1
|
Autorino R, Gui B, Panza G, Boldrini L, Cusumano D, Russo L, Nardangeli A, Persiani S, Campitelli M, Ferrandina G, Macchia G, Valentini V, Gambacorta MA, Manfredi R. Radiomics-based prediction of two-year clinical outcome in locally advanced cervical cancer patients undergoing neoadjuvant chemoradiotherapy. Radiol Med 2022; 127:498-506. [PMID: 35325372 PMCID: PMC9098600 DOI: 10.1007/s11547-022-01482-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/08/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study is to determine if radiomics features extracted from staging magnetic resonance (MR) images could predict 2-year long-term clinical outcome in patients with locally advanced cervical cancer (LACC) after neoadjuvant chemoradiotherapy (NACRT). MATERIALS AND METHODS We retrospectively enrolled patients with LACC diagnosis who underwent NACRT followed by radical surgery in two different institutions. Radiomics features were extracted from pre-treatment 1.5 T T2w MR images. The predictive performance of each feature was quantified in terms of Wilcoxon-Mann-Whitney test. Among the significant features, Pearson correlation coefficient (PCC) was calculated to quantify the correlation among the different predictors. A logistic regression model was calculated considering the two most significant features at the univariate analysis showing the lowest PCC value. The predictive performance of the model created was quantified out using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 175 patients were retrospectively enrolled (142 for the training cohort and 33 for the validation one). 1896 radiomic feature were extracted, 91 of which showed significance (p < 0.05) at the univariate analysis. The radiomic model showing the highest predictive value combined the features calculated starting from the gray level co-occurrence-based features. This model achieved an AUC of 0.73 in the training set and 0.91 in the validation set. CONCLUSIONS The proposed radiomic model showed promising performances in predicting 2-year overall survival before NACRT. Nevertheless, the observed results should be tested in larger studies with consistent external validation cohorts, to confirm their potential clinical use.
Collapse
Affiliation(s)
- Rosa Autorino
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Benedetta Gui
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Giulia Panza
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy.
| | - Luca Boldrini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy.,Mater Olbia Hospital, 07026, Olbia, SS, Italy
| | - Luca Russo
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Salvatore Persiani
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maura Campitelli
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy
| | - Gabriella Macchia
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| |
Collapse
|
2
|
Li Y, Chen Z, Wang X, Li X, Zhou J, Zhang Y. Clinical outcomes observation in stage IIB-IIIB cervical cancer treated by adjuvant surgery following concurrent chemoradiotherapy. BMC Cancer 2021; 21:442. [PMID: 33882876 PMCID: PMC8059156 DOI: 10.1186/s12885-021-08146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the feasibility of adjuvant surgery following concurrent chemoradiation therapy (CCRT) in stage IIB-IIIB (according to FIGO staging of 2009) cervical cancer and analyze risk factors of recurrence after surgery. METHODS Forty-nine patients diagnosed with stage IIB-IIIB cervical cancer were reviewed retrospectively. We investigated the risk factors of recurrence after surgery using Chi-squared Test and further analyzed multiple factors affecting postoperative recurrence using the multi-factor logistic regression. Furthermore, the correlation of surgery outcomes (including operation time, bleeding, and hospitalization date and surgery complications) with the time which carried out between CCRT and completion surgery was analyzed. RESULTS Tumor histology and residual tumor in the cervix were significantly associated with postoperative recurrence (P = 0.014 and P = 0.040, respectively). Logistic regression analysis demonstrated that the independent risk factors of postoperative recurrence were age and residual tumor in the cervix (P = 0.017 and P = 0.030, respectively). Complications (operation time, bleeding, hospitalization date) were compared between patients with an interval with radiotherapy less than 6 weeks and patients with an interval longer than 6 weeks. There were statistical differences in the amount of bleeding and postoperative complications between the two groups (P = 0.019 and P = 0.044, respectively). CONCLUSION CCRT combined with surgery for stage IIB-IIIB cervical cancer was feasible, reduced the rate of postoperative recurrence and surgery complications were tolerated.
Collapse
Affiliation(s)
- Yong Li
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Shandong, 266003, Qingdao, China
| | - Zhiying Chen
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, P. R. China
| | - Xiang Wang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, P. R. China
| | - Xiumei Li
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Shandong, 266003, Qingdao, China
| | - Jie Zhou
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, P. R. China
| | - Yongchun Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, P. R. China.
| |
Collapse
|
3
|
Gui B, Autorino R, Miccò M, Nardangeli A, Pesce A, Lenkowicz J, Cusumano D, Russo L, Persiani S, Boldrini L, Dinapoli N, Macchia G, Sallustio G, Gambacorta MA, Ferrandina G, Manfredi R, Valentini V, Scambia G. Pretreatment MRI Radiomics Based Response Prediction Model in Locally Advanced Cervical Cancer. Diagnostics (Basel) 2021; 11:diagnostics11040631. [PMID: 33807494 PMCID: PMC8066099 DOI: 10.3390/diagnostics11040631] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to create a radiomics model for Locally Advanced Cervical Cancer (LACC) patients to predict pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) analysing T2-weighted 1.5 T magnetic resonance imaging (MRI) acquired before treatment start. Patients with LACC and an International Federation of Gynecology and Obstetrics stage from IB2 to IVA at diagnosis were retrospectively enrolled for this study. All patients underwent NACRT, followed by radical surgery; pCR―assessed on surgical specimen―was defined as absence of any residual tumour. Finally, 1889 features were extracted from MR images; features showing statistical significance in predicting pCR at the univariate analysis were selected following an iterative method, which was ad-hoc developed for this study. Based on this method, 15 different classifiers were trained considering the most significant features selected. Model selection was carried out using the area under the receiver operating characteristic curve (AUC) as target metrics. One hundred eighty-three patients from two institutions were analysed. The model, showing the highest performance with an AUC of 0.80, was the random forest method initialised with default parameters. Radiomics appeared to be a reliable tool in pCR prediction for LACC patients undergoing NACRT, supporting the identification of patient risk groups, which paves treatment pathways tailored according to the predicted outcome.
Collapse
Affiliation(s)
- Benedetta Gui
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Rosa Autorino
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Maura Miccò
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Correspondence:
| | - Adele Pesce
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Luca Russo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Salvatore Persiani
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Gabriella Macchia
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Giuseppina Sallustio
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Giovanni Scambia
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| |
Collapse
|
4
|
Yoshida K, Kajiyama H, Yoshihara M, Tamauchi S, Ikeda Y, Yoshikawa N, Nishino K, Niimi K, Suzuki S, Kikkawa F. The role of additional hysterectomy after concurrent chemoradiation for patients with locally advanced cervical cancer. Int J Clin Oncol 2019; 25:384-390. [PMID: 31552530 DOI: 10.1007/s10147-019-01551-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The standard treatment for cervical cancer is chemoradiation although some patients showed treatment resistance. The purpose of this study was to investigate the clinical efficacy of surgery after chemoradiation for cervical cancer. METHODS Patients with FIGO stage IB2 to IIB cervical cancer were included in the study between 2005 and 2015. A total of 50 patients who underwent surgery after neoadjuvant chemoradiation and 76 patients who received only chemoradiation were compared. Baseline differences between the two groups were adjusted with inverse probability of treatment weighting method using propensity scores composed of the following independent variables: age, stage, tumor size, lymph node metastasis, and histological subtypes. RESULTS Median follow-up was 64.8 (range 4.8-143.9) months. After adjustment with inverse probability of treatment weighting, Kaplan-Meier curves showing adjusted progression-free survival and overall survival were significantly longer in the neoadjuvant chemoradiation compared with the chemoradiation-only group (p = 0.027 and p = 0.017, respectively). Moreover, in patients with squamous cell carcinoma, recurrence in previously irradiated field and recurrence both in and out of previously irradiated field were significantly decreased in the neoadjuvant chemoradiation compared with the chemoradiation-only group (3.1% and 18.4%, respectively; OR 0.142, p = 0.001]. Adverse events of surgery after chemoradiation were acceptable, although temporary hydronephrosis was frequently observed (23.1%). CONCLUSIONS Surgery after chemoradiation reduced pelvic recurrence, and as a result, patients who underwent neoadjuvant chemoradiation showed more favorable survival outcomes compared with those who only underwent chemoradiation.
