw A, Pötter R, Kirisits C. Risk Factors for Local Failure Following Chemoradiation and Magnetic Resonance Image-Guided Brachytherapy in Locally Advanced Cervical Cancer: Results From the EMBRACE-I Study. J Clin Oncol 2023; 41:1933-1942. [PMID: 36599120 DOI: 10.1200/jco.22.01096] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging-based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.
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Affiliation(s)
- Maximilian P Schmid
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | | | - Umesh Mahantshetty
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai and Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Ina Jürgenliemk-Schulz
- University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, the Netherlands
| | | | - Lars U Fokdal
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Alina Sturdza
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Barbara Segedin
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kjersti Bruheim
- The Norwegian Radium Hospital, Oslo University Hospital, Department of Oncology, Oslo, Norway
| | - Fleur Huang
- Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada
| | - Bhavana Rai
- Postgraduate Institute of Medical Education and Research, Department of Radiotherapy and Oncology, Chandigarh, India
| | - Rachel Cooper
- St James's University Hospital, Leeds Cancer Centre, Leeds, United Kingdom
| | | | | | - Bradley R Pieters
- Amsterdam University Medical Centers, University of Amsterdam, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Primoz Petric
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dariga Ramazanova
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Robin Ristl
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Sadhana Kannan
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai and Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - Rohini Hawaldar
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai and Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - Stefan Ecker
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | - Kathrin Kirchheiner
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | - Li Tee Tan
- Cambridge University Hospitals, Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Remi Nout
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
| | - Nicole Nesvacil
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | - Astrid de Leeuw
- University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, the Netherlands
| | - Richard Pötter
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
| | - Christian Kirisits
- Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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3
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Zhou Y, Rassy E, Coutte A, Achkar S, Espenel S, Genestie C, Pautier P, Morice P, Gouy S, Chargari C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers (Basel) 2022; 14:cancers14102449. [PMID: 35626051 PMCID: PMC9139662 DOI: 10.3390/cancers14102449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cervical cancers is a human papillomavirus infection-induced gynecologic cancer. Due to the uneven access to prevention measures in the world, it is still a leading cause of cancer death in women in low- and middle-income countries. The mainstay of treatment for early-stage cervical cancers is upfront surgery. Clinical trials confirmed the place of adjuvant radiotherapy to improve disease control, but also highlighted the need for a careful selection of patients prior to surgery, in order to avoid the cumulative morbidities of each treatment. In locally advanced cervical cancers, the standard of care remains concurrent pelvic chemoradiotherapy followed by an image-guided adaptive brachytherapy boost allowing for dose escalation and leading to a very high probability of local control. Systemic failures remain a major concern, and neoadjuvant or adjuvant approaches in this context are discussed in the light of recent literature. Abstract Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients’ outcome and minimize treatment-related morbidity.
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Affiliation(s)
- Yuedan Zhou
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Samir Achkar
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France;
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
- Correspondence:
