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Ifosfamide - History, efficacy, toxicity and encephalopathy. Pharmacol Ther 2023; 243:108366. [PMID: 36842616 DOI: 10.1016/j.pharmthera.2023.108366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
In this review we trace the passage of fundamental ideas through 20th century cancer research that began with observations on mustard gas toxicity in World War I. The transmutation of these ideas across scientific and national boundaries, was channeled from chemical carcinogenesis labs in London via Yale and Chicago, then ultimately to the pharmaceutical industry in Bielefeld, Germany. These first efforts to checkmate cancer with chemicals led eventually to the creation of one of the most successful groups of cancer chemotherapeutic drugs, the oxazaphosphorines, first cyclophosphamide (CP) in 1958 and soon thereafter its isomer ifosfamide (IFO). The giant contributions of Professor Sir Alexander Haddow, Dr. Alfred Z. Gilman & Dr. Louis S. Goodman, Dr. George Gomori and Dr. Norbert Brock step by step led to this breakthrough in cancer chemotherapy. A developing understanding of the metabolic disposition of ifosfamide directed efforts to ameliorate its side-effects, in particular, ifosfamide-induced encephalopathy (IIE). This has resulted in several candidates for the encephalopathic metabolite, including 2-chloroacetaldehyde, 2-chloroacetic acid, acrolein, 3-hydroxypropionic acid and S-carboxymethyl-L-cysteine. The pros and cons for each of these, together with other IFO metabolites, are discussed in detail. It is concluded that IFO produces encephalopathy in susceptible patients, but CP does not, by a "perfect storm," involving all of these five metabolites. Methylene blue (MB) administration appears to be generally effective in the prevention and treatment of IIE, in all probability by the inhibition of monoamine oxidase in brain potentiating serotonin levels that modulate the effects of IFO on GABAergic and glutamatergic systems. This review represents the authors' analysis of a large body of published research.
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Zhang GY, Zhang R, Bai P, Li SM, Zhang YY, Chen YR, Huang MN, Wu LY. Concurrent definitive chemoradiation incorporating intensity-modulated radiotherapy followed by adjuvant chemotherapy in high risk locally advanced cervical squamous cancer: a phase II study. BMC Cancer 2022; 22:1331. [PMID: 36539745 PMCID: PMC9764592 DOI: 10.1186/s12885-022-10406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage IIIB-IVA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseII study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. OBJECTIVES To determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. STUDY DESIGN Patients were enrolled if they had biopsy proven stage IIIA-IVA squamous cervical cancer or stage IIB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 ~ 50.0 Gy at 1.8 Gy ~ 2.0 Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0-65 Gy at 2.0- 2.6 Gy/fraction in 25 fractions. A total dose of 28 ~ 35 Gy high-dose- rate brachytherapy was prescribed to point A in 4 ~ 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30 mg/m2 was initiated on the first day of radiotherapy for over 1-h during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m2 was given as a 3-h infusion on day1, followed by cisplatin 35 mg/m2 with 1-h infusion on day1-2 (70 mg/m2 in total). RESULTS Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5%, 90.3%, and 88.0%, respectively. Four of the patients died of the disease, and the 5-year overall survival was 92.1%. Most of the toxicities reported during concurrent chemo-radiotherapy were mild and transient. The occurrence of hematological toxicities elevated mildly during adjuvant chemotherapy, as 32% (16/50) and 4% (2/50) patients experienced grade 3-4 leukopenia and thrombocytopenia, respectively. Grade 3-4 late toxicities were reported in 3 patients. CONCLUSIONS The incorporation of intensity-modulated radiotherapy and adjuvant paclitaxel plus cisplatin chemotherapy were highly effective and well-tolerated in the treatment of high-risk locally advanced cervical cancer. The former yields an improved loco-regional control, whereas distant metastases could be effectively eradicated with mild toxicities when adjuvant regimen was prescribed.
