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Fang C, Zhu Y, Zhang P, Zhu T, Zhang Y. The impact of different clinicopathologic factors and salvage therapies on cervical cancer patients with isolated para-aortic lymph node recurrence. Discov Oncol 2024; 15:54. [PMID: 38427141 PMCID: PMC10907327 DOI: 10.1007/s12672-023-00825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/10/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cervical cancer patients with isolated para-aortic lymph nodes (PALN) recurrence were mainly associated with treatment failure. For these patients, radiotherapy, chemotherapy, surgery ± adjuvant therapy or chemoradiotherapy may be advised, however, no specific therapy has been proposed yet. This study aimed to explore factors influencing the prognosis of cervical cancer cases with isolated PALN recurrence and to find out an effective salvage therapy. METHODS Cervical cancer cases with isolated PALN recurrence who received therapies in Zhejiang Cancer Hospital between January 2013 and June 2021 were analyzed retrospectively. RESULTS Carcinoembryonic antigen (CEA) level > 10 ng/mL and positron emission tomography/computed tomography (PET/CT) imaging method used to detect the recurrence were found to be associated with the local control rate. PALN (positive), squamous-cell carcinoma-antigen (SCC-Ag) level (> 10 ng/mL) upon initial diagnosis, and CEA level (> 10 ng/mL), number of metastatic lymph nodes (several) at recurrence were associated with worse survival. Compared with surgery ± adjuvant therapy, chemotherapy (CT) alone or sequential chemoradiotherapy (SCRT) was associated with worse PFS or OS. Concurrent chemoradiotherapy (CCRT) after PALN recurrence could reduce the risk of the second recurrence. 3-year OS of cases after surgery ± adjuvant therapy was the highest (65%), followed by CCRT (45.7%), SCRT (38.9%), radiotherapy (RT) (33.3%), and CT (20.6%). CONCLUSION In cervical cancer patients with isolated PALN recurrence, chemoradiotherapy or surgery ± adjuvant therapy may be preferred as the salvage treatment.
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Affiliation(s)
- Chenyan Fang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Yinfeng Zhu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Ping Zhang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Tao Zhu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Yingli Zhang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
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Lv X, Rao H, Feng T, Wu C, Lou H. Whether individualized dose escalation should be recommended for lymph nodes with different sizes in the definitive radiotherapy of cervical cancer? Radiat Oncol 2022; 17:167. [PMID: 36266716 PMCID: PMC9585835 DOI: 10.1186/s13014-022-02132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Dose escalation for positive node maybe improve the regional control of patients with node-positive cervical cancer, but the optimal dose for nodes of different sizes remains controversial. The purpose of this study was to explore the individualized dose escalation for lymph nodes (LNs) with different sizes in the definitive radiotherapy of cervical cancer. Methods A total of 1002 cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB1–IVA, who were treated by definitively radiotherapy between September 2013 and December 2016 were enrolled. All LNs identified by computed tomography/magnetic resonance imaging (CT/MRI) were assigned into three groups according to the short diameters of < 1 cm, 1–2 cm or ≥ 2 cm at pretreatment. Results In total, 580 patients with 1310 LNs were detected. The nodal control rate in groups of LNs < 1 cm, 1–2 cm and ≥ 2 cm was 99.4%, 96%, and 75.9%, respectively (P = 0.000). Among LNs < 1 cm, the control, overall survival (OS) and progression-free survival (PFS) rates did not significantly differ among three dose-based groups (≤ 50.4 Gy, 50.4–60 Gy, > 60 Gy) (control rate, 99.4% vs. 99.3% vs. 100%, P = 0.647) (5-year OS, 76.2% vs. 79% vs. 81.6%, P = 0.682) (5-year PFS, 74.1% vs. 73.9% vs. 78.9% P = 0.713). Among LNs of 1–2 cm, the control and PFS rates were significantly higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy (control rate, 98% vs. 93.6%, P = 0.028) (5-year PFS, 69.6% vs. 56.7%, P = 0.025). However, this did not cause a significant difference for 5-year OS rate (72.6% vs. 68.3%, P = 0.5). Among LNs ≥ 2 cm, the control, OS, and PFS rates were higher in the group of dose ≥ 55 Gy than the group of dose < 55 Gy, while no significant difference was found (control rate, 82.1% vs. 63.2%, P = 0.107) (5-year OS, 60.6% vs. 37.5%, P = 0.141) (5-year PFS, 51.5% vs.37.5%, P = 0.232). Conclusions Radiation dose escalation is not necessary for LNs < 1 cm, and dose escalation of 55 Gy is enough for LNs of 1–2 cm.