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Ma R, Alifu N, Du Z, Chen S, Heng Y, Wang J, Zhu L, Ma C, Zhang X. Indocyanine Green-Based Theranostic Nanoplatform for NIR Fluorescence Image-Guided Chemo/Photothermal Therapy of Cervical Cancer. Int J Nanomedicine 2021; 16:4847-4861. [PMID: 34305398 PMCID: PMC8297555 DOI: 10.2147/ijn.s318678] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/30/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Indocyanine green (ICG) is a favorable fluorescence nanoprobe for its strong NIR-I fluorescence emission and good photothermal capabilities. However, the stability and tumor targeting ability of ICG is poor, which limits its further applications. To further improve the photothermal and therapeutic efficiency of ICG, bovine serum albumin (BSA) was utilized to encapsulate the ICG and the chemotherapeutic drug doxorubicin (DOX) was loaded to form the BSA@ICG-DOX theranostic nanoplatform. Methods In this study, ICG-loaded BSA nanoparticles (NPs) and the BSA@ICG-DOX NPs were fabricated using reprecipitation methods. Next, the tumour inhibition ability and biocompatibility of the NPs were evaluated. A subcutaneous xenografted nude mice model was established and imaging guided synergetic therapy was performed with the assistance of BSA@ICG-DOX NPs under 808 nm laser irradiation. Results The BSA@ICG NPs exhibited strong NIR-I fluorescence emission, excellent photothermal properties, biocompatibility, and tumor targeting ability. To further improve the therapeutic efficiency, the chemotherapeutic drug doxorubicin (DOX) was loaded into the BSA@ICG NPs to form the BSA@ICG-DOX theranostic nanoplatform. The BSA@ICG-DOX NPs were spherical with an average size of ~194.7 nm. The NPs had high encapsulation efficiency (DOX: 19.96% and ICG: 60.57%), and drug loading content (DOX: 0.95% and ICG: 3.03%). Next, excellent NIR-I fluorescence and low toxicity of the BSA@ICG-DOX NPs were verified. Targeted NIR-I fluorescence images were obtained after intravenous injection of the NPs into the subcutaneous cervical tumors of the mice. Conclusion To improve the anti-tumor efficiency of the ICG@BSA NPs, the chemotherapeutic drug DOX was loaded into the BSA@ICG NPs. The NIR excitation/emission and targeted BSA@ICG-DOX NPs enables high-performance diagnosis and chemo/photothermal therapy of subcutaneous cervical tumors, providing a promising approach for further biomedical applications.
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Affiliation(s)
- Rong Ma
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Nuernisha Alifu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, People's Republic of China
| | - Zhong Du
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Shuang Chen
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Youqiang Heng
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Jing Wang
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Lijun Zhu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, People's Republic of China
| | - Cailing Ma
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of High Incidence Diseases in Central Asia/Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Xueliang Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, People's Republic of China
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5
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Ogorodniitchouk O, Aunier J, Bousarsar A, Lahmamssi C, Sotton S, Ouaz H, Moreno-Acosta P, Moslemi D, Molekzadehmoghani M, Langrand-Escure J, Magne N, Vallard A. Five-fraction HDR brachytherapy in locally advanced cervical cancer: A monocentric experience. Cancer Radiother 2021; 25:463-468. [PMID: 34023215 DOI: 10.1016/j.canrad.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The 5-fraction scheme (5×5-5.5Gy) is a common High-Dose Rate (HDR) intracavitary brachytherapy regimen for locally advanced cervical cancer (LACC). Yet, its equivalence with Pulse-Dose rate (PDR) schemes remains unproved. The present study aimed at reporting on the outcome of LACC patients treated with 5-fraction HDR brachytherapy. MATERIALS AND METHODS The medical records of all consecutive patients treated with curative-intent HDR brachytherapy for a LACC in a French Cancer Center were retrospectively reviewed. RESULTS Thirty-eight LACC patients underwent a 5-fraction intracavitary HDR brachytherapy between 2015 and 2019 (median dose=25Gy/5 fractions, following external-beam radiotherapy). Median age at diagnosis was 60 (range: 29-87). Thirty-one patients (81.5%) underwent concurrent chemotherapy. Tumor stages ranged from 3 IB2 (7.8%), 4 IB3 (10.5%), 4 IIA2 (10.5%), 12 IIB (31.7%), 1 IIIA (2.6%), 2 IIIB (5.3%), 7 IIIC1 (18.5%), 4 IIIC2 (10.5%), 1 IVA (2.6%) (2018 FIGO). Median D90% to CTVHR reached 79.5Gy (EQD2). Median D90% to CTVIR reached 59.5Gy (EQD2). Median Bladder D2cc was 69.8Gy (EQD2). Median Rectum D2cc was 58.3Gy (EQD2). Acute/late grade 3 toxicity was reported in one patient (2.6%). No grade 4-5 toxicity occurred. At a median 38 months follow-up, 10 patients (26.3%) had local (n=7, 18.4%), nodal (n=6, 15.7%) and/or distant (n=7, 18.4%) relapse. Three-year overall survival rate was of 81.6%. CONCLUSION The 5-fraction HDR scheme was well tolerated even in frail patients. Three-year local control was lower than expected. Treatment (absence of parametrial interstitial implants and use of cervical EBRT boost) and patients' characteristics (age, comorbidities) may explain such results.