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Affiliation(s)
- Gong-yi Zhang
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Rong Zhang
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Ping Bai
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Shu-min Li
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Yuan-yuan Zhang
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Yi-ran Chen
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Man-ni Huang
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
| | - Ling-ying Wu
- grid.506261.60000 0001 0706 7839Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.17 Panjiayuan, Chaoyang District, Beijing, 100021 China
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Radzishevska Y, Sukhina О, Vasylyev L, Sukhin V, Nemaltsova К, Kulinich H, Solodovnikova O. Treatment strategy and clinical characteristics of patients with cervical cancer as prognostic parameters of survival. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.3.2022.65-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Cervical cancer (CRC) ranks second in the world among all malignant neoplasms of the female genital organs. According to the WHO, more than 500000 new cases of CRC are detected annually in the world. In 2021, 3398 new cases of the disease were registered in Ukraine. Currently a number of factors that have a rather high individual prognostic significance influences the CRC development. Among these factors are those which are associated with an adverse outcome: heavy hereditary anamnesis, growth form of tumor and its localization, variant of spread, depth of invasion into the stroma, morphological structure, methods of treatment, etc. Over the last decade, there has been an unfavorable trend towards an increase in the number of young patients who have an advanced tumor process, which significantly restricts methods and reduces the chances of the successful treatment. Thereby, the high level of morbidity and mortality from CRC, especially among young patients, as well as the unsatisfactory results of 5-year survival after traditional methods of treatment, indicate that the cancer of this type is the prior problem in domestic oncology.
Purpose. To make scientific analysis of modern treatment strategies and characteristics of CRC as prognostic survival parameters.
Materials and methods. The literature review included available full-text publications, which were obtained as a result of an in-depth analysis of foreign and domestic scientific publications.
Results. Authors gave analysis of modern domestic and foreign literature on the evaluation of the effectiveness of treatment of cervical cancer patients; namely, how treatment strategies, individual characteristics of patients and characteristics of the tumor affect the results of treatment and prognosis of patient survival. It is shown which parameters, factors and important nuances of the disease should be taken into account, which is decisive in choosing treatment tactics and preventing complications.
Conclusions. Knowing and taking into account the prognostic parameters of the survival of cervical cancer patients is important for the assessment of treatment standards, as well as the development of personalized tactics for the treatment and monitoring of this disease.
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Is There a Place for Adjuvant Chemotherapy in the Treatment of Locally Advanced Cervical Cancer? Curr Oncol 2022; 29:5223-5237. [PMID: 35892984 PMCID: PMC9332289 DOI: 10.3390/curroncol29080415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Findings on the efficacy of adjuvant chemotherapy (ACT) of locally advanced cervical cancer (LACC) after the concurrent chemoradiation (CCRT) therapy were inconsistent, and the OUTBACK trial was expected to shed some light regarding the topic. Its results on ACT in LACC were negative, with the conclusion of not to use it. The objective of this review was to present the inconsistencies of previous studies, along with the OUTBACK trial in more detail, and to rethink whether its results provide an unambiguous and definite answer to the optimal position of ACT in the treatment of LACC. To critically appraise the OUTBACK trial and understand the consequences of its results, we used only randomized controlled studies (RCTs) on ACT in LACC that have been included in high-quality systematic reviews and meta-analyses. We calculated the pooled prediction intervals using a random effects meta-analysis of all published randomized studies including the OUTBACK trial. After combining the OUTBACK trial with the results of four previous randomized trials, the pooled hazard ratio for overall survival benefit of CCRT + ACT was 0.95 (95% CI 0.75; 1.20). The pooled hazard ratio of the four previous trials was 1.00 (95% CI 0.69; 1.44). The OUTBACK trial improved the precision of the pooled estimate, but the clinical heterogeneity and the consequent prediction intervals are still very wide, and with 95% reliability, we can expect that if the new study, using a similar approach to the ACT, on a randomly selected patient population from the presented five trials is conducted, its hazard ratio for overall survival after ACT would be between 0.47 and 1.93. In conclusion, there is an absolute need for further research in order to optimally define the position of ACT in the treatment of LACC.