Collapse
Affiliation(s)
- Kosuke Yoshida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
5
|
Wei LC, Li X, Zhang Y, Dang YZ, Li WW, Li JP, Zhao LN, Liu SJ, Li X, Shi M. Individualized pelvic lymphadenectomy should follow neoadjuvant concurrent chemoradiotherapy for locally advanced cervical cancer. Medicine (Baltimore) 2018; 97:e0331. [PMID: 29620659 PMCID: PMC5902266 DOI: 10.1097/md.0000000000010331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To study the outcomes following concurrent chemoradiotherapy (CCRT) and subsequent radical surgery for locally advanced cervical cancer (LACC), analyze the relationship between imaging-diagnosed and postoperative-diagnosed lymph node (LN) involvement, and identify patients who would benefit from individualized pelvic lymphadenectomy.We retrospectively reviewed records of 410 patients who underwent CCRT followed by radical surgery for International Federation of Gynecology and Obstetrics Stage Ib2-IIIb disease. Correlations of LN size on imaging before CCRT with pathological responses after CCRT, overall survival (OS), distant metastasis-free survival (DMFS), and complications were analyzed.During a median follow-up of 51.3 months, the respective 5-year OS and DMFS were 86.7% and 88.6%, respectively. Pathological primary tumor type, LN size on imaging before CCRT, and pathologic response after CCRT were independent prognostic factors for OS. Patients with a LN ≥0.8 cm had a significantly higher residual carcinoma rate versus those with LN <0.8 cm (33% vs 22.6%, P = .032). Postoperative pathological positive LN frequencies differed significantly by LN size on imaging (LN <0.8 cm vs LN ≥0.8 cm, 3% vs 19.3%, P < .0001). Grade 1-3 lower extremity edema occurred in 23.9% of cases; no grade 3-4 gastrointestinal and genitourinary toxicities were observed.CCRT followed by radical surgery for LACC yielded encouraging outcomes without unacceptable complications. Additionally, patients with a LN <0.8 cm on imaging before CCRT had a very low risk of postoperative pathological positive LN identification. Individualized pelvic lymphadenectomy (e.g., omitting or limiting the extent of LN dissection) might be an alternative option for some patients with a low risk of LN metastasis.
Collapse
Affiliation(s)
- Li-Chun Wei
- Department of Radiation Oncology, Xijing Hospital, The Fourth Military Medical University Department of Radiation Oncology, Xi'an Gaoxin Hospital Department of Gynecology and Obstetrics Department of Pathology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Ma Y, Zhao G, Qi J, Sun P, Liu C, Qu P, Chan KKL. Neoadjuvant brachytherapy and chemotherapy followed by radical surgery for stage IB2 and IIA cervical cancer: A retrospective comparison with chemoirradiation. Mol Clin Oncol 2018; 8:617-622. [PMID: 29556393 DOI: 10.3892/mco.2018.1580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/06/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to assess the immediate and long-term results of preoperative brachytherapy and chemotherapy followed by radical surgery compared with those of standard chemoirradiation in patients with stage IB2-IIA cervical cancer. The medical records of 70 patients with stage IB2 and IIA cervical cancer who were treated between June 2006 and June 2010 were reviewed. The patients received either standard chemoirradiation (CRT) treatment (n=20) or neoadjuvant brachytherapy with one cycle of chemotherapy followed by radical hysterectomy [operation (OT) group; n=50]. Further adjuvant chemoirradiation was administered to patients with high-risk disease. Early and late complications as well as survival were compared between the two groups. No serious operative complications occurred in the OT group. In the CRT group, the incidence of symptomatic vaginal stenosis, as well as that of proctitis and cystitis, was higher compared with that in the OT group (35 vs. 4% and 20 vs. 2%, repectively). The median follow-up period was 52 months (range, 11-84 months). In the CRT group, the 3-year overall and disease-free survival rates were 95% [95% confidence interval (CI): 76.14-86.46] and 90% (95% CI: 59.94-73.66), respectively, whereas in the OT group, the respective rates were 90% (95% CI: 72.93-83.07) and 90% (95% CI: 71.84-82.96). In conclusion, the survival of patients with stage IB2-IIA cervical cancer treated with preoperative brachytherapy and chemotherapy followed by radical surgery was similar to that of patients treated with chemoirradiation, but with a more favorable side effect profile. Thus, this tri-modal treatment option requires further evaluation in prospective randomized studies.
Collapse
Affiliation(s)
- Yaomei Ma
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Guiling Zhao
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Ji Qi
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Peisong Sun
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Caiyan Liu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Nankai, Tianjin 300241, P.R. China
| | - Karen K L Chan
- Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR 999077, P.R. China
| |
Collapse
|
7
|
Bifulco G, Mandato VD, Piccoli R, Bucci L, Giampaolino P, Nappi C. Multiple Bowel Stenosis and Perforation as Long-Term Complications of Chemoradiotherapy for Advanced Cervical Cancer in a Young Woman: Case Report. TUMORI JOURNAL 2018; 94:592-5. [DOI: 10.1177/030089160809400425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although combined treatment (chemoradiotherapy) appears to improve the overall and progression-free survival of patients wih locally advanced cervical cancer, some acute toxicity is increased (hematological toxicity, nausea, vomiting) while the long-term side effects are unclear. Case A35-year-old Caucasian woman with a diagnosis of advanced cervical cancer (FIGO stage IIIB) was treated with neoadjuvant chemoradiotherapy not followed by radical surgery. She underwent whole pelvic radiation therapy for a total of 40 Gy in fractions of 2.5 Gy given 4 times per week for 4 consecutive weeks followed by 2 sessions of intracavitary brachytherapy starting within 7 days of completion of external beam radiotherapy (3500 mg/h and 2500–3000 mg/h). Cis-DDP IV was administered at a dose of 25 mg/m2 on day 1 and then weekly until completion of the radiotherapeutic protocol. After several months the patient presented persistent gastrointestinal symptoms and an X-ray showed findings consistent with bowel occlusion. The patient underwent emergency surgery and multiple bowel stenosis with perforation was diagnosed. Discussion This is the first report in which neoadjuvant chemoradiotherapy is associated with the late complication of multiple stenosis and bowel perforation in a young woman with advanced cervical cancer. Considering that despite the large number of studies about noncisplatin agents there is not enough evidence to justify treatment with alternative agents, this case report might provide new important data regarding the late morbidity of cisplatin-based concurrent chemoradiation.
Collapse
Affiliation(s)
- Giuseppe Bifulco
- Dipartimento di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione Umana
| | | | - Roberto Piccoli
- Dipartimento di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione Umana
| | - Luigi Bucci
- Dipartimento di Chirurgia Generale, Geriatrica, Oncologica e Tecnologie Avanzate, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | | | - Carmine Nappi
- Dipartimento di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione Umana
| |
Collapse
|
8
|
Li L, Hou Y, Yu J, Lu Y, Chang L, Jiang M, Wu X. Synergism of ursolic acid and cisplatin promotes apoptosis and enhances growth inhibition of cervical cancer cells via suppressing NF-κB p65. Oncotarget 2017; 8:97416-97427. [PMID: 29228621 PMCID: PMC5722573 DOI: 10.18632/oncotarget.22133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/17/2017] [Indexed: 01/03/2023] Open
Abstract
Objective This study was designed to investigate the effect of combination of ursolic acid (UA) with cisplatin (DDP) on cervical cancer cell proliferation and apoptosis. Methods The mRNA and protein expressions of nuclear factor-kappa B (NF-κB) p65 in cervical cancer cells were examined using RT-PCR and western blot. MTT and colony formation assays were performed to examine the DDP toxicity and the proliferation ability of cervical cancer cells. Cell morphology was observed by means of Hoechst33258 and transmission electron microscopy (TEM). The apoptosis rate and cell cycle were assessed through flow cytometry assay. Western blot was used to detect the expression of apoptosis-related molecules. Results The mRNA and protein expressions of NF-κB p65 in cervical cancer cells were significantly higher than that in cervical epithelial cells. The combined treatment of UA and DDP inhibited cervical cancer cell growth and promoted apoptosis more effectively than DDP treatment or UA treatment alone (P < 0.05). Compared with the DDP group and UA group, the expressions of Bcl-2 and NF-κB p65 in DDP +UA group were decreased, while the expressions of Bax, Caspase-3 and PARP cleavage were observably increased. The expression of nuclear NF-κB p65 significantly reduced in UA group and DDP +UA group. si-p65 group displayed a decrease of cell proliferation ability and led to a significant reduction in the number of SiHa cell colony formation. Conclusion The combination of UA with DDP could more effectively inhibit SiHa cells proliferation and facilitate cell apoptosis through suppressing NF-κB p65.