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Affiliation(s)
- O Ogorodniitchouk
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - J Aunier
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - A Bousarsar
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - C Lahmamssi
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - S Sotton
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - H Ouaz
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - P Moreno-Acosta
- Research group in Cancer Biology, Research Branch, National Cancer Institute, Bogota, Colombia
| | - D Moslemi
- Departement of Clinical Radiotherapy & Oncology, Babol University of Medical Sciences, Babol, Iran
| | - M Molekzadehmoghani
- Department of Radiation-Oncology, Shahid Behesti University Medial Sciences, Tehran, Iran
| | - J Langrand-Escure
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - N Magne
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France.
| | - A Vallard
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
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6
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Lu W, Lu C, Yu Z, Gao L. Chemoradiotherapy alone vs. chemoradiotherapy and hysterectomy for locally advanced cervical cancer: A systematic review and updated meta-analysis. Oncol Lett 2020; 21:160. [PMID: 33552278 PMCID: PMC7798101 DOI: 10.3892/ol.2020.12421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022] Open
Abstract
The benefit of adjuvant hysterectomy after definitive concurrent chemoradiotherapy (CCRT) for locally-advanced cervical cancer (LACC) is controversial. The purpose of the present study was to systematically search the literature and perform a meta-analysis to compare overall survival (OS) and disease-free survival (DFS) between patients subjected to CCRT with hysterectomy and those who underwent CCRT alone. The PubMed, Scopus, Embase and Google scholar databases were searched. A meta-analysis to determine hazard ratios (HRs) and odds ratios (ORs) with meta-regression was performed for the following moderators: Disease stage, histology and proportion of radical hysterectomy. Data from 14 studies were included. The results indicated that patients who received CCRT with hysterectomy had significantly better OS (HR, 0.72; 95% CI, 0.56 to 0.91; I2=19%; P=0.007) and DFS (HR, 0.72; 95% CI, 0.56 to 0.93; I2=27%; P=0.01) than those treated with CCRT alone. However, in a subgroup analysis by study type, the results were significant only for retrospective studies but not for randomized controlled trials (RCTs). However, only 2 RCTs were included with small sample size, heterogeneity and low overall quality. Subgroup analyses based on the use of brachytherapy in the CCRT with hysterectomy group demonstrated no difference in OS and DFS between the two groups. Regarding the absolute numbers of death and recurrence events, no significant difference in mortality (OR, 0.91; 95% CI, 0.62 to 1.33; I2=0%; P=0.64) was determined between the two groups, but a significantly reduced incidence of recurrence was observed in the CCRT with hysterectomy group (OR, 0.61; 95% CI, 0.47-0.79; I2=29%; P=0.0002). The meta-regression results point to a significant influence of the proportion of stage II patients on OS. Despite the overall analysis indicating improved OS and DFS with the use of adjuvant hysterectomy after CCRT, subgroup analysis based on similar treatment protocols failed to demonstrate any significant benefit of hysterectomy in LACC. However, the results indicated that the recurrence rate may be higher in patients undergoing CCRT without hysterectomy. The limited quality of the studies included and selection bias from retrospective studies restrict the possibility to draw strong conclusions.
