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Alarcón-Barrios S, Luvián-Morales J, Castro-Eguiluz D, Delgadillo-González M, Lezcano-Velázquez BO, Arango-Bravo EA, Flores-Cisneros L, Aguiar Rosas S, Cetina-Pérez L. Chemoradiotherapy treatment with gemcitabine improves renal function in locally advanced cervical cancer patients with renal dysfunction. Curr Probl Cancer 2024; 48:101041. [PMID: 37988902 DOI: 10.1016/j.currproblcancer.2023.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Cervical cancer (CC) in Mexico is diagnosed mainly in locally advanced (LACC) and advanced (ACC) stages, where ureteral obstruction is more frequent. The standard treatment for this population is concurrent chemoradiotherapy (CCRT) with cisplatin, which is nephrotoxic and could lead to further deterioration of renal function in LACC patients with renal function decline. We aimed to evaluate the effect of CCRT with Gemcitabine on renal function in LACC patients. METHODS This retrospective study included LACC patients treated with CCRT with Gemcitabine as a radiosensitizer from February 2003 to December 2018. Data were collected from medical archives and electronic records. We assessed renal function before and after CCRT treatment and analyzed the patient's response to treatment and survival. RESULTS 351 LACC patients treated were included and stratified into two groups: 198 with Glomerular Filtration Rate (GFR) ≥60ml/min (group A) and 153 with GFR<60ml/min (group B). An improvement in GFR was observed after CCRT in patients in group B, from 33 ml/min to 57.5 ml/min (p<0.001). Complete response was observed in 64.1% of patients in Group A and 43.8% in Group B (p<0.0001). Factors associated with increased risk of death included having a GFR of 15-29 ml/min (HR: 2.17; 1.08-4.35), having GFR<15 ml/min (HR: 3.08; 1.63-5.79), and receiving Boost treatment (HR: 2.09; 1.18-3.69). On the other hand, receiving brachytherapy is a positive predictor for OS (HR:0.51; 0.31-0.84). CONCLUSION CCRT with gemcitabine is an appropriate treatment option for patients diagnosed with LACC who present impaired renal function due to the disease's obstructive nature or other comorbidities.
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Affiliation(s)
- Silvia Alarcón-Barrios
- Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, México; MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Julissa Luvián-Morales
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT) Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Merari Delgadillo-González
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Brenda Olivia Lezcano-Velázquez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eder Alexandro Arango-Bravo
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Sebastián Aguiar Rosas
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Lucely Cetina-Pérez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Bacorro W, Baldivia K, Yu KK, Mariano J, Gonzalez G, Sy Ortin T. Outcomes with definitive radiotherapy among patients with locally advanced cervical cancer with relative or absolute contraindications to cisplatin: A systematic review and meta-analysis. Gynecol Oncol 2022; 166:614-630. [PMID: 35760651 DOI: 10.1016/j.ygyno.2022.06.018] [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: 05/10/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The standard treatment for locally advanced cervical cancer (LACC) is chemoradiation (CRT) with cisplatin, followed by brachytherapy, but is less defined for cisplatin-intolerant patients. We synthesized evidence on treatment outcomes with definitive radiotherapy (RT) with or without chemotherapy (ChT) in these patients. METHODS We performed a systematic search and included 20 relevant studies. We extracted data on response, survival, compliance, and toxicity, and performed meta-analyses of outcome rates and risk ratios. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity. Meta-regression was performed to examine the effects of other variables. RESULTS Due to lack of comparative data, most comparisons were indirect and derived from the proportional meta-analyses. Complete response (85%) and survival (62% 5yOS) rates are comparable to those published for LACC without contraindications to cisplatin. Survival rate is better with CRT than RT alone (5yOS, 73% vs 58%), and with nodal boost (NB) than without (5yOS, 71% vs 56%). Carboplatin CRT is associated with lower 5yOS (44%) but better ChT compliance (86%) when compared to other interventions. ChT compliance is better in renal failure than elderly cohorts (89% vs 67%). RT compliance is lower with CRT than RT alone (90% vs 96%), and higher with NB than none (96% vs 93%). NB is associated with lower RT compliance than no NB, when ChT is given. Meta-regression results affirm ChT and NB to be significant positive factors for survival, and NB, which is associated with greater use of advanced RT techniques, for RT compliance. CONCLUSION For those with relative contraindications, cisplatin CRT is effective and well-tolerated. For those with absolute contraindications, carboplatin is well-tolerated but with unclear effectiveness. Nodal boost is effective and well-tolerated, but is less tolerated when concurrent ChT is given.