Collapse
Affiliation(s)
- Lan Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| | - Yu Hou
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| | - Jing Yu
- Department of Gynaecology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| | - Yulin Lu
- Nursing School, Kunming Medical University, Kunming 650118, China
| | - Li Chang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| | - Meiping Jiang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| | - Xingrao Wu
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming 650118, China
| |
Collapse
|
9
|
Disease courses in patients with residual tumor following concurrent chemoradiotherapy for locally advanced cervical cancer. Gynecol Oncol 2017; 144:34-39. [DOI: 10.1016/j.ygyno.2016.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
|
10
|
Gui B, Valentini AL, Miccò M, D'Agostino GR, Tagliaferri L, Zannoni GF, Fanfani F, Manfredi R, Bonomo L. Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery. Acta Radiol 2016; 57:1123-31. [PMID: 26622060 DOI: 10.1177/0284185115617346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Imaging findings of residual cervical tumor after chemoradiotherapy can closely resemble those of post-irradiation inflammation. PURPOSE To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC). MATERIAL AND METHODS Retrospective analysis of prospectively collected data from 41 patients with histopathologically proven LACC (International Federation of Gynecology and Obstetrics stage ≥IB2) who underwent MRI before and after chemoradiotherapy. At each examination, a qualitative and semi-quantitative analysis of primary tumor, including tumor volume and signal intensity were assessed on T2-weighted (T2W) images. All patients had surgery after post-chemoradiotherapy MRI. MRI and histopathologic results were compared. RESULTS All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively. CONCLUSION The differentiation of residual tumor from post-irradiation inflammation with early post- chemoradiotherapy MRI (within 28-60 days) is difficult with a high risk of false positive results. Combination of qualitative and semi-quantitative analysis does not improve the accuracy. Conversely, post-chemoradiotherapy MRI has a high negative predictive value with a low risk of false negative results. The role of conventional MRI combined with functional techniques should be evaluated.
Collapse
Affiliation(s)
- Benedetta Gui
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Anna Lia Valentini
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Maura Miccò
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Giuseppe Roberto D'Agostino
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Luca Tagliaferri
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Gian Franco Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Francesco Fanfani
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, University of Verona, Policlinico G.B. Rossi, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| |
Collapse
|
11
|
Fanfani F, Vizza E, Landoni F, de Iaco P, Ferrandina G, Corrado G, Gallotta V, Gambacorta MA, Fagotti A, Monterossi G, Perrone AM, Lazzari R, Colangione SP, Scambia G. Radical hysterectomy after chemoradiation in FIGO stage III cervical cancer patients versus chemoradiation and brachytherapy: Complications and 3-years survival. Eur J Surg Oncol 2016; 42:1519-25. [PMID: 27241922 DOI: 10.1016/j.ejso.2016.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/19/2016] [Accepted: 05/14/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To compare patterns and rates of early and late complications, and survival outcome in FIGO stage III cervical cancer patients underwent to radical hysterectomy after chemo-radiation (CT-RT) vs. chemo-radiation alone. METHODS Between May 1996 and April 2013 150 FIGO stage III cervical cancer patients were treated. We divide patients according to type of treatment: 77 were submitted to standard treatment (Group A), and 73 to completion hysterectomy after chemo-radiation (Group B). RESULTS The baseline characteristics of the 2 groups were superimposable. We observed lower intra-operative and treatment-related early urinary and gastro-intestinal complications in Group B with respect to Group A (p < 0.001). Vascular complications were registered only in Group B (p < 0.001). We found a significantly higher rate of local recurrences in the Group A than in the Group B (p < 0.002). We registered 29 deaths in the Group A and 22 in the Group B (p = 0.021). The 3-years disease-free survival rate in the Group A and in the Group B was 62.9% and 68.3%, respectively (p = 0.686), and the 3-years overall survival rate in the Group A and in the Group B was 63.2% and 67.7%, respectively (p = 0.675). CONCLUSIONS This study confirms that radical hysterectomy after CT-RT is an effective therapeutic approach for advanced cervical cancer. Further prospective and randomized studies should be performed in order to solve the question about the standard approach, and how the different pattern of complication could impact on the quality of life.
Collapse
Affiliation(s)
- F Fanfani
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy.
| | - E Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - F Landoni
- Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - P de Iaco
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Ferrandina
- Department of Medicine and Health Sciences, University of Molise, Campobasso/Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - G Corrado
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - V Gallotta
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - M A Gambacorta
- Department of Radiotherapy, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - A Fagotti
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - G Monterossi
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| | - A M Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - R Lazzari
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - S P Colangione
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Department of Women and Child Health Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
12
|
Todo Y, Watari H. Concurrent chemoradiotherapy for cervical cancer: background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups. Chin J Cancer Res 2016; 28:221-7. [PMID: 27199520 PMCID: PMC4865615 DOI: 10.21147/j.issn.1000-9604.2016.02.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) is regarded as the standard treatment for locally advanced uterine cervical cancer (LACC), including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics (FIGO) staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage III-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin (CDDP), surgery following CCRT, adjuvant chemotherapy (CT) following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease.
Collapse
Affiliation(s)
- Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo 060-8648, Japan
| |
Collapse
|
13
|
Laparoscopic hysterectomy after concurrent radiochemotherapy in locally advanced cervical cancer compared to laparotomy: A multi institutional prospective pilot study of cost, surgical outcome and quality of life. Eur J Surg Oncol 2016; 42:391-9. [DOI: 10.1016/j.ejso.2015.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/20/2015] [Accepted: 09/08/2015] [Indexed: 12/27/2022] Open
|
14
|
Petrillo M, Zannoni GF, Martinelli E, Pedone Anchora L, Ferrandina G, Tropeano G, Fagotti A, Scambia G. Polarisation of Tumor-Associated Macrophages toward M2 Phenotype Correlates with Poor Response to Chemoradiation and Reduced Survival in Patients with Locally Advanced Cervical Cancer. PLoS One 2015; 10:e0136654. [PMID: 26335330 PMCID: PMC4559430 DOI: 10.1371/journal.pone.0136654] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/06/2015] [Indexed: 12/11/2022] Open
Abstract
Objective we investigate the prognostic role of pre-treatment ratio between Type 1 (M1) and Type 2 (M2) tumor-associated macrophages (TAMs) in locally advanced cervical cancer (LACC) patients treated with chemoradiation (CT/RT). Methods 84 consecutive LACC patients treated with cisplatin-based CT/RT for a total dose of 50.0 Gy, followed by radical surgery were analysed. Double-staining immunohistochemistry of CD163/p-STAT, CD68/pSTAT1, CD163/c-MAF, and CD68/c-MAF was performed on tumor samples taken at the time of diagnosis. TAMs with CD163+pSTAT1+, or CD68+pSTAT1+ were defined M1; CD163+c-MAF+ or CD68+c-MAF+ defined the M2 phenotype. The number of M1 and M2 cells was counted at low magnification by evaluating for each case the same tumour area. The ratio between M1 and M2 (M1/M2) was finally calculated. Results At diagnosis, we observed a direct correlation between the number of circulating monocytes and of TAMs (p-value = 0.001). Patients with high M1/M2 experienced more frequently complete pathologic response (no residual tumor) to CT/RT, compared to cases with low M1/M2 (55.0% Vs 29.5%; p-value = 0.029). At multivariate analysis M1/M2 (OR = 2.067; p-value = 0.037) emerged as independent predictor of pathologic response to CT/RT. Women with high M1/M2 showed a longer 5-yrs Disease-free (67.2% Vs. 44.3%; p-value = 0.019), and 5-yrs Overall (69.3% Vs. 46.9%; p-value = 0.037) survival, compared to cases with low M1/M2. The presence of a high M1/M2 ratio was independently associated with an unfavourable survival outcome in multivariate analysis. Conclusions polarisation of TAMs toward a M2 phenotype, as reflected by a lower M1/M2 ratio, is an independent predictor of poor response to CT/RT, and shorter survival in LACC.