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Affiliation(s)
- Xiaojuan Lv
- Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan East Road 1, Hangzhou, 310022, Zhejiang, China
| | - Huiting Rao
- Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China.,The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China
| | - Tao Feng
- Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China.,The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China
| | - Chufan Wu
- Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China.,The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China
| | - Hanmei Lou
- Department of Gynecologic Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. .,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan East Road 1, Hangzhou, 310022, Zhejiang, China. .,The Second Affiliated College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China.
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Qin F, Pang H, Yu T, Luo Y, Dong Y. Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review. Technol Cancer Res Treat 2022; 21:15330338221086403. [PMID: 35341413 PMCID: PMC8966198 DOI: 10.1177/15330338221086403] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the fourth most common malignant tumor globally in terms of morbidity and mortality. The presence of lymph node metastasis (LNM) is an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in cervical cancer patients. The International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2018. An important revision designates patients with regional LNM as stage IIIC, pelvic LNM only as stage IIIC1, and para-aortic LNM as stage IIIC2. However, the current staging system is only based on the anatomical location of metastatic lymph nodes (LNs). It does not consider other LN status parameters, which may limit its prognostic significance to a certain extent and needs further exploration and confirmation in the future. The purpose of this review is to summarize the choice of treatment for stage IIIC cervical cancer and the effect of different LN status parameters on prognosis.
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Affiliation(s)
- Fengying Qin
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Huiting Pang
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Yu
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yahong Luo
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yue Dong
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
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Prognostic Factors of Advanced Cervical Cancer with Distant Metastasis. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yang E, Huang S, Ran X, Huang Y, Li Z. The 5-year overall survival of cervical cancer in stage IIIC-r was little different to stage I and II: a retrospective analysis from a single center. BMC Cancer 2021; 21:203. [PMID: 33639874 PMCID: PMC7912513 DOI: 10.1186/s12885-021-07890-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging guideline for cervical cancer includes stage IIIC recognized by preoperative radiology (IIIC-r) to state there are lymph nodes metastases (LNM) identified by imaging tools. We aim to explore the reasonability and limitations of stage IIIC-r and try to explore the potential reasons. Methods Electronic medical records were used to identify patients with cervical cancer. According to the new staging guidelines, patients were reclassified and assigned into five cohorts: stage I, stage II, stage IIIC-r, LNM confirmed by pathology (IIIC-p) and LNM detected by radiology and confirmed by pathology (IIIC r + p). Five-year overall survivals were estimated for each cohort. The diagnosis accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and diameter of detected lymph nodes were also evaluated. Results A total of 619 patients were identified. The mean follow-up months were 65 months (95% CI 64.43–65.77) for all patients. By comparison, the 5-year overall survival rates were not statistically different (p = 0.21) among stage IIIC-r, stage I and stage II. While, the rates were both statistical different (p<0.001) among stage IIIC-p, IIIC r + p and stage I and stage II. The sensitivities of CT and MRI in detecting LNM preoperatively were 51.2 and 48.8%. The mean maximum diameter of pelvic lymph nodes detected by CT cohort was 1.2 cm in IIIC-r cohort, and was 1.3 cm in IIIC r + p cohort. While, the mean maximum diameter of pelvic lymph nodes detected by MRI was 1.2 cm in IIIC-r cohort, and was 1.48 cm in IIIC r + p cohort. When the diagnosis efficacy of the diameter of pelvic lymph nodes in detecting LNM were evaluated, the area under the receiver operating characteristic curve (ROC curve) was 0.58 (p = 0.05). Conclusions It seems that the FIGO 2018 staging guideline for cervical cancer is likely to has certain limitations for the classification of those with LNM. CT or MRI, however, has limitations on detecting LNM. It would be better to use more accurate imaging tools to identify LNM in the clinical practices.
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Affiliation(s)
- E Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shuying Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xuting Ran
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China.