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Sun C, Wang S, Ye W, Wang R, Tan M, Zhang H, Zhou J, Li M, Wei L, Xu P, Zhu G, Lang J, Lu S. The Prognostic Value of Tumor Size, Volume and Tumor Volume Reduction Rate During Concurrent Chemoradiotherapy in Patients With Cervical Cancer. Front Oncol 2022; 12:934110. [PMID: 35912169 PMCID: PMC9329537 DOI: 10.3389/fonc.2022.934110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to investigate the relationship between prognostic and tumor parameters of cervical cancer patients, such as tumor size (TS), tumor volume (TV), and tumor volume reduction rate (TVRR) after external beam radiotherapy. Methods A total of 217 patients with advanced cervical cancer, classified as Federation of Gynecology and Obstetrics (FIGO) IIa–IVa, were enrolled in the study. Pre- and mid-RT pelvic magnetic resonance imaging (MRI) were performed twice, during RT and just before brachytherapy. Results The median follow-up time was 51 months (range, 7–111 months). The 5-year overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS) rates were 81.3, 85.1, and 92.9%, respectively. Multivariate analysis revealed that tumor parameters including FIGO stage >II (Hazard Ratio, 2.377 and 95% confidence interval [CI], 1.091–5.182; P = 0.029), pre-RT TV >61.6 cm3 (HR, 0.417 and 95% CI, 0.188–0.926; P = 0.032), and mid-RT TV >11.38 cm3 (HR, 3.192 and 95% CI, 1.094–9.316; P = 0.034) were observably associated with OS. Univariate analysis showed that the tumor volume reduction rate (TVRR) was dramatically associated with overall survival (HR, 0.204 and 95% CI 0.033–1.282; P <0.001) and local failure-free survival (P = 0.050). Conclusions In this retrospective study, TVRR and mid-radiotherapy tumor volume are independent and strong prognostic parameters for patients with local advanced cervical cancer receiving CCRT.
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Affiliation(s)
- Chang Sun
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shubin Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenjing Ye
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - RanLin Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingyu Tan
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanyi Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Zhou
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Peng Xu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guiquan Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
- *Correspondence: Shun Lu, ; Jinyi Lang,
| | - Shun Lu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Prevention and Control Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
- *Correspondence: Shun Lu, ; Jinyi Lang,
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Horeweg N, Mittal P, Gradowska PL, Boere I, Nout RA, Chopra S. A systematic review and meta-analysis of adjuvant chemotherapy after chemoradiation for locally advanced cervical cancer. Crit Rev Oncol Hematol 2022; 172:103638. [PMID: 35189325 DOI: 10.1016/j.critrevonc.2022.103638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022] Open
Abstract
We investigated whether the addition of adjuvant chemotherapy to chemoradiation improves overall survival (OS) and progression-free survival (PFS) by conducting a systematic review and meta-analysis. Systematic searches in the databases of PubMed, Embase and Web of Science yielded 881 articles. Two reviewer authors independently selected 31 articles for full text review and deemed eight studies eligible for inclusion. Two were randomised controlled trials (RCT), one was a large (n=609) matched-case study and the remaining were small retrospective cohort studies; in total 2,150 patients. Risk of bias assessment showed that the RCTs were at low risk and all other studies were at high risk of bias. Pooled hazard ratios for OS and PFS were 0.78 (95%CI 0.45-1.33, p=0.36) and 0.85 (95%CI 0.65-1.10, p=0.22), respectively. Analysis stratified by study design and sensitivity analysis showed similar results. Funnel plots showed significant publication bias due to a lack of small studies with negative outcomes.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands.
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, 400012, Mumbai, India.
| | - Patrycja L Gradowska
- Department of Hematology - HOVON Data Center, Erasmus MC Cancer Institute, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Parel, Homi Bhabha National Institute, 410210 Mumbai, India.