Collapse
Affiliation(s)
- Marco Petrillo
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
- Department of Oncology, Gynecologic Oncology Unit, Foundation “John Paul II” Catholic University of the Sacred Heart, Campobasso, Italy
- * E-mail:
| | - Gian Franco Zannoni
- Department of Human Pathology, Division of Gynecologic Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrica Martinelli
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Pedone Anchora
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanna Tropeano
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, St. Maria Hospital, University of Perugia, Terni, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
15
|
Dang YP, Yuan XY, Tian R, Li DG, Liu W. Curcumin improves the paclitaxel-induced apoptosis of HPV-positive human cervical cancer cells via the NF-κB-p53-caspase-3 pathway. Exp Ther Med 2015; 9:1470-1476. [PMID: 25780454 PMCID: PMC4353755 DOI: 10.3892/etm.2015.2240] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 12/18/2014] [Indexed: 12/21/2022] Open
Abstract
Paclitaxel, isolated from Taxus brevifolia, is considered to be an efficacious agent against a wide spectrum of human cancers, including human cervical cancer. However, dose-limiting toxicity and high cost limit its clinical application. Curcumin, a nontoxic food additive, has been reported to improve paclitaxel chemotherapy in mouse models of cervical cancer. However, the underlying mechanisms remain unclear. In this study, two human cervical cancer cell lines, CaSki [human papilloma virus (HPV)16-positive] and HeLa (HPV18-positive), were selected in which to investigate the effect of curcumin on the anticancer action of paclitaxel and further clarify the mechanisms. Flow cytometry and MTT analysis demonstrated that curcumin significantly promoted paclitaxel-induced apoptosis and cytotoxicity in the two cervical cell lines compared with that observed with paclitaxel alone (P<0.05). Reverse transcription-polymerase chain reaction indicated that the decline of HPV E6 and E7 gene expression induced by paclitaxel was also assisted by curcumin. The expression levels of p53 protein and cleaved caspase-3 were increased significantly in the curcumin plus paclitaxel-treated HeLa and CaSki cells compared with those in the cells treated with paclitaxel alone (P<0.01). Significant reductions in the levels of phosphorylation of IκBα and the p65-NF-κB subunit in CaSki cells treated with curcumin and paclitaxel were observed compared with those in cells treated with paclitaxel alone (P<0.05). This suggests that the combined effect of curcumin and paclitaxel was associated with the NF-κB-p53-caspase-3 pathway. In conclusion, curcumin has the ability to improve the paclitaxel-induced apoptosis of HPV-positive human cervical cancer cell lines via the NF-κB-p53-caspase-3 pathway. Curcumin in combination with paclitaxel may provide a superior therapeutic effect on human cervical cancer.
Collapse
Affiliation(s)
- Yu-Ping Dang
- Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing 100142, P.R. China
| | - Xiao-Ying Yuan
- Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing 100142, P.R. China
| | - Rong Tian
- Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing 100142, P.R. China
| | - Dong-Guang Li
- Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing 100142, P.R. China
| | - Wei Liu
- Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing 100142, P.R. China
| |
Collapse
|
16
|
Survivin protein as predictor of pathologic response in patients with locally advanced cervical cancer treated with chemoradiation followed by radical surgery. Hum Pathol 2014; 45:1872-8. [PMID: 24997647 DOI: 10.1016/j.humpath.2014.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/10/2014] [Accepted: 03/18/2014] [Indexed: 11/20/2022]
Abstract
We investigated the correlation of pathologic response and immunohistochemically assessed expression of survivin protein in 71 patients with locally advanced cervical cancer treated with chemoradiation (CT/RT) followed by radical surgery. The prognostic role of survivin expression was also evaluated. Immunohistochemical analysis of survivin expression was carried out using the polyclonal rabbit antisurvivin antibody. Cytoplasmic survivin immunoreaction was observed in 69 (97.2%) of 71 cases and nuclear staining in 7 (9.8%) of 71 women. Median cytoplasmic survivin expression was 160 (range, 0-280), and higher levels were observed in patients with residual disease (≥3 mm) in the cervix (survivin level, 160 versus 120; P = .016) and in women with metastatic lymph nodes (survivin levels, 160 versus 150; P = .032). No differences were documented in the distribution of patients with positive nuclear staining, according to clinicopathological variables. In multivariate analysis, cytoplasmic survivin expression emerged as an independent predictor of residual cervical disease and lymph node status after CT/RT. During a follow-up period of 83 months (range, 8-175 months), recurrences occurred in 24 (33.8%) women, and all patients died of disease. Women with high cytoplasmic survivin experienced shorter disease-free survival compared with patients with low levels (5-year disease-free survival, 80.8% versus 55.3%; P = .033). Only a trend was observed for greater overall survival in patients with high expression (5-year overall survival, 81.0% versus 55.3%; P = .069). No survival differences were documented for nuclear survivin status. The immunohistochemically assessed survivin cytoplasmic levels at diagnosis represent a reliable and easily assessable tool to predict response to CT/RT in patients with locally advanced cervical cancer.
Collapse
|
17
|
Sun L, Sheng X, Jiang J, Li X, Liu N, Liu Y, Zhang T, Li D, Zhang X, Wei P. Surgical morbidity and oncologic results after concurrent chemoradiation therapy for advanced cervical cancer. Int J Gynaecol Obstet 2014; 125:111-5. [DOI: 10.1016/j.ijgo.2013.07.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/23/2013] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
|
18
|
Wang N, Li WW, Li JP, Liu JY, Zhou YC, Zhang Y, Hu J, Huang YH, Chen Y, Wei LC, Shi M. Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy: a retrospective study of 240 patients with FIGO stage IIB cervical carcinoma. Onco Targets Ther 2014; 7:91-100. [PMID: 24421644 PMCID: PMC3888351 DOI: 10.2147/ott.s52710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the long-term survival outcome and late toxicity in patients with FIGO (International Federation of Gynecology and Obstetrics) stage IIB cervical carcinoma after two treatment modalities, ie, concurrent chemoradiotherapy followed by radical surgery and concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy. METHODS Between November 2004 and November 2011, 240 patients with FIGO stage IIB cervical carcinoma were analyzed, comprising 119 patients treated with concurrent chemoradiotherapy followed by radical surgery (group 1) and 121 patients treated with concurrent chemoradiotherapy followed by high-dose-rate intracavitary brachytherapy (group 2). Local control, overall survival, progression-free survival, and treatment-related complications were compared between the two groups. RESULTS The median follow-up duration was 36 months. Concurrent chemoradiotherapy followed by radical surgery showed a survival benefit when comparing group 1 and group 2 (3-year overall survival, 94.9% versus 84.6%, P=0.011; 3-year progression-free survival, 91.0% versus 81.8%, P=0.049, respectively). Three-year local pelvic control was 94.6% in group 1 and 93.3% in group 2 (P=0.325). Prognostic factors in group 1 were: age (≤35 years versus >35 years), 3-year progression-free survival (74.1% versus 90.9%, P=0.037); tumor diameter (≥6 cm versus <6 cm); and 3-year progression-free survival, (60.6% versus 92.9%, P=0.004). Prognostic factors in group 2 were: tumor diameter (≥4 cm versus <4 cm); 3-year overall survival (78.0% versus 94.8%, P=0.043); tumor diameter (≥6 cm versus <6 cm); 3-year progression-free survival (42.9% versus 84.2%, P=0.032); and 3-year overall survival (42.9% versus 87.1%, P=0.013). Further, 50 patients (42.02%) in group 1 and 46 patients (38.02%) in group 2 suffered from late complications. Analysis of the difference in composition of late complications showed that the rate of leg edema was higher in group 1 (35.29% versus 4.96%, P=0.000) while the rate of radiation enteritis was higher in group 2 (30.58% versus 5.04%, P=0.000). CONCLUSION In patients with FIGO stage IIB cervical carcinoma, concurrent chemoradiotherapy followed by radical surgery achieved higher overall survival and progression-free survival rates in comparison with radical radiotherapy associated with concurrent chemotherapy. Tumor diameter could be a common prognostic factor in these two groups of patients.
Collapse
Affiliation(s)
- Ning Wang
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Wei-Wei Li
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jian-Ping Li
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Juan-Yue Liu
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yong-Chun Zhou
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Ying Zhang
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jing Hu
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yan-Hong Huang
- Department of Gynecology and Obstetrics, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yan Chen
- Department of Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Li-Chun Wei
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Mei Shi
- Department of Radiation Oncology, Fourth Military Medical University, Xi'an, People's Republic of China
| |
Collapse
|
19
|
Sarraf Z, Hamedi B, Hooshmand S, Mosalaie A, Robati M, Momtahan M, Farhadi P. The Effect of Extrafascial Hysterectomy After Completion of External Beam Radiotherapy for Treatment of Locally Advanced Stages (IIB-III) of Cervical Cancer. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e10758. [PMID: 24693381 PMCID: PMC3955496 DOI: 10.5812/ircmj.10758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022]
Abstract
Background: Worldwide, cervical cancer is one of the most challenging gynecologic cancers in treatment. Objectives: This study was designed with the aim of comparing patients treated with External Beam Radiotherapy (EBRT) and Interactivity Brachytherapy (ICBT) with EBRT and extrafascial hysterectomy in locally advanced stages of cervical cancer (IIB-III). Patients and Methods: The present study was designed as a case-control which was performed on the patients with cervical cancer in locally advanced stages (IIB-III) admitted to Namazi and Faghihi hospitals (university hospitals in Shiraz) between 2008-2011. 51 patients were included in two distinct groups: 25 patients were treated with EBRT and Interactivity Brachytherapy (group A). 26 patients were treated with EBRT and extrafascial hysterectomy group B. Results: In group A, the number of patients with FIGO stage IIb and III were 16 and 9, respectively, and 17 and 9 in group B. The median duration of follow-up was 24 months. There were no significant differences between two groups in metastasis and recurrence rate (P > 0.05). 5-years overall survival rate was 54.8% [95% CI: 39-70.9] in group A and in group B was 50.9% [95% CI: 41.5-60] and The LOG-rank test which controls the effect of treatment modalities on overall survival rate, did not show any significant difference between two groups (P = 0.407). Conclusion: The results of our study showed that the trend of treatment using EBRT along with intracavity brachytherapy may have the same outcome as the method of using EBRT and extrafascial hysterectomy. Overall, it seems that external beam radiation followed by extrafascial hysterectomy could be a proper substitute for brachytherapy.