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Affiliation(s)
- Weijia Lu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Canxiong Lu
- Department of Laboratory, Foshan Sanshui Hospital of Chinese Medicine, Foshan, Guangdong 528100, P.R. China
| | - Zhiwu Yu
- Division of Laboratory Science, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Lei Gao
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
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Fabian A, Krug D, Alkatout I. Radiotherapy and Its Intersections with Surgery in the Management of Localized Gynecological Malignancies: A Comprehensive Overview for Clinicians. J Clin Med 2020; 10:E93. [PMID: 33383960 PMCID: PMC7796321 DOI: 10.3390/jcm10010093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Surgery, including minimally invasive surgery, and radiotherapy are key modalities in the treatment of gynecological malignancies. The aim of this review is to offer the multidisciplinary care team a comprehensive summary of the intersections of surgery and radiotherapy in the local treatment of gynecological malignancies. Recent advances in radiotherapy are highlighted. Relevant publications were identified through a review of the published literature. Ovarian, endometrial, cervical, vaginal, and vulvar cancer were included in the search. Current guidelines are summarized. The role of radiotherapy in adjuvant as well as definitive treatment of these entities is synthesized and put into context with surgery, focusing on survival and quality of life. Although these outcomes have improved recently, further research must be focused on the number of life years lost, and the potential morbidity encountered by patients.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany;
| | - David Krug
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany;
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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8
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Souza ECA, Santos DZ, Torres JCC, Vale DB, Bragança JF, Teixeira JC. Post-radiotherapy hysterectomy does not benefit females with cervical adenocarcinoma. Mol Clin Oncol 2020; 13:92. [PMID: 33194198 DOI: 10.3892/mco.2020.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/08/2020] [Indexed: 12/24/2022] Open
Abstract
Cervical adenocarcinoma is associated with a poor prognosis, which may be caused by the infiltrative growth pattern and metastasis of tumor cells. There is a lack of consensus on hysterectomy after radiotherapy for the improvement of selected cases. The present study aimed to assess the oncological outcome of post-radiotherapy hysterectomy in females with cervical adenocarcinoma. A total of 39 females with cervical adenocarcinoma at stages IB1 to IIIB, managed primarily with radiotherapy with complete response, and underwent extrafascial hysterectomy as consolidation therapy between 1988 to 2015 were studied. Surgery complications and residual disease were evaluated. A comparison group was constructed, comprising 41 females with cervical adenocarcinoma managed with exclusive radiotherapy or chemoradiotherapy demonstrating complete response, without surgery. Descriptive and survival analysis was performed. The groups were comparable in terms of age, cancer stage, radiotherapy (dose and duration) and follow-up, although 67% of hysterectomies were performed prior to 2002 and 46% of the radiotherapy group received chemoradiation. Late complications were similar. There were nine recurrences (23%) in the case series and 10 recurrences (24%) in the radiotherapy group. Residual disease was detected in 56% (22/39) of uterine specimens, of which 12 were up to 10 mm. Residual disease was associated with recurrence (31% vs. 6%, P=0.028). The overall survival rate was 75% for the case series vs. 88% for the radiotherapy group (P=0.579), and the disease-free survival rate was 79-80% for both. Removal of residual disease by hysterectomy did not improve the overall survival rate (P=0.283) and disease-free survival rate (P=0.072). Post-radiotherapy hysterectomy in cervical adenocarcinoma is a feasible procedure with acceptable complications, however, it did not bring relevant benefits in recurrences, disease-free survival, and overall survival rates.
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Affiliation(s)
| | - Daniel Zaidan Santos
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas (SP) 13083-881, Brazil
| | - Jose Carlos Campos Torres
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas (SP) 13083-881, Brazil
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas (SP) 13083-881, Brazil
| | - Joana Froes Bragança
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas (SP) 13083-881, Brazil
| | - Julio Cesar Teixeira
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas (SP) 13083-881, Brazil
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9
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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:220-234. [DOI: 10.1016/j.prro.2020.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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10
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Albert A, Allbright R, Lee A, Vijayakumar S. Preoperative chemoradiation followed by hysterectomy for cervical cancer: patterns of care and survival in a large, hospital database. J Gynecol Oncol 2019; 30:e41. [PMID: 30887759 PMCID: PMC6424845 DOI: 10.3802/jgo.2019.30.e41] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Adjuvant hysterectomy following chemoradiation (CRT) is a treatment option used worldwide for early-stage cervical cancer but the benefit of hysterectomy in this setting is unclear. An analysis of the National Cancer Database (NCDB) was performed to identify patterns of care and determine the survival impact of adjuvant hysterectomy. METHODS The NCDB was queried for patients with International Federation of Gynecology and Obstetrics stage IB2 to IIA2 cervical cancer diagnosed from 2010-2014 who underwent preoperative concurrent chemoradiation followed by hysterectomy (CRT+S) or definitive CRT. Overall survival (OS) curves were generated using the Kaplan-Meier method and compared via the log-rank test. Univariable and multivariable logistic regression and Cox regression were used to determine covariables associated with utilization and OS. RESULTS There were 1,546 patients who met the study criteria, of which 1,407 (91.0%) received concurrent CRT alone and 139 (9.0%) received CRT+S. Four-year OS for the CRT+S group was 82.2% and 74.9% for the CRT group (p=0.036). On subgroup analysis by lymph node status, the 4-year OS for patients without positive pelvic or para-aortic lymph nodes was 84.9% in the CRT+S group vs. 77.8% in the CRT group (p=0.072). On multivariable Cox regression, there was no difference in survival based on treatment group (hazard ratio=0.63; 95% confidence interval=0.06-1.04; p=0.069). CONCLUSION We found from this hospital database that completion hysterectomy is used infrequently and did not result in a significant survival difference when accounting for other factors.