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Zhang J, Qin L, Chen HM, Hsu HC, Chuang CC, Chen D, Wu SY. Overall survival, locoregional recurrence, and distant metastasis of definitive concurrent chemoradiotherapy for cervical squamous cell carcinoma and adenocarcinoma: before and after propensity score matching analysis of a cohort study. Am J Cancer Res 2020; 10:1808-1820. [PMID: 32642292 PMCID: PMC7339279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023] Open
Abstract
PURPOSE To estimate the outcomes of definitive concurrent chemoradiotherapy (CCRT) for bulky or advanced-stage cervical squamous cell carcinoma (SCC) and adenocarcinoma (ADC). PATIENTS AND METHODS We enrolled patients who had been diagnosed as having cervical SCC or ADC and received definitive CCRT. A Cox regression analysis was performed to determine the hazard ratio (HR) and 95% confidence intervals (95% CI); independent predictors were stratified or controlled for in the analysis, and the endpoint was all-cause mortality among patients with cervical SCC and ADC who received CCRT. Propensity score matching was performed to create well-balanced groups. RESULTS we enrolled 3258 patients who had International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IVA cervical cancer without distant metastasis. Among them, 2927 patients with cervical SCC and 331 patients with cervical ADC received definitive CCRT. The results of multivariate Cox regression analysis indicated that ADC, advanced FIGO stage, no intracavitary brachytherapy, old age, earlier year of diagnosis, and higher comorbidity scores were significant independent poor prognostic factors of all-cause mortality in patients with cervical cancer who received definitive CCRT. Patients with cervical ADC who received definitive CCRT had higher all-cause mortality, locoregional recurrence (LRR), and distant metastasis (DM) (adjusted HR [95% CI]: 2.10 [1.79-2.46], 1.79 [1.35-2.37], and 1.97 [1.54-2.53] for all-cause mortality, LRR, and DM, respectively) compared with patients with cervical SCC who received CCRT. CONCLUSION Definitive CCRT in patients with cervical ADC resulted in lower overall survival, higher LRR, and higher DM rate compared with patients with cervical SCC.
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Affiliation(s)
- Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou UniversityZhengzhou, Henan, China
| | - Lei Qin
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Ho-Min Chen
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Han-Chuan Hsu
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Chih-Chi Chuang
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Dar Chen
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Szu-Yuan Wu
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical UniversityTaipei, Taiwan
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Zhang J, Qin L, Chen HM, Hsu HC, Chuang CC, Chen D, Wu SY. Outcome patterns of cervical adenocarcinoma and squamous cell carcinoma following curative surgery: before and after propensity score matching analysis of a cohort study. Am J Cancer Res 2020; 10:1793-1807. [PMID: 32642291 PMCID: PMC7339276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023] Open
Abstract
To estimate the outcome patterns and predictors of curative surgery for cervical squamous cell carcinoma (SCC) and adenocarcinoma (ADC) for overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM), we enrolled 4628 patients who had received a diagnosis of cervical SCC or ADC and received curative surgery. Cox regression analysis was employed to calculate hazard ratios and confidence intervals (CIs); independent predictors were controlled for or stratified in the analysis, and the endpoint was all-cause death. Propensity score matching was conducted to create well-balanced groups. Multivariate Cox regression analysis indicated that the pathologic type of ADC, age ≥ 70 years, advanced pathologic stage, positive margin, poorly differentiated cancer, undifferentiated cancer, adjuvant sequential chemotherapy and radiotherapy, earlier year of diagnosis, Charlson comorbidity index (CCI) = 1, CCI ≥ 2, low income levels, and treatment at a nonmedical center were significant independent poor prognostic factors for all-cause mortality in cervical cancer treated with curative surgery. Adjusted hazard ratios (95% CIs) for patients with cervical ADC who received curative surgery were 2.34 (1.96-2.79), 1.15 (0.89-1.49), and 2.16 (1.75-2.66) compared with cervical SCC for all-cause mortality, LRR, and DM, respectively. This study indicated that curative surgery for cervical ADC was associated with poorer OS and higher DM rates relative to cervical SCC, but no significant differences were identified in LRR.