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Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer : A retrospective single institution study. Wien Klin Wochenschr 2021; 133:1155-1161. [PMID: 34674038 DOI: 10.1007/s00508-021-01958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Given the lack of primary and secondary prevention programs and cancer awareness in general, cervical cancer remains one of the main causes of cancer-related death in developing countries, such as Bosnia and Herzegovina. Optimization of combinations of external radiation therapy (ERT), brachytherapy and chemotherapy is still needed to improve outcomes in the treatment of advanced cervical cancer. PATIENTS AND METHODS We retrospectively analyzed 48 consecutive patients with Fédération Internationale de Gynecologie et d'Obstetrique (FIGO) 2009 stage IB2-IVA, who were treated with primary concomitant chemobrachyradiotherapy (CCBRT) and consolidation chemotherapy at the Department of Oncology, University Hospital Mostar, Bosnia and Herzegovina between December 2012 and June 2020. Patients were treated with ERT plus two cycles of concomitant chemobrachytherapy with ifosfamide and cisplatin and low-dose rate (LDR) brachytherapy followed by four cycles of consolidation chemotherapy at 3‑week intervals. We evaluated local control rate (LCR), disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and toxicity. RESULTS After 45.5 months (interquartile range, IQR = 47 months) of median follow-up, 5‑year DFS was 72.8% (95% confidence interval. CI 59-78%), OS was 76.6% (95% CI 60-79%), and DSS was 88% (95% CI 71-86%) with acceptable toxicity. LCR was 94%. CONCLUSION Primary CCBRT and consolidation chemotherapy applied in standard clinical practice in the treatment of locally advanced cervical cancer (LACC) produce respectable outcomes.
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Horeweg N, Mittal P, Gradowska PL, Boere I, Chopra S, Nout RA. Adjuvant Systemic Therapy after Chemoradiation and Brachytherapy for Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:1880. [PMID: 33919905 PMCID: PMC8070970 DOI: 10.3390/cancers13081880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Standard of care for locally advanced cervical cancer is chemoradiation and brachytherapy. The addition of adjuvant systemic treatment may improve overall survival. A systematic review and meta-analysis was conducted to summarize evidence on survival outcomes, treatment completion and toxicity. METHODS PubMed, EMBASE and Web of Science were systematically searched for relevant prospective and retrospective studies. Two authors independently selected studies, extracted data and assessed study quality. Pooled hazard ratios for survival endpoints were estimated using random effect models. Weighted averages of treatment completion and toxicity rates were calculated and compared by the Fisher exact test. RESULTS The search returned 612 articles; 35 articles reporting on 29 different studies on adjuvant chemotherapy or immunotherapy were selected for systematic review. Twelve studies on an adjuvant platinum-pyrimidine antagonist or platinum-taxane were included for meta-analysis. The pooled hazard ratios for overall survival were 0.76 (99%CI: 0.43-1.34, p = 0.22) and 0.47 (99%CI: 0.12-1.86, p = 0.16) for the addition of, respectively, a platinum-pyrimidine antagonist or platinum-taxane to chemoradiation and brachytherapy. Completion rates were 82% (95%CI: 76-87%) for platinum-pyrimidine antagonist and 74% (95%CI: 63-85%) for platinum-taxane. Severe acute hematological and gastro-intestinal toxicities were significantly increased by adding adjuvant chemotherapy to chemoradiation and brachytherapy. CONCLUSIONS The addition of adjuvant platinum-pyrimidine antagonist or platinum-taxane after chemoradiation and brachytherapy does not significantly improve overall survival, while acute toxicity is significantly increased. These adjuvant treatment strategies can therefore not be recommended for unselected patients with locally advanced cervical cancer.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai 400094, India;
| | - Patrycja L. Gradowska
- Department of Hematology—HOVON Data Center, Erasmus MC Cancer Institute, P.O. box 2040, 3000CA Rotterdam, The Netherlands;
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, P.O. box 2040, 3000CA Rotterdam, The Netherlands;
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Parel, Homi Bhabha National Institute, Mumbai 400094, India;
| | - Remi A. Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, P.O. box 2040, 3000CA Rotterdam, The Netherlands;
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Wang W, Liu X, Hou X, Lian X, Liu Z, Shen J, Sun S, Yan J, Miao Z, Wang D, Meng Q, Fu J, Zhang F, Qiu J, Hu K. Posttreatment squamous cell carcinoma antigen predicts treatment failure in patients with cervical squamous cell carcinoma treated with concurrent chemoradiotherapy. Gynecol Oncol 2019; 155:224-228. [DOI: 10.1016/j.ygyno.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
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Ali N, Valimohammad AT, Abbasi AN, Mansha MA, Hafiz A, Qureshi BM. Chemoradiation and the Role of Adjuvant Chemotherapy in Lymph Nodal-Metastatic Cervical Cancer. J Glob Oncol 2018; 4:1-4. [PMID: 30241186 PMCID: PMC6180839 DOI: 10.1200/jgo.2017.009852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report the long-term outcome in lymph nodal–metastatic cervical
squamous cell cancer after chemoradiation followed by adjuvant
chemotherapy. Patients and Methods Between 2010 and 2013, five patients were diagnosed with advanced cervical
cancer with clinically involved para-aortic lymph nodes (ie, International
Federation of Gynecology and Obstetrics stage IVB). These patients were
treated with concurrent chemoradiation therapy followed by adjuvant
chemotherapy. Concurrent chemoradiation consisted of cisplatin given once
per week concomitantly with extended-field radiation therapy followed by
high-dose-rate brachytherapy. Adjuvant chemotherapy comprised four courses
of carboplatin and paclitaxel given every three weeks. The primary outcomes
were local and distant failures. Results None of the patients had local recurrence or distal failure after a minimum
follow-up time of 3 years. Conclusion Adjuvant chemotherapy after chemoradiation has a probable role in the
management of lymph nodal–metastatic cervical cancer.