Collapse
Affiliation(s)
- Zahra Sarraf
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Bahareh Hamedi
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Bahareh Hamedi, Obstetrics and Gynecology Department Office, Shahid Faghihi Hospital, Zand Avenue, Shiraz, IR Iran, Tel: +98-7112332365, Fax: +98-7112332365, E-mail:
| | - Soodabeh Hooshmand
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ahmad Mosalaie
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Minoo Robati
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mozhdeh Momtahan
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Pouya Farhadi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| |
Collapse
|
20
|
Hequet D, Marchand E, Place V, Fourchotte V, De La Rochefordière A, Dridi S, Coutant C, Lecuru F, Bats AS, Koskas M, Bretel JJ, Bricou A, Delpech Y, Barranger E. Evaluation and impact of residual disease in locally advanced cervical cancer after concurrent chemoradiation therapy: Results of a multicenter study. Eur J Surg Oncol 2013; 39:1428-34. [DOI: 10.1016/j.ejso.2013.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022] Open
|
21
|
Fanfani F, Fagotti A, Gagliardi M, Ferrandina G, Monterossi G, Gallotta V, Zannoni G, Scambia G. Pre-hysterectomy cone biopsy is able to predict response in locally advanced cervical cancer patients submitted to neo-adjuvant chemoradiation. Eur J Surg Oncol 2013; 39:1025-9. [DOI: 10.1016/j.ejso.2013.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/11/2013] [Accepted: 06/06/2013] [Indexed: 01/20/2023] Open
|
22
|
Wei LC, Wang N, Shi M, Liu JY, Li JP, Zhang Y, Huang YH, Li X, Chen Y. Clinical outcome observation of preoperative concurrent chemoradiotherapy/radiotherapy alone in 174 Chinese patients with local advanced cervical carcinoma. Onco Targets Ther 2013; 6:67-74. [PMID: 23404048 PMCID: PMC3569376 DOI: 10.2147/ott.s39495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To study outcomes of concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone followed by radical surgery in patients with local advanced cervical cancer. METHODS A retrospective approach was carried out in 174 Chinese patients with International Federation of Obstetricians and Gynaecologists stage IB2-IIIB cervical carcinoma. A total of 121 patients were treated with CCRT, while the remaining 53 patients received RT alone, and the regimen of chemotherapy was weekly cisplatin (40 mg/m2). Pathological response, overall survival (OS), progression-free survival (PFS), and complications were analyzed. RESULTS The median age was 45 years and the mean primary tumor diameter was 4.8 ± 1.0 cm. Pathological complete response (CR) was achieved in 53 patients (30.5%). The CR rate was relatively higher in the CCRT group (31.4% vs 28.3%, P = 0.724), particularly when tumor diameter was less than 5 cm (38.2% vs 30.8%, P = 0.623). With median follow-up of 24 months, patients with CR had improved 3-year OS (100% vs 83.6%, P = 0.018) and 3-year PFS (93.1% vs 83.2%, P = 0.035) compared to patients with residual disease. CCRT was associated with significantly improved 3-year PFS (92.0% vs 76.5%, P = 0.032) compared to RT alone in patients with tumor diameter less than 5 cm. Thirty-seven patients (21.3%) experienced more than grade 2 toxicity, and one patient (0.6%) developed grade 3 uronephrosis. Data thus indicated that pathologic response, tumor size, and lymph-node involvement were highly correlated with clinical outcomes of the local advanced cervical disease. CONCLUSION Preoperative CCRT achieved outcomes superior to RT alone, depending on the pathologic response, tumor size and lymph-node involvement as major prognostic factors.
Collapse
|
23
|
Zhao YB, Wang JH, Chen XX, Wu YZ, Wu Q. Values of three different preoperative regimens in comprehensive treatment for young patients with stage Ib2 cervical cancer. Asian Pac J Cancer Prev 2013; 13:1487-9. [PMID: 22799353 DOI: 10.7314/apjcp.2012.13.4.1487] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy of concurrent chemoradiotherapy, neoadjuvant chemotherapy, and intracavity brachytherapy in comprehensive treatment for young patients with stage Ib2 cervical cancer. METHODS One hundred and twelve young patients with stage Ib2 cervical cancer were enrolled retrospectively in our hospital from January 2003 to June 2005. They were categorized into three groups according to preoperative regimens, including the concurrent chemoradiotherapy group (Group 1, n=38), the neoadjuvant chemotherapy (Group 2, n=49), and the intracavity brachytherapy group (Group 3, n=25). Radical hysterectomy was performed following these regimens. Chemotherapy and radiotherapy were given according to pelvic lymph node metastasis, deep cervical stromal invasion, intravascular cancer emboli, histological grading, vaginal stump and positive surgical margin. RESULTS The cancer disappearance and superficial muscle invasion rates were statistically significantly better in the concurrent chemoradiotherapy group than in the other two groups (P<0.01). No statistically significant difference was noted in the deep muscle invasion rate, surgical time and intraoperative blood loss among three groups, but significantly more postoperative complications occurred in the concurrent chemoradiotherapy group. The 2-year pelvic recurrence was statistically significantly lower in the concurrent chemoradiotherapy group compared to other two groups, while the 5-year survival was higher. CONCLUSION Concurrent chemoradiotherapy is efficacious for young patients with stage Ib2 cervical cancer.
Collapse
Affiliation(s)
- Yi-Bing Zhao
- Department of Gynecologic Oncology, Jiangsu Cancer Hospital and Research Institute, Nanjing, China.
| | | | | | | | | |
Collapse
|
24
|
Benedetti Panici P, Perniola G, Tomao F, Fischetti M, Savone D, Di Donato V, Angioli R, Muzii L. An Update of Laparoscopy in Cervical Cancer Staging: Is It a Useful Procedure? Oncology 2013; 85:160-5. [DOI: 10.1159/000351995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/09/2013] [Indexed: 11/19/2022]
|
25
|
Concomitant boost plus large-field preoperative chemoradiation in locally advanced uterine cervix carcinoma: Phase II clinical trial final results (LARA-CC-1). Gynecol Oncol 2012; 125:594-9. [DOI: 10.1016/j.ygyno.2012.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
|
26
|
Forner DM, Lampe B. Exenteration as a primary treatment for locally advanced cervical cancer: long-term results and prognostic factors. Am J Obstet Gynecol 2011; 205:148.e1-6. [PMID: 21640963 DOI: 10.1016/j.ajog.2011.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/04/2011] [Accepted: 03/29/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Whereas pelvic exenteration is an established therapy for the treatment of recurrent cervical carcinoma, it is not often performed for primary locally advanced cervical cancer (LACC). STUDY DESIGN This retrospective study analyzed survival data and prognostic factors of 35 patients with LACC who were treated by pelvic exenteration. RESULTS After surgery, 33 patients (97%) were macroscopically free of tumor. In 20 patients, pelvic lymph nodes (LN) were involved, and in 6 of these, metastatic tissue had reached the paraaortal nodes. Overall, the patients' mean 5 year survival was 43%, and the median survival time was 30 months; these values ranged from 15% to 70% and from 15 to 44 months, respectively, depending on LN involvement (P=.006). Pelvic LN involvement was the only significant factor for overall survival found in the multivariate analysis (P=.02). CONCLUSION In LACC with free LNs and no distant metastases, pelvic exenteration has good long-term results.