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Affiliation(s)
- Ashley Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Robert Allbright
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
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11
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Li H, Pang Y, Cheng X. Surgery of primary sites for stage IVB cervical cancer patients receiving chemoradiotherapy: a population-based study. J Gynecol Oncol 2019; 31:e8. [PMID: 31788998 PMCID: PMC6918894 DOI: 10.3802/jgo.2020.31.e8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/04/2019] [Accepted: 07/25/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the impact of surgery of primary sites on stage IVB cervical cancer patients from a population-based database, the Surveillance, Epidemiology and End Results (SEER). METHODS Propensity score matching was performed to minimize heterogeneity in patient between with-surgery group and without-surgery group. Clinicopathological characteristics were compared using the χ² or Fisher's exact test. Survival analysis included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. RESULTS Between 2010-2015, a total of 1,139 International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemoradiotherapy (CRT) were included in this retrospective study. Within post-matching cohort, the median duration of overall survival (OS) in stage IVB cervical cancer patients receiving CRT was 22 months. The overall 5-year survival rate was 25.7%. The increasing American Joint Committee on Cancer T stage (T1 vs. T2, p=0.033, hazard ratio [HR]=1.79, 95% confidence interval [CI]=1.05-3.05; T1 vs. T3, p=0.003, HR=2.20, 95% CI=1.31-3.67; T1 vs. T4, p=0.037, HR=2.75, 95% CI=1.06-7.12) and visceral metastasis (with vs. without, p=0.038, HR=1.60, 95% CI=1.03-2.49) was reported as independent risk factors of OS. Surgery of primary sites combined with CRT tended to prolong the survival of stage IVB cervical cancer patients (p<0.001, HR=0.36, 95% CI=0.21-0.61) compared with CRT, especially for patients without visceral metastasis (p=0.005, HR=0.31, 95% CI=0.14-0.70). CONCLUSIONS In conclusion, patients with stage IVB cervical cancer may achieve their best outcomes through CRT combined with surgery of primary sites. However, it deserves large scale prospective clinical trials to confirm.