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Affiliation(s)
- Nasir Ali
- All authors: Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Asim Hafiz
- All authors: Aga Khan University Hospital, Karachi, Pakistan
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Lee JH, Lee SW, Kim JR, Kim YS, Yoon MS, Jeong S, Kim JH, Lee JY, Eom KY, Jeong BK, Lee SH. Tumour size, volume, and marker expression during radiation therapy can predict survival of cervical cancer patients: a multi-institutional retrospective analysis of KROG 16-01. Gynecol Oncol 2017; 147:577-584. [PMID: 29110878 DOI: 10.1016/j.ygyno.2017.09.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/31/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this multi-institutional study was to determine the prognostic impact of tumour parameters, such as tumour size (TS), tumour volume (TV), and marker expression, on survival during radiation therapy (RT) for cervical cancer patients. METHODS A total of 231 patients with histologically confirmed cervical cancer, classified as Federation of Gynecology and Obstetrics (FIGO) Ib2-IVa, were enrolled in this study. Pre- and mid-RT pelvic magnetic resonance imaging (MRI) and squamous cell carcinoma antigen (SCC-ag) analysis were performed twice, during RT and just before brachytherapy. RESULTS The median follow-up time was 27.8months (range, 2-116months). Multivariate analysis revealed that stage (odds ratio [OR], 2.936 and 95% confidence interval [CI], 1.119-7.707; P=0.029), tumour volume reduction rate (TVRR) (OR, 3.435 and 95% CI, 1.062-11.106; P=0.039), and SCC-ag reduction rate (SCCRR) (OR, 5.104 and 95% CI, 1.769-14.727; P=0.003) were independently associated with overall survival (OS), while pre-RT TS (OR, 2.148 and 95% CI, 1.221-3.810; P=0.009), mid-RT TV (OR, 3.106 and 95% CI, 1.685-5.724; P<0.0001) and SCCRR (OR, 1.954 and 95% CI, 1.133-3.369; P=0.016) were associated with progression-free survival (PFS). Based on the prognostic factor analysis, patients with the highest prognostic risk score of 3 showed poorer overall survival and progression free survival than patients with lower prognostic risk scores. CONCLUSION We identified that tumour parameters such as TVRR, SCCRR, pre-RT TS, and mid-RT TV areindependent and strong prognostic parameters for patients with cervical cancer receiving RT. This scoring system-based prognostic factor analysis could be used to help develop optimized treatment plans for cervical cancer patients during RT.
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Affiliation(s)
- Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea; Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Ree Kim
- Department of Radiation Oncology, Cheil General Hospital, Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Yeon Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Songmi Jeong
- Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Ja Young Lee
- Department of Radiation Oncology, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea
| | - Keun Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, College of Medicine, Bundang, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seok Ho Lee
- Department of Radiation Oncology, Gachon University of Medical and Science, Incheon, Republic of Korea.