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Affiliation(s)
- Warren Bacorro
- Department of Clinical Epidemiology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines.
| | - Kathleen Baldivia
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Kelvin Ken Yu
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Jocelyn Mariano
- Department of Obstetrics and Gynecology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Teresa Sy Ortin
- Department of Radiation Oncology, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Gynecologic Oncology Unit, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
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Manzanares-Leal GL, Coronel-Martínez J, Rodríguez-Morales M, Bustamante-Montes LP, Sandoval-Trujillo H, Ramírez-Durán N. Changes in the diversity of local cervical bacteria in women with cervical cancer receiving antineoplastic treatment. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:56. [PMID: 34729064 PMCID: PMC8506239 DOI: 10.4103/jrms.jrms_757_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/08/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Background Some studies show changes in the microbiota in people undergoing antineoplastic treatment. Currently, there is not enough evidence of this effect in the treatment of cervical cancer (CC). The objective was to determine changes in the diversity of local cervical bacteria in women with CC receiving chemotherapy, radiotherapy, and brachytherapy. Materials and Methods A descriptive, longitudinal, and prospective study was conducted in 68 women with locally advanced CC with a treatment plan based on the administration of chemotherapy, external beam radiotherapy, and brachytherapy. Cervical-vaginal fluid samples were taken during antineoplastic treatment. The samples were used to isolate bacterial strains. The bacteria were identified at the molecular level by comparing sequences of the 16S ribosomal RNA gene. Results The bacteria identified belonged to three phyla: Firmicutes, Proteobacteria, and Actinobacteria. Nine genera and 25 species of bacteria were identified. The most frequent species were Staphylococcus epidermidis, Corynebacterium amycolatum, and Enterococcus faecalis. There were statistically significant differences when comparing bacterial diversity found in the different stages of treatment (≤0.05). Bacterial diversity decreased as antineoplastic treatment progressed and increased at the end of therapy. Conclusion Antineoplastic treatments generate changes in the diversity of local cervical bacterial communities of women with CC.
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Affiliation(s)
- Gauddy Lizeth Manzanares-Leal
- Laboratory of Medical and Environmental Microbiology, Faculty of Medicine, Autonomous University of the State of Mexico, Toluca, Mexico
| | | | - Miguel Rodríguez-Morales
- Clinical Research Division, National Institute of Cancerology, Mexico City, Mexico.,Laboratory of Molecular Microbiology, National School of Biological Sciences, National Polytechnic Institute, Mexico City, Mexico
| | | | - Horacio Sandoval-Trujillo
- Department of Biological Systems, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico
| | - Ninfa Ramírez-Durán
- Laboratory of Medical and Environmental Microbiology, Faculty of Medicine, Autonomous University of the State of Mexico, Toluca, Mexico
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Brau-Figueroa H, Arango-Bravo E, Castro-Eguiluz D, Galicia-Carmona T, Lugo-Alferez LA, Cruz-Bautista I, Jiménez-Lima R, Cetina-Pérez L. Effectiveness of Concomitant Chemoradiotherapy with Gemcitabine in Locally Advanced Cervical Cancer Patients with Comorbidities. Cancer Res Treat 2021; 54:554-562. [PMID: 34384015 PMCID: PMC9016315 DOI: 10.4143/crt.2021.375] [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: 03/24/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The standard treatment for locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy with cisplatin (CDDP) followed by brachytherapy. The presence of comorbidities are risk factors for nephrotoxicity and are associated with lower survival. Gemcitabine is a radiosensitizing drug that has shown efficacy and safety in this context. The effectiveness of concomitant chemoradiotherapy with gemcitabine was evaluated versus cisplatin in LACC patients with comorbidities and preserved renal function. Materials and Methods An observational, longitudinal and paired study was carried out that included patients treated between February 2003 and December 2015. The primary objectives were to evaluate response rates, progression-free survival, and overall survival; the secondary objectives were to evaluate toxicity and renal function. Results Sixty-three patients treated with gemcitabine at 300 mg/m2 weekly and 126 patients treated with CDDP 40 mg/m2 weekly were included. There were no significant differences in response rates and survival rates. Treatment with cisplatin presented a higher frequency of hematological toxicities, while gemcitabine presented a higher frequency of gastrointestinal toxicities. A decrease in glomerular filtration rate (GFR; baseline vs. 1-year post-treatment) was observed in the cisplatin group (p=0.002), while not in the gemcitabine group (p=0.667). In a multivariate analysis, it is observed that only CDDP correlates with the decrease in GFR (hazard ratio, 2.42; p=0.012). Conclusion In LACC patients with comorbidities, gemcitabine and CDDP show the same efficacy, with different toxicity profiles. Treatment with cisplatin is associated with a significant decrease in GFR during follow-up, compared to treatment with gemcitabine that does not decrease it.