Collapse
|
27
|
Ferrandina G, Margariti PA, Smaniotto D, Petrillo M, Salerno MG, Fagotti A, Macchia G, Morganti AG, Cellini N, Scambia G. Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol 2010; 119:404-10. [PMID: 20817228 DOI: 10.1016/j.ygyno.2010.08.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 07/31/2010] [Accepted: 08/06/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Preoperative chemoradiation (CT/RT) has been shown to achieve encouraging results in terms of clinical outcome in locally advanced cervical cancer (LACC). The study aims at analyzing the long-term results of this multimodal approach in a single institution series of 184 cases. METHODS Patients underwent whole pelvic irradiation combined with cisplatin and 5-fluorouracil. After evaluation of clinical response, patients were triaged to surgery. Surgical morbidity was classified according to Chassagne grading system. Univariate and multivariate analyses were used to assess the prognostic and predictive role of clinicopathological parameters. RESULTS Clinical response was observed in 96.1% of cases. A total of 174 cases were submitted to radical surgery: 124 patients (71.3%) showed complete/microscopic pathological response. In multivariate analysis, clinical response, stage of disease, and histotype predicted response to CT/RT. With a median follow-up of 58 months, recurrence and death of disease were observed in 42 and 40 patients, respectively. The 5-year DFS was 75.5%, while the 5-year OS was 77.4%. Patients with no residual disease showed a significant longer DFS than patients with microscopic (p value = 0.0128), and macroscopic (p value = 0.0001) residual tumor after treatment. In multivariate analysis, residual tumor and stage of disease were the two most relevant prognostic factors for DFS and OS. As far as long-term toxicity is concerned, 8 out of 22 complications were grade 3/4. CONCLUSION Preoperative CT/RT is worth further investigation in LACC patients, providing encouraging survival outcomes and a favourable long-term toxicity profile.
Collapse
Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Catholic University of Campobasso, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Macchia G, Ferrandina G, Deodato F, Ruggieri V, Massaccesi M, Salutari V, Valentini V, Cellini N, Scambia G, Morganti AG. Concomitant boost dose escalation plus large-field preoperative chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a phase I study (LARA-CC-1). Gynecol Oncol 2010; 118:128-33. [DOI: 10.1016/j.ygyno.2010.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/20/2010] [Accepted: 04/24/2010] [Indexed: 11/30/2022]
|
29
|
Delpech Y, Bricou A, Lousquy R, Barranger E. [Debate for: hysterectomy in locally advanced cervical cancer]. ACTA ACUST UNITED AC 2009; 37:834-6. [PMID: 19766047 DOI: 10.1016/j.gyobfe.2009.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Y Delpech
- Service de gynécologie-obstétrique, CHU de Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | | | | | | |
Collapse
|
30
|
Colombo P, Bertrand M, Gutowski M, Mourregot A, Fabbro M, Saint-Aubert B, Quenet F, Gourgou S, Kerr C, Rouanet P. Total laparoscopic radical hysterectomy for locally advanced cervical carcinoma (stages IIB, IIA and bulky stages IB) after concurrent chemoradiation therapy: Surgical morbidity and oncological results. Gynecol Oncol 2009; 114:404-9. [DOI: 10.1016/j.ygyno.2009.05.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 05/26/2009] [Accepted: 05/30/2009] [Indexed: 10/20/2022]
|
31
|
Park DC, Suh MJ, Yeo SG. Neoadjuvant paclitaxel and cisplatin in uterine cervical cancer: long-term results. Int J Gynecol Cancer 2009; 19:943-7. [PMID: 19574789 DOI: 10.1111/igc.0b013e3181a23c2e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the effect of neoadjuvant chemotherapy with paclitaxel and cisplatin on long-term (5-year) survival of patients with stage IB2 to IIB cervical cancer. MATERIALS AND METHODS Forty-three consecutive patients with International Federation of Gynecology and Obstetrics stage IB2 to IIB uterine cervical cancer were treated with intravenous paclitaxel (60 mg/m), followed by intravenous cisplatin (60 mg/m) every 10 days. Two weeks after the third cycle of chemotherapy, the patients underwent surgery or radiation therapy, depending on overall condition. They were followed up, and 5-year survival rates and factors affecting prognosis were evaluated. RESULTS All of 43 patients underwent surgery. Of the 43 patients, 17 (39.5%) showed a complete response, 22 (51.2%) had a partial response to cisplatin-paclitaxel, making the overall response rate 90.7%; the remaining 4 patients (9.3%) had a stable disease. A down-staging response was seen in 72.1% (31/43) of patients showing a response. After surgery, patients received adjuvant therapy according to their pathological findings. Among the 43 patients, 37 were followed up. Kaplan-Meier analysis showed that the overall 2- and 5-year survival rates were 94.5% and 89.2%, respectively. Initial stage, response to neoadjuvant chemotherapy, differentiation, depth of invasion after chemotherapy, and metastasis were significantly correlated with survival. Differences in TA4, tumor size, and stage before and after chemotherapy were also significantly correlated with survival. In contrast, initial tumor size, carcinoembryonic antigen concentration, cell type, and lymphovascular invasion did not correlate significantly with survival rate. CONCLUSIONS Combination neoadjuvant chemotherapy with paclitaxel and cisplatin may improve long-term survival of patients with uterine cervical cancer.
Collapse
Affiliation(s)
- Dong Choon Park
- Department of Obstetrics and Gynecology, Saint Vincent's Hospital, Catholic University of Korea, Seoul, South Korea
| | | | | |
Collapse
|
32
|
Cetina L, Garcia-Arias A, Candelaria M, Cantú D, Rivera L, Coronel J, Bazan-Perkins B, Flores V, Gonzalez A, Dueñas-González A. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients. World J Surg Oncol 2009; 7:19. [PMID: 19220882 PMCID: PMC2649933 DOI: 10.1186/1477-7819-7-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 02/16/2009] [Indexed: 11/10/2022] Open
Abstract
Background A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. Methods In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. Results A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31) and 22 (3–27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. Conclusion The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.
Collapse
Affiliation(s)
- Lucely Cetina
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/INCan, Mexico City, México.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Dornhöfer N, Höckel M. New developments in the surgical therapy of cervical carcinoma. Ann N Y Acad Sci 2008; 1138:233-52. [PMID: 18837903 DOI: 10.1196/annals.1414.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
For almost a century abdominal radical hysterectomy has been the standard surgical treatment of early-stage macroscopic carcinoma of the uterine cervix. The excessive parametrial resection of the original procedures of Wertheim, Okabayashi, and Meigs has later been "tailored" to tumor extent. Systematic pelvic and eventually periaortic lymph node dissection is performed to identify and treat regional disease. Adjuvant (chemo)radiation therapy is liberally added to improve locoregional tumor control when histopathological risk factors are present. The therapeutic index of the current surgical treatment, particularly if combined with radiation, appears to be inferior to that of primary chemoradiation as an oncologically equivalent therapeutic alternative. Several avenues of new conceptual and technical developments have been used since the 1990s with the goal of improving the therapeutic index. These are: surgical staging, including sentinel node biopsy and nodal debulking; minimal access and recently robotic radical hysterectomy; fertility-preserving surgery; nerve-sparing radical hysterectomy; total mesometrial resection based on developmentally defined surgical anatomy; and supraradical hysterectomy. The superiority of these new developments over the standard treatment remains to be demonstrated by controlled prospective trials. Multimodality therapy including surgery for locally advanced disease represents another area of clinical research. Both neoadjuvant chemotherapy followed by radical surgery, with or without adjuvant radiation, and completion surgery after (chemo)radiation are feasible and have to be compared to primary chemoradiation as the new nonsurgical treatment standard. Surgical treatment of postirradiation persisting or recurrent cervical carcinoma has been traditionally limited to pelvic exenteration for central disease. Applying the principle of developmentally derived anatomical compartments increases R0 resectability. The laterally extended endopelvic resection allows even the extirpation of a subset of visceral pelvic side wall tumors with clear margins. Many questions regarding the indication for these "ultraradical" operations, the surgery of irradiated tissues, and the optimal reconstructive procedures are still open and demand multi-institutional controlled trials to be answered.