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A postoperative scoring system for distant recurrence in node-positive cervical cancer patients after radical hysterectomy and pelvic lymph node dissection with para-aortic lymph node sampling or dissection. Gynecol Oncol 2017; 144:536-540. [PMID: 28108027 DOI: 10.1016/j.ygyno.2017.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/31/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify risk factors for distant recurrence in node-positive cervical cancer patients who underwent radical hysterectomy and pelvic lymph node dissection (PLND) with para-aortic lymph node sampling (PALNS) or para-aortic lymph node dissection (PALND). METHODS A total of 299 patients in whom lymph node metastasis was confirmed after radical surgery at Asan Medical Center for stage IA2 to IIB cervical cancer from February 2001 to December 2012 were identified. In all, 72 (24.1%) patients underwent PLND only and 227 (75.9%) underwent PLND with PALNS or PALND. Four patients were excluded due to diagnosed with small cell carcinoma. The clinicopathologic data of 223 patients were retrospectively analyzed. Distant recurrence was defined as recurrence at a site over the pelvic radiation field. RESULTS Among all 223 study patients, the mean number of positive lymph nodes was 4.46. There were 54 (24.2%) patients with distant metastasis. Multivariate analyses using the Cox proportional hazards model showed that histologic types (HR=3.031, P≤0.001 for adenocarcinoma, HR=2.302, P=0.066 for adenosquamous carcinoma), number of positive lymph nodes (HR=1.077, P≤0.001), and surgical stage (HR=1.264, P=0.022) were independent risk factors for distant recurrence of cervical cancer. A scoring system for the prediction of distant recurrence was generated by incorporating these factors and showed good discrimination and calibration (concordance index of 0.753). In an internal validation set, this scoring system showed good discrimination with a C-statistics of 0.777. According to the Hosmer-Lemeshow test, the chi-square was 0.650 and the P-value was 0.723. CONCLUSIONS We have developed a robust scoring system that can predict the risk of distant recurrence in node-positive cervical cancer patients after radical operation. This scoring system was used to identify a group of patients who required systemic control of distant micrometastasis. This group of patients is an appropriate target for consolidation chemotherapy after concurrent chemoradiation therapy.
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Yang K, Park W, Huh SJ, Bae DS, Kim BG, Lee JW. Clinical outcomes in patients treated with radiotherapy after surgery for cervical cancer. Radiat Oncol J 2016; 35:39-47. [PMID: 27927011 PMCID: PMC5398353 DOI: 10.3857/roj.2016.01893] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 01/17/2023] Open
Abstract
Purpose The purpose of this study was to analyze clinical outcomes from cervical cancer and stratify patients into risk groups for prognostic factors for early-stage disease. Materials and Methods We retrospectively reviewed patients with stage IB or IIA cervical cancer treated with adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) following primary surgery at Samsung Medical Center from 2001 to 2011. Adjuvant RT was added for patients with intermediate-risk factors, and adjuvant CCRT was performed on high-risk patients after surgery. Results We reviewed 247 patients—149 in the high-risk group and 98 in intermediate-risk group. The median follow-up was 62 months. Loco-regional failure (LRF) alone occurred in 7 patients (2.8%), distant metastasis alone in 37 patients (15.0%) and LRF with DM in 4 patients (1.6%). The 5-year disease-free survival (DFS) and overall survival (OS) rates for both groups were 79.7% and 87.6%, respectively. In the high-risk group, the 5-year DFS and OS probabilities were 72.5% and 81.9%, respectively. Histologic type, pathologic tumor size, and the number of pelvic lymph node (PLN) metastasis were significant prognostic factors for DFS and OS. We suggest a scoring system (0–3) using these prognostic factors to predict poor prognosis in high-risk patients. Using this system, patients with higher scores have higher recurrence and lower survival rates. Conclusion In the high-risk cervical-cancer group who received primary surgery and adjuvant CCRT, non-squamous type, large tumor size and the number of PLN metastasis were significant prognostic factors, and the number of these factors was associated with survival rates.
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Affiliation(s)
- Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, 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
| | - Byoung-Gie 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
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Concurrent chemobrachytherapy in locally advanced cervical carcinoma: A hypothesis worth exploring. Brachytherapy 2016; 15:200-4. [DOI: 10.1016/j.brachy.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/22/2015] [Accepted: 12/31/2015] [Indexed: 11/22/2022]
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