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Affiliation(s)
- Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou UniversityZhengzhou, Henan, China
| | - Lei Qin
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Ho-Min Chen
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Han-Chuan Hsu
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Chih-Chi Chuang
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Dar Chen
- Department of Obstetrics and Gynecology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
| | - Szu-Yuan Wu
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical UniversityTaipei, Taiwan
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Jeong SY, Park H, Kim MS, Kang JH, Paik ES, Lee YY, Kim TJ, Lee JW, Kim BG, Bae DS, Choi CH. Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status. Cancer Res Treat 2020; 52:516-523. [PMID: 31671937 PMCID: PMC7176965 DOI: 10.4143/crt.2019.328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Lymph node metastasis (LNM) is the most significant prognostic factor in cervical cancer that was recently incorporated into the International Federation of Gynecology and Obstetrics (FIGO) staging system. This study was performed to evaluate whether the prognostic significance of LNM differs according to disease status. MATERIALS AND METHODS Patients with FIGO stage IB or higher cervical cancer who had pretreatment computed tomography and/or magnetic resonance imaging studies as well as long-term follow-up were enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was used to determine the prognostic significance of LNM. The HRs were compared between the different tumor groups (based on stage, histology, tumor size, primary treatment, age, parametrium involvement, and lymphovascular space invasion). RESULTS A total of 970 patients treated between January 1999 and December 2007 were included. The pretreatment LNM had prognostic significance in patients with stage IB1/IIA (HR for progression-free survival 2.10, p=0.001; HR for overall survival 1.99, p=0.005). However, the significance gradually decreased or disappeared with advancing stages. Similarly, the prognostic significance of the pretreatment LNM decreased with advancing disease status, including old age, parametrial involvement or lymphovascular space involvement. In contrast, the tumor size was associated with the prognostic significance of LNM with advancing status. The significance of the clinical LNM did not reflect the significance of the clinical stage. In contrast, the tumor size, parametrial involvement, and significance of the pathologic LNM reflected the clinical stage. CONCLUSION In patients with cervical cancer, pretreatment LNM on imaging has different clinical significance depending on the tumor status.
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Affiliation(s)
- Soo Young Jeong
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyea Park
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong Seon Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hyeok Kang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - E Sun Paik
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Correspondence: Chel Hun Choi, MD, PhD Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3545 Fax: 82-2-3410-0630 E-mail:
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Chen CS, Ou YC, Lin H, Wang CJ, Chen HC, Fang FM, Hsu HC, Huang YJ, Wang YM, Huang CC, Chou SY, Cheng JY, Huang EY. Analysis of prognostic factors and clinical outcomes in uterine cervical carcinoma with isolated para-aortic lymph node recurrence. Am J Transl Res 2019; 11:7492-7502. [PMID: 31934296 PMCID: PMC6943452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
To evaluate clinical outcomes and to identify prognostic factors in isolated para-aortic lymph node (PALN) recurrence, we retrospectively reviewed 65 patients who developed PALN recurrence as the first site of tumor progression from a total of 1521 patients who were treated with curative pelvic radiation therapy (RT) for uterine cervical carcinoma between May 1993 and January 2017. Forty-five of the 65 patients received salvage therapy. The median salvage PALN radiation dose was 54 Gy (range: 18 to 62 Gy). Prognostic factors for overall survival (OS) and distant metastases (DMs) were analyzed with univariate and multivariate Cox regression. The median follow-up period for surviving patients was 61 months (4-202 months). The median OS was 27.7 months (0.3-202 months). The highest level of PALN metastases at or above the L1 spinal level (hazard ratio [HR] 9.88, 95% confidence interval [CI] 3.44-28.38, P<0.001) and the presence of leg edema and/or back pain at recurrence (HR 3.25, 95% CI 1.57-6.75, P=0.002) were significantly associated with worse OS. A significantly higher incidence of DMs (HR 5.97, 95% CI 2.05-17.35, P=0.001) was found in the patients with a high level (≥L1) of PALN metastases. Salvage RT (HR 0.35, 95% CI 0.17-0.71, P=0.004) and restaging with positron emission tomography/computed tomography (PET/CT) (HR 0.2, 95% CI 0.04-0.93, P=0.039) were independent predictors of a better OS. In conclusion, a high level (≥L1) of PALN metastases predicts poor survival and a high rate of DMs. Periodic surveillance for early detection and restaging by PET/CT imaging to identify the optimal treatment at recurrence is recommended.
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Affiliation(s)
- Chung-Shih Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Chiayi and Chang Gung University College of MedicineChiayi, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Chong-Jong Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Hui-Chun Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Shang-Yu Chou
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Jen-Yu Cheng
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University College of MedicineTaiwan
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Liu X, Wang W, Meng Q, Zhang F, Hu K. Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasis. Jpn J Clin Oncol 2019; 49:263-269. [PMID: 30668725 DOI: 10.1093/jjco/hyy184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate the efficacy and toxicity of extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy in patients with cervical cancer with positive para-aortic lymph nodes (PALN). METHODS From September 2007 to December 2014, a total of 59 patients who had cervical cancer with para-aortic lymph node metastasis were treated with concurrent chemoradiotherapy at our institution. A dose of 45-50.4 Gy in 25-28 fractions with extended-field intensity-modulated radiation therapy was prescribed to planning target volume, and a dose of 30-36 Gy in 5-6 fractions was prescribed to Point A with high-dose-rate brachytherapy. A concurrent first-line cisplatin-based chemotherapy regimen was used. RESULTS The median duration of follow-up was 32.1 months (range, 3.2-103.7 months). The 2- and 3-year overall survival, disease-free survival and local control rates were 69.0 and 52.8%, 45.0 and 41.3% and 83.4 and 81.0%, respectively. Distant metastasis was the major pattern of treatment failure, which occurred in 26 patients (44.1%). The incidence of Grade 3 or greater acute hematologic, gastrointestinal and genitourinary toxicity was 50.9, 1.7 and 3.4%, respectively. Only one patient had both Grade 3 late gastrointestinal and genitourinary toxicity. CONCLUSIONS The study found that extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy was safe and effective in patients who had cervical cancer with positive PALN.