Collapse
Affiliation(s)
- Nadja Dornhöfer
- Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany
| | | |
Collapse
|
34
|
Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2/II cervical carcinoma with chemoradiation therapy. Cancer 2008; 113:2158-65. [DOI: 10.1002/cncr.23817] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
35
|
Distefano M, Riccardi S, Capelli G, Costantini B, Petrillo M, Ricci C, Scambia G, Ferrandina G. Quality of life and psychological distress in locally advanced cervical cancer patients administered pre-operative chemoradiotherapy. Gynecol Oncol 2008; 111:144-50. [DOI: 10.1016/j.ygyno.2008.06.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/27/2008] [Accepted: 06/30/2008] [Indexed: 11/30/2022]
|
36
|
Chemoradiation With Concomitant Boost Followed by Radical Surgery in Locally Advanced Cervical Cancer: A Dose-Escalation Study. Am J Clin Oncol 2008; 31:280-4. [DOI: 10.1097/coc.0b013e31815aff03] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Carcopino X, Houvenaeghel G, Buttarelli M, Esterni B, Tallet A, Goncalves A, Jacquemier J. Equivalent survival in patients with advanced stage IB–II and III–IVA cervical cancer treated by adjuvant surgery following chemoradiotherapy. Eur J Surg Oncol 2008; 34:569-75. [PMID: 17531428 DOI: 10.1016/j.ejso.2007.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 04/12/2007] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate survival in patients with advanced cervical cancer who underwent surgery after concurrent chemoradiotherapy. METHODS One hundred and forty-four patients with biopsy-proven stage IB-IVA cervical cancer underwent adjuvant surgery after concurrent chemoradiotherapy. Surgical resection was classified as curative (no evidence of remaining disease after surgery) or palliative (remaining disease after surgery). Endpoints were pelvic control, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included tumour FIGO stage, type of surgery (curative versus palliative), pelvic control, response to chemoradiotherapy and lymphatic status. RESULTS Tumour FIGO stages were IB-II in 91 cases and III-IVA in 53 cases. Surgery was curative in 127 cases. Pelvic control was achieved in 114 patients and was equivalent in stage IB-II and III-IVA patients. So far, 60 patients have died. The 5-year OS and DFS rates were, respectively, 57.6% [95% CI: 49.1-67.5] and 65% [95% CI: 56.2-75]. OS was significantly affected by the type of surgery (p<2.10(-16)), the presence of tumoural residue (p=0.002) and the pelvic lymphatic status (p<0.001). DFS was affected by the pelvic (p=0.02) and para-aortic lymphatic status (p=0.009). No significant difference was observed between OS and DFS in stage IB-II and III-IVA patients, whereas a macroscopic tumoural residue was observed in, respectively, 30.9 and 52.2% of cases (p=0.022). CONCLUSION Survival rates were equivalent between patients with IB-II and III-IVA cervical cancer, suggesting that adjuvant surgery following chemoradiotherapy may improve local control.
Collapse
Affiliation(s)
- X Carcopino
- Department of Surgery, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France.
| | | | | | | | | | | | | |
Collapse
|
38
|
Battaglia A, Buzzonetti A, Monego G, Peri L, Ferrandina G, Fanfani F, Scambia G, Fattorossi A. Neuropilin-1 expression identifies a subset of regulatory T cells in human lymph nodes that is modulated by preoperative chemoradiation therapy in cervical cancer. Immunology 2007; 123:129-38. [PMID: 18028372 DOI: 10.1111/j.1365-2567.2007.02737.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We examined the phenotype and function of CD4+ T cells expressing the semaphorin III receptor neuropilin-1 (Nrp1) in human lymph nodes and peripheral blood. In lymph nodes, Nrp1 identified a small regulatory CD4+ CD25(high) T-cell subpopulation (Nrp1+ Treg) that expressed higher levels of Forkhead box P3 (Foxp3) message and protein than Nrp1- Treg, and various molecular markers of activated Treg, i.e. CD45RO, human leucocyte antigen (HLA)-DR and glucocorticoid-induced tumour necrosis factor receptor (GITR). Similarly to conventional Treg, Nrp1+ Treg proliferated poorly in vitro, and exerted contact-dependent in vitro suppression of T-cell proliferation and cytokine secretion. However, Nrp1+ Treg were more efficient than Nrp1- Treg at inducing suppression. Nrp1 was also expressed on a small subpopulation of CD25(int) and CD25- CD4+ T cells that expressed more Foxp3, CD45RO, HLA-DR and GITR than their Nrp1- counterparts. In contrast, in peripheral blood Nrp1 identified a minor CD4+ T-cell subset that did not display the phenotypic features of Treg lacking Foxp3 expression and marginally expressing CD25. Hence, the function of Nrp1+ CD4+ T cells seemingly depends on their anatomical location. In a previous report, we proposed that Treg may curb the anti-tumour T-cell response in cervical cancer. We show here that Treg and Nrp1+ Treg levels dropped in the tumour-draining lymph nodes of patients with cervical cancer following preoperative chemoradiotherapy in a direct relationship with the reduction of tumour mass, suggesting that suppressor cell elimination facilitated the generation of T cells mediating the destruction of the neoplastic cells left behind after cytotoxic therapy.
Collapse
|
39
|
Nishiyama Y, Yamamoto Y, Kanenishi K, Ohno M, Hata T, Kushida Y, Haba R, Ohkawa M. Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDG PET. Eur J Nucl Med Mol Imaging 2007; 35:287-95. [DOI: 10.1007/s00259-007-0627-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 09/28/2007] [Indexed: 12/01/2022]
|
40
|
Morice P, Uzan C, Zafrani Y, Delpech Y, Gouy S, Haie-Meder C. The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecol Oncol 2007; 107:S122-4. [PMID: 17761269 DOI: 10.1016/j.ygyno.2007.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to review the results of completion surgery after chemoradiation therapy in stage IB2/II cervical carcinoma. METHODS Analysis of series published in the literature about completion surgery in this context. RESULTS Stages of the disease included in those series were stage IB2-IVA disease. The rate of residual disease was correlated with initial stage of the disease and the use of preoperative brachytherapy. Morbidity of such management varied between 15% and 47% and was correlated with the radicality of the surgical procedure and the size of the residual disease. The rate of complete pathological response varied between 52% and 76%. The survival of patients was correlated with the presence and the size of the residual disease and the presence of a nodal involvement. CONCLUSION Completion surgery after chemoradiation therapy has a place in the multimodality management of stage IB2 or II cervical cancer, particularly in cases of bulky residual disease. Nevertheless further investigations are needed, particularly with collaborative studies, to analyze the real impact of such surgery on the survival of patients.
Collapse
Affiliation(s)
- P Morice
- Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
| | | | | | | | | | | |
Collapse
|
41
|
Fagotti A, Fanfani F, Longo R, Legge F, Mari A, Gagliardi ML, Scambia G. Which role for pre-treatment laparoscopic staging? Gynecol Oncol 2007; 107:S101-5. [PMID: 17727929 DOI: 10.1016/j.ygyno.2007.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate in cervical cancer patients the impact of pre-treatment laparoscopic staging on treatment plan and disease free survival. METHODS A review of the present literature has been performed and data have been compared to results obtained in a large series of patients not surgically staged. RESULTS Among 134 abstracts resulting from Medline research, 13 were deemed potentially relevant to the study questions. The presence of intraperitoneal diffusion of disease can be recognized in locally advanced cervical cancer patients (LACC) in a percentage ranging between 1.9% and 29%. The rate of aortic positive nodes in clinically negative LACC patients cases has been reported between 11% and 25%, by laparoscopy. In our Division, 152 LACC patients have been treated between October 1997 and February 2007. None of the patients has been submitted to pre-treatment laparoscopic staging, whereas in all cases a pre-operative MRI has been performed. With a median follow-up 28.0 months (range 3-126 months), 31 recurrences have been observed. The 5-year DFS has been 83% and OS 90%. Although only a retrospective analysis can be carried out, such result well compares to cases surgically staged. CONCLUSIONS Pre-treatment surgical staging can identify positive nodes in LACC patients considered clinically negative, and recognize intraperitoneal disease, thus making the physician tailor the treatment on the bases of histopathological result. Moreover, it offers the potential advantage of debulking of macroscopically positive nodes, and to transpose the ovary outside the radiation. However, the positive impact on DFS has still to be demonstrated.