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Affiliation(s)
- Haoran Li
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Cancer institute, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangyang Pang
- Department of Urology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xi Cheng
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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12
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Rajasooriyar C, Lin MY, Kalra R, Lim A, Narayan K. The role of positron emission tomography in the selection of patients for salvage hysterectomy following chemoradiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer 2019; 29:266-271. [PMID: 30630887 DOI: 10.1136/ijgc-2018-000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients selection for salvage hysterectomy following chemoradiotherapy of cervical cancer is vital to avoid significant morbidity. The purpose of this study was to describe the role of post-treatment F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scanning (FDG-PET/CT) in patient selection for salvage hysterectomy. METHODS This was a retrospective analysis of 49 patients with cervical cancer treated between January 1996 and December 2012 who were candidates for salvage hysterectomy. RESULTS Three groups were defined based on institutional treatment guidelines, as experience in using post-treatment FDG-PET/CT to guide management evolved. Group 1 consisted of 15 patients who underwent planned hysterectomy based on clinical, cytological, or histological suspicion. Of these, only three (20%) patients had residual disease on histology. Group 2 consisted of 13 patients who had post-treatment FDG-PET/CT 3-6 months after the completion of chemoradiotherapy due either to suspicion of recurrence on examination or patients thought to be at high risk of recurrence at the primary site. Of these, eight patients had hysterectomy and four patients showed positive histology for residual tumor. Group 3 had 21 patients who showed isolated FDG uptake at the primary site on first FDG-PET/CT scanning at 6 months. A subsequent FDG-PET/CT scan after 3 months showed disease progression in seven and complete metabolic response in 14, and surgery was avoided in all patients. CONCLUSION FDG-PET/CT scanning at 6 months after radiotherapy is a good tool for assessing treatment response in patients with cervical cancer. In patients with persistent uptake on 6 months post-treatment FDG-PET/CT, repeat imaging at a 3-month interval helps in selecting patients for salvage hysterectomy.
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Affiliation(s)
- Chrishanthi Rajasooriyar
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia .,Department of Clinical Oncology, Teaching Hospital, Jaffna, Sri Lanka
| | - Ming-Yin Lin
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rashi Kalra
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Andrew Lim
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kailash Narayan
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Huang XB, Zhang WW, Wu SG, Sun JY, He ZY, Zhou J. Survival benefits with the addition of adjuvant hysterectomy to radiochemotherapy for treatment of stage I-II adenocarcinoma of the uterine cervix. J Surg Oncol 2018; 118:574-580. [PMID: 30114328 DOI: 10.1002/jso.25153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/10/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Xiao-Bin Huang
- Gynecology Department; Foshan Maternal and Child Healthcare Hospital; Foshan China
| | - Wen-Wen Zhang
- Department of Radiation Oncology; Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine; Guangzhou China
| | - San-Gang Wu
- Department of Radiation Oncology; Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University; Xiamen China
| | - Jia-Yuan Sun
- Department of Radiation Oncology; Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine; Guangzhou China
| | - Zhen-Yu He
- Department of Radiation Oncology; Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine; Guangzhou China
| | - Juan Zhou
- Department of Obstetrics and Gynecology; The First Affiliated Hospital of Xiamen University; Xiamen China
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Multimodal Management of Locally Advanced Neuroendocrine Cervical Carcinoma: A Single Institution Experience. Int J Gynecol Cancer 2018; 28:1013-1019. [PMID: 29595759 DOI: 10.1097/igc.0000000000001242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to report our institutional experience of a multimodal approach for treatment of locally advanced high-grade neuroendocrine cervical cancer. METHODS AND MATERIALS Patients with primary locally advanced neuroendocrine cervical cancer diagnosed between 2001 and 2014 were included. The scheduled treatment sequence was as follows: pelvic +/- para-aortic radiotherapy (according to tumor stage), associated with chemotherapy based on platine-derivate and etoposide regimen, followed with a brachytherapy boost, then completion surgery if there was no progression +/- consolidation etoposide chemotherapy (for a total of 5-6 cycles). Disease-free survival (DFS) and overall survival (OS) were reported and prognostic factors were searched. RESULTS A total of 24 patients fulfilled inclusion criteria. Median age was 48 (range 22-77 years). Fourteen patients (58%) had pelvic lymph node metastases. After chemoradiation/brachytherapy, a radical hysterectomy could be performed in 18 of 24 patients (75%). Histologically complete resection was achieved in 14 (78%) of 18 patients. Complete pathological response was reported in 7 (39%) of 18. With median follow-up of 29.7 months, 10 (42%) of 24 patients experienced tumor relapse, all associated with distant failure, including one local failure. The DFS and OS rates estimated at 3 years were 55% and 63%, respectively. Lymph node metastases and tumor stage were prognostic for DFS (P = 0.016 and P = 0.022, respectively). Complete resection was associated with a lower incidence of relapses, as compared with microscopically incomplete resection (P = 0.04). A total of 12 (86%) of 14 patients with histologically complete resection were in complete remission at last follow-up. Apart from manageable acute hematological toxicities, most treatment complications were mild to moderate. CONCLUSIONS This series based on a multimodal management compares favorably with previously published data. Most patients could be eligible to surgery, and complete remission was achieved in 85% of those amenable to complete resection.