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Affiliation(s)
- Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquang Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Du R, Li L, Ma S, Tan X, Zhong S, Wu M. Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations. Asia Pac J Clin Oncol 2018; 14:e380-e385. [PMID: 29855154 DOI: 10.1111/ajco.12997] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rongxu Du
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Lei Li
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Shuiqing Ma
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Xianjie Tan
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Sen Zhong
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
| | - Ming Wu
- Department of Obstetrics and Gynecology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing China
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12
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Prognostic significance of residual lymph node status after definitive chemoradiotherapy in patients with node-positive cervical cancer. Gynecol Oncol 2018; 148:449-455. [PMID: 29329882 DOI: 10.1016/j.ygyno.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/19/2022]
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13
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Ouyang Y, Wang Y, Chen K, Cao X, Zeng Y. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer. Oncol Lett 2018; 14:7069-7076. [PMID: 29344136 PMCID: PMC5754842 DOI: 10.3892/ol.2017.7077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/11/2017] [Indexed: 11/11/2022] Open
Abstract
The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (P<0.001). The median follow-up time was 29.5 months. The 3-year overall survival (OS) rates of EF-IMRT and pelvic IMRT were 79.4 and 82.3% (P=0.45), respectively, and the 3-year disease-free survival (DFS) rates of EF-IMRT and pelvic IMRT were 61.0 and 73.7% (P=0.55), respectively. Cox's regression analysis revealed that EF irradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.
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Affiliation(s)
- Yi Ouyang
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Yanhong Wang
- Department of Radiotherapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Kai Chen
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Xinping Cao
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Yiming Zeng
- Respiratory Department, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
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Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol 2016; 27:e43. [PMID: 27171673 PMCID: PMC4864519 DOI: 10.3802/jgo.2016.27.e43] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 01/20/2023] Open
Abstract
Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.
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Affiliation(s)
- Haoran Li
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xi Cheng
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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Ng BH, Rozita A, Adlinda A, Lee WC, Wan Zamaniah W. Extended field radiotherapy with or without chemotherapy in patients with cervical cancer and positive para-aortic lymph nodes: a single institution retrospective review. Asian Pac J Cancer Prev 2016; 16:3827-33. [PMID: 25987044 DOI: 10.7314/apjcp.2015.16.9.3827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positive para-aortic lymph node (PALN) at diagnosis in cervical cancer patients confers an unfavorable prognosis. This study reviewed the outcomes of extended field radiotherapy (EFRT) and concurrent chemotherapy with extended field RT (CCEFRT) in patients with positive PALN at diagnosis. MATERIALS AND METHODS Medical records of 407 cervical cancer patients between 1st January 2002 to 31st December 2012 were reviewed. Some 32 cases with positive PALN were identified to have received definitive extended field radiotherapy with or without chemotherapy. Treatment outcomes, clinicopathological factors affecting survival and radiotherapy related acute and late effects were analyzed. RESULTS Totals of 13 and 19 patients underwent EFRT and CCEFRT respectively during the period of review. The median follow-up was 70 months. The 5-year overall survival (OS) was 40% for patients who underwent CCEFRT as compared to 18% for patients who had EFRT alone, with median survival sof 29 months and 13 months, respectively. The 5-years progression free survival (PFS) for patients who underwent CCEFRT was 32% and 18% for those who had EFRT. Median PFS were 18 months and 12 months, respectively. Overall treatment time (OTT) less than 8 weeks reduced risk of death by 81% (HR=0.19). Acute side effects were documented in 69.7% and 89.5% of patients who underwent EFRT and CCEFRT, respectively. Four patients (12.5%) developed radiotherapy late toxicity and there was no treatment-related death observed. CONCLUSIONS CCEFRT is associated with higher 5-years OS and median OS compared to EFRT and with tolerable level of acute and late toxicities in selected patients with cervical cancer and PALN metastasis.
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Affiliation(s)
- Boon Huat Ng
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia E-mail :
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