Collapse
Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Campobasso, Italy
| | | | | | | | | | | | | |
Collapse
|
42
|
Delpech Y, Haie-Meder C, Rey A, Zafrani Y, Uzan C, Gouy S, Pautier P, Lhommé C, Duvillard P, Castaigne D, Morice P. Para-Aortic Involvement and Interest of Para-Aortic Lymphadenectomy after Chemoradiation Therapy in Patients with Stage IB2 and II Cervical Carcinoma Radiologically Confined to the Pelvic Cavity. Ann Surg Oncol 2007; 14:3223-31. [PMID: 17713822 DOI: 10.1245/s10434-007-9526-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/22/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pelvic radiation therapy with concomitant chemotherapy (PCRT) is the standard treatment of stage IB2/II cervical carcinoma. The impact of concomitant chemotherapy on positive para-aortic nodes (PA+), however, remains unknown. The aim of this study was twofold: to evaluate the rate of histological PA+ after PCRT and to determine the survival of patients with PA+. METHODS Patients fulfilling the following inclusion criteria were studied: (1) stage IB2/II cervical carcinoma, (2) histological subtype: squamous cell, adenocarcinoma or an adenosquamous tumor, (3) exclusion of patients with radiological PA+ (CT scan/MRI), (4) pelvic external radiation therapy of 45 Gy with concomitant chemotherapy (cisplatin 40 mg/m2/week) + utero-vaginal brachytherapy, and (5) completion surgery after the end of PCRT including at least a para-aortic lymphadenectomy. RESULTS Seventy-three patients (16 stage IB2, 57 stage II) treated between 1998 and 2004 fulfilled all the inclusion criteria. PA+ after PCRT were observed in 13 patients (18%) with a median of five (range, 2-22) positive nodes. Overall and disease-free survival at 24 months in patients with PA+ was 40% and 17%. Only two patients with PA+ are currently alive and in remission. CONCLUSIONS The rate of PA+ remains high after PCRT in patients treated for stage IB2/II cervical carcinoma. Furthermore, the survival rate of patients with PA+ is very low. These important results suggest that detection of PA + at the time of completion surgery (after PCRT) is not beneficial for improving survival.
Collapse
Affiliation(s)
- Yann Delpech
- Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
|
44
|
Candelaria M, Cetina L, Garcia-Arias A, Lopez-Graniel C, de la Garza J, Robles E, Duenas-Gonzalez A. Radiation-sparing managements for cervical cancer: a developing countries perspective. World J Surg Oncol 2006; 4:77. [PMID: 17101048 PMCID: PMC1660541 DOI: 10.1186/1477-7819-4-77] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 11/13/2006] [Indexed: 01/13/2023] Open
Abstract
Cervical cancer is the seventh most frequent cancer worldwide but more than 80% of cases occur in developing countries. Till date, radiation therapy with external beam and brachytherapy remains as the core treatment for most stages of cervical cancer. However, radiation treatment protocols and equipment modelled on the best developed countries can be seldom applied directly to developing countries owing to financial constraints and lack of qualified personnel, thus, a substantial proportion of patients do not have access to even palliative radiation therapy. Treatment options when the standard therapy is either not available or difficult to reproduce in particular settings is highly desirable with the potential to save lives that otherwise could be lost by the lack of adequate treatment. These options of treatment ideally had to have show, 1) that these are not inferior to the "standard" in terms of either survival or quality of life; 2) that these can be delivered in settings were the "standard" is not available or if available its quality is poor; and 3) that the treatment option be accepted by the population to be treated. Based on these considerations, it is obvious that cervical cancer patients, particularly those who live in countries with limited resources and therefore may not have sufficient radiation therapy resources are in need of newer therapeutical options. There is now a considerable amount of information emanating from clinical studies where surgery has a major role in treating this disease. These forms of "radiation-sparing" treatments include total mesometrial resection that could make unnecessary the use of adjuvant radiation; neoadjuvant chemotherapy that could avoid the use of adjuvant radiation in around 85% of patients and preoperative chemoradiation that could make brachytherapy dispensable. The feasibility and therapeutical value of these potential forms of management need to be prospectively evaluated.
Collapse
Affiliation(s)
- Myrna Candelaria
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Lucely Cetina
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Alicia Garcia-Arias
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Carlos Lopez-Graniel
- Department of Gynecology Oncology, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Jaime de la Garza
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Elizabeth Robles
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Alfonso Duenas-Gonzalez
- Unidad de Investigación Biomédica en Cáncer. Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México. Instituto Nacional de Cancerología. Mexico City, Mexico
| |
Collapse
|
45
|
Houvenaeghel G, Buttarelli M, de Troyer J, Carcopino X, Lelièvre L, Tallet A, Goncalves A, Jacquemier J. Place de la chirurgie après chimioradiothérapie des cancers du col localement évolués. Cancer Radiother 2006; 10:471-6. [PMID: 16931091 DOI: 10.1016/j.canrad.2006.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standard treatment of locally advanced cervical carcinoma is actually represented by concomitant chemoradiotherapy followed by brachytherapy since several randomised study results in 1999. Surgical resection after concomitant chemoradiotherapy for locally advanced cervical carcinoma is discussed without evidence of benefice on survival and because morbidity. The aim of this study is to discuss surgery after chemoradiotherapy in terms of rate of morbidity and residual tumor, rate of pelvic disease control, overall survival and disease-free survival.
Collapse
Affiliation(s)
- G Houvenaeghel
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, 232, Boulevard Sainte-Marguerite, 13273 Marseille Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Ferrandina G, Martinelli E, Zannoni GF, Distefano M, Paglia A, Ferlini C, Scambia G. Expression of class III beta tubulin in cervical cancer patients administered preoperative radiochemotherapy: correlation with response to treatment and clinical outcome. Gynecol Oncol 2006; 104:326-30. [PMID: 17030352 DOI: 10.1016/j.ygyno.2006.08.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 08/13/2006] [Accepted: 08/30/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Alterations of the beta subunit of tubulin have been reported to be predictive of resistance to radiation and antitubulin agents in several solid tumors. The aim of the study was to investigate the clinical role of beta III tubulin expression as prognostic factor for survival and as a predictive parameter of response to preoperative radiochemotherapy in a single institutional series of locally advanced cervical cancer (LACC) patients. METHODS The study included 98 LACC patients admitted to the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso between January 1998 and January 2005. Immunohistochemistry was performed by using the polyclonal rabbit anti-beta III tubulin antibody (Covance, Princeton, NJ, USA). The value of 10% immunostained tumor cells was arbitrarily chosen as cut-off value to distinguish cases with high versus low beta III tubulin content. RESULTS In the whole series, beta III tubulin immunoreaction was detectable in 66/98 cases (67.3%), and the percentage of positively stained cells ranged from 0 to 100% (median=10%). The percentages of cases with high beta III tubulin expression were shown not to be differently distributed according to clinico-pathological characteristics. There was no statistically significant difference in the distribution of cases with high beta III tubulin expression according to clinical and pathological response to treatment. During the follow-up period, recurrence and death of disease occurred in 15 and 13 cases, respectively. There was no difference in disease-free and overall survival in cases with high versus low beta III tubulin expression. CONCLUSIONS The assessment of class III beta tubulin status seems of little usefulness in order to identify LACC patients with poor chance of response to concomitant radiochemotherapy and unfavorable prognosis.
Collapse
|
47
|
Ferrandina G, Distefano M, Smaniotto D, Morganti A, Paglia A, Macchia G, Corvari B, Lorusso D, Scambia G. Anemia in patients with locally advanced cervical carcinoma administered preoperative radiochemotherapy: association with pathological response to treatment and clinical outcome. Gynecol Oncol 2006; 103:500-5. [PMID: 16677692 DOI: 10.1016/j.ygyno.2006.03.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 03/14/2006] [Accepted: 03/20/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the role of anemia at presentation (basal HB) and during treatment (nadir HB) as predictor of pathological response, as well as disease-free (DFS) and overall survival (OS) in LACC patients undergoing chemoradiation followed by radical surgery. METHODS 114 consecutive LACC patients were accrued at the Gynecologic Oncology Unit, Catholic University, Rome and at the Department of Oncology, Catholic University of Campobasso, Italy. Neoadjuvant treatment included chemotherapy with cisplatin (20 mg/m2) and 5-fluorouracil (1000 mg/m2, 24-h infusion) (both on days 1-4 and 27-30) and external radiotherapy to the whole pelvic region (22 fractions, 1.8 Gy/day, totaling 39.6 Gy). Clinical responders underwent radical surgery. Hemoglobin levels were recorded and expressed in gram per literx10(-2) (g/dl). The value of 10 g/dl was arbitrarily chosen as cut-off value. RESULTS In cases showing high basal HB status, the percentage of pathological response was significantly higher than in patients showing low HB status (76.3% versus 46.7%) (P value=0.027). When logistic regression was applied, only advanced stage remained associated with a poor chance of response to treatment. Cases with low basal HB status had a shorter DFS and OS than cases with a high HB status (P value=0.0001 and 0.0022, respectively). Similar results were obtained when analyzing nadir HB status. In multivariate analysis, high basal HB status, and advanced stage, retained an independent negative prognostic role for DFS and OS. CONCLUSIONS Anemia identifies LACC patients administered preoperative radiochemotherapy, who are at higher risk of recurrence and death of disease.
Collapse
|