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15
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Shi D, Liang Z, Zhang C, Zhang H, Liu X. The effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy: a meta-analysis. BMC Cancer 2018; 18:308. [PMID: 29558900 PMCID: PMC5859532 DOI: 10.1186/s12885-018-4232-x] [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: 09/07/2017] [Accepted: 03/15/2018] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND To determine the effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy. METHODS PubMed, Web of Science, ProQuest and Medline were searched using the key words "cervical cancer", "locally advanced disease", "radiotherapy" and "surgery or hysterectomy". Eight articles were selected and analysed using the STATA 12.0 software package. The log hazard ratio (HR) and its standard error for overall survival were calculated to assess the effect of surgery on patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy. RESULTS In total, 2176 patients with locally advanced cervical cancer were identified. The pooled HR for overall survival was 1.13 (95% confidence interval (CI) 0.906-1.409), and there were no differences among the eight manuscripts (z = 1.08, p = 0.278). In the subgroup analysis, the pooled HR for overall survival was 1.169 (95% CI 0.924-1.480), and no differences among patients with stage IB-IIB disease were found in six articles (z = 1.30, p = 0.193). There was no publication bias regarding overall survival or stage IB-IIB disease. CONCLUSIONS This meta-analysis suggested that surgery had no effect on overall survival after radiotherapy/chemoradiotherapy; therefore, it is not recommended for patients with locally advanced cervical cancer.
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Affiliation(s)
- Dan Shi
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhenzhen Liang
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Cheng Zhang
- Department of Cardiology department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huaiyu Zhang
- Department of Gastrointestinal Colorectal and anal surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaodong Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.
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Preoperative Chemoradiotherapy in Locally Advanced Bulky Squamous Cell Carcinoma of the Uterine Cervix. Int J Gynecol Cancer 2017; 27:1943-1948. [DOI: 10.1097/igc.0000000000001094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
ObjectivesThe aim of this study was to evaluate long-term survival and feasibility in patients with bulky squamous cell carcinoma of the uterine cervix who underwent surgery after concurrent chemoradiotherapy.MethodsA review of patients with locally advanced bulky squamous cell cervical cancer who underwent chemoradiation followed by surgery with pelvic lymphadenectomy was performed. Chemoradiotherapy included 2 monthly doses of intra-arterial chemotherapy with cisplatin (50 mg/m2) and mitomycin C (10 mg/body) and external irradiation to the whole pelvis and high-dose-rate brachytherapy. From 2000 to 2006, 23 patients were enrolled in a single institution. Patient distribution according to the International Federation of Gynecology and Obstetrics stage was as follows: 9 stage IB2, 10 stage IIB, and 4 stage IIIB. Radiological lymph node involvement was present in 69.6% (16/23), including 2 cases of para-aortic lymph node swelling. The radiological response, pathological response, overall and disease-free survival, and late complications were assessed.ResultsAmong the patients, 12 (52.2%) showed pathological complete response, and 11 (47.8%) showed a pathological partial response for cervical lesions. Among the cases of radiological pelvic lymph node swelling, the response rate was 93.3% (14/15). Only 1 case showed viable cancer cells in the resected pelvic lymph nodes among radiological complete response cases. In the median follow-up duration (121 months; range, 17–180 months), the 5-year overall survival and disease-free survival were 95.7% and 86.7%, respectively. Seven events in 4 patients led to the development of postoperative fistula formation requiring a rescue surgery.ConclusionsChemoradiotherapy followed by surgery was effective for patients with bulky squamous cell carcinoma of the uterine cervix. Further investigation to select suitable patients for this multimodal treatment will be required.
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