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Affiliation(s)
- Hasan Brau-Figueroa
- National Network of Cancer Records, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eder Arango-Bravo
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Consejo Nacional de Ciencia y Tecnología (CONACyT)- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Ivette Cruz-Bautista
- Research Unit in Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roberto Jiménez-Lima
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Lucely Cetina-Pérez
- Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
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Datta NR, Stutz E, Gomez S, Bodis S. Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2018; 103:411-437. [PMID: 30391522 DOI: 10.1016/j.ijrobp.2018.09.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Abstract
Treatment options in locally advanced cervix cancer (LACC) have evolved around radiation therapy (RT) and/or chemotherapy (CT), hypoxic cell sensitizers, immunomodulators (Imm), and locoregional moderate hyperthermia (HT). A systematic review and network meta-analysis was conducted to synthesize the evidence for efficacy and safety in terms of long-term locoregional control (LRC), overall survival (OS), and grade ≥3 acute morbidity (AM) and late morbidity (LM). Five databases were searched, and 6285 articles (1974-2018) were screened per the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Fifty-nine randomized trials in untreated LACC without surgical intervention were shortlisted. These used 13 different interventions: RT alone and/or neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent chemoradiation therapy (CTRT) (weekly cisplatin [CDDP]/3-weekly CDDP/combination CT with CDDP/non-CDDP-based CT), hypoxic cell sensitizers, Imm, or HT. Odds ratios (ORs) using random effects network meta-analysis were estimated. Interventions for each endpoint were ranked according to their corresponding surface under cumulative ranking curve values. Of the 9894 patients evaluated, the total events reported for LRC, OS, AM, and LM were 5431 of 8197, 4482 of 7958, 1710 of 7183, and 441 of 6333, respectively. ORs and 95% credible intervals (CrIs) for the 2 best strategies were HT + RT versus CTRT + ACT (OR, 1.23; 95% CrI, 0.49-3.19) for LRC, CTRT (3-weekly CDDP) versus HTCTRT (OR, 1.14; 95% CrI, 0.35-3.65) for OS, RT + ACT versus RT (OR, 0.01; 95% CrI, 0.00-1.04) for AM, and NACT + RT + ACT versus RT + Imm (OR, 0.42; 95% CrI, 0.02-7.39) for LM. The 3 interventions with the highest cumulative surface under cumulative ranking curve values for all 4 endpoints were HTRT, HTCTRT, and CTRT (3-weekly CDDP). Articles with low risk of bias and those published during 2004 to 2018 also retained these interventions as the best. Two-step cluster analysis grouped these 3 modalities in a single distinctive cluster. HTRT, HTCTRT, and CTRT with 3-weekly CDDP were identified as therapeutic modalities with the best comprehensive impact on key clinical endpoints in LACC. This warrants a phase 3 randomized trial among these strategies for a head-to-head comparison and additional validation.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland.
| | - Emanuel Stutz
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Silvia Gomez
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland
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Ma L, Liu JM, Zhang J, Li H. A pilot study of oral S-1 for treating heavily pretreated patients with advanced or recurrent cervical cancer among Chinese population. Medicine (Baltimore) 2018; 97:e10922. [PMID: 29851825 PMCID: PMC6392667 DOI: 10.1097/md.0000000000010922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This pilot study retrospectively aimed to assess the feasibility effectiveness and safety of oral S-1 in heavily pretreated patients with advanced or recurrent cervical cancer (ARCC) among Chinese population.Thirty patients with ARCC who had undergone one or more lines of chemotherapy received oral S-1 (40-60 mg/m) twice daily for 6 weeks. Outcome measurements included tumor response, time to progression (TTP), overall survival (OS) time, and occurrence of adverse events (AEs).The overall response rate was 43.3%. After a median follow-up of 6 months, the median TTP was 4.4 months and the median OS time was 10.2 months. The most frequent grade 3 or 4 AEs were neutropenia (13.3%) and nausea (16.7%).The results of this study show that oral S-1 is effective and well-tolerated in patients with ARCC who were heavily pretreated among Chinese population.
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Affiliation(s)
- Li Ma
- Department of Gynaecology and Obstetrics, Second Affiliated Hospital of Mudanjiang Medical University
| | - Jin-miao Liu
- Department of Oncology, The Affiliated Hongqi Hospital of Mudanjiang Medical University
| | - Jing Zhang
- Department of Anatomy, Mudanjiang Medical University, Mudanjiang, China
| | - Hui Li
- Department of Oncology, The Affiliated Hongqi Hospital of Mudanjiang Medical University
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Fu ZZ, Li K, Peng Y, Zheng Y, Cao LY, Zhang YJ, Sun YM. Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis. Medicine (Baltimore) 2017; 96:e5853. [PMID: 28079819 PMCID: PMC5266181 DOI: 10.1097/md.0000000000005853] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis. METHODS We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens. RESULTS Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens. CONCLUSION Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.
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Affiliation(s)
- Zhan-Zhao Fu
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | | | - Yong Peng
- Department of Biomedical Engineering, Yanshan University
| | | | - Li-Yan Cao
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | - Yun-Jie Zhang
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | - Yong-Mei Sun
- Department of Gynaecology, the First Hospital of Qinhuangdao, Qinhuangdao, P.R. China.
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Peng YH, Wang XX, Zhu JS, Gao L. Neo-adjuvant chemotherapy plus surgery versus surgery alone for cervical cancer: Meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2016; 42:128-35. [PMID: 26807961 DOI: 10.1111/jog.12896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Yun-Hua Peng
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Xin-Xiu Wang
- General Hospital of Lanzhou Petrochemical Company; Lanzhou City Gansu Province China
| | - Jing-Song Zhu
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Li Gao
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
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