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Zhou Y, Wang W, Tang J, Hu K, Zhang F. Comparison of outcomes between early-stage cervical cancer patients without high-risk factors undergoing adjuvant concurrent chemoradiotherapy and radiotherapy alone after radical surgery. BMC Cancer 2024; 24:548. [PMID: 38689248 PMCID: PMC11061922 DOI: 10.1186/s12885-024-12284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE For patients with early-stage cervical cancer without high-risk factors, there is no consensus regarding the optimal postoperative treatment regimen and whether postoperative concurrent radiochemotherapy (CCRT) is superior to radiotherapy (RT) alone. PATIENTS AND METHODS The medical records of patients with stage I-IIA cervical cancer, who underwent radical surgery and postoperative RT or CCRT between June 2012 and December 2017, were retrospectively reviewed. Patients with any high-risk factors, including positive pelvic lymph node(s), positive resection margin(s), and parametrial invasion, were excluded. Patients with large tumors (≥ 4 cm), deep stromal invasion (≥ 1/2), and lymphovascular space involvement were categorized as the intermediate-risk group. Patients without intermediate-risk factors were categorized as the low-risk group. RESULTS A total of 403 patients were enrolled and divided into 2 groups according to postoperative treatment: RT alone (n = 105); and CCRT (n = 298). For risk stratification, patients were also divided into 2 groups: intermediate-risk (n = 350); and low-risk (n = 53). The median follow-up was 51.7 months. Patients in the intermediate-risk group and those with multiple intermediate-risk factors were more likely to undergo CCRT. For patients who underwent RT alone or CCRT in the intermediate-risk group, 5-year overall survival (OS) rates were 93.4% and 93.8% (p = 0.741), and 5-year disease-free survival (DFS) rates were 90.6% and 91.4%, respectively (p = 0.733). Similarly, for patients who underwent RT alone or CCRT in the low-risk group, the 5-year OS rates were 100.0% and 93.5% (p = 0.241), and 5-year DFS rates were 94.4% and 93.5%, respectively (p = 0.736). Adjuvant CCRT or RT were not independent risk factors for either OS or DFS. Patients who underwent CCRT appeared to develop a higher proportion of grade ≥ 3 acute hematological toxicities than those in the RT group (44.0% versus 11.4%, respectively; p < 0.001). There was no significant difference in grade ≥ 3 chronic toxicities of the urogenital and gastrointestinal systems between the CCRT and RT groups. CONCLUSION There was no significant difference in 5-year OS and DFS rates between patients with early-stage cervical cancer without high-risk factors undergoing postoperative CCRT versus RT alone. Patients who underwent CCRT appeared to develop a higher proportion of grade ≥ 3 acute hematological toxicities than those who underwent RT alone.
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Affiliation(s)
- Yuncan Zhou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Tang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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2
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Guo Q, Wang R, Jin D, Yin Z, Hu B, Li R, Wu D. Comparison of adjuvant chemoradiotherapy versus radiotherapy in early-stage cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2022; 61:15-23. [PMID: 35181028 DOI: 10.1016/j.tjog.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/25/2022] Open
Abstract
The presence of intermediate risk factors reduces the predictability of radical hysterectomy, demanding the use of adjuvant therapy for treatment of Early stage cervical cancer (ESCC) patients. Adjuvant radiotherapy (RT) and chemoradiotherapy (CRT) has been widely used with varied efficacy and safety issues. Therefore, the aim of this systematic review and meta-analysis was to update the available evidence and assess the effect of post-surgical adjuvant RT versus adjuvant CRT on survival rate and complications/toxicities in management of ESCC patients with intermediate risk factors. PubMed, EMBASE and Web of Science (WOS) and CENTRAL were searched using a combination of relevant keywords. All studies comparing outcomes of adjuvant RT versus CRT in ESCC patients with intermediate-risk factors in terms of recurrence free survival (RFS), overall survival (OS) and toxicities/complications were included. Both qualitative and quantitative analysis was carried out. The risk of bias assessment was done using Newcastle-Ottawa scale (NOS) for retrospective cohort studies and Cochrane risk of bias assessment tool was used for randomized clinical trials. Eleven retrospective cohort studies and two randomized clinical trials were included in this review. Adjuvant CRT was found to have better RFS with ESCC patients with multiple intermediate risk factors with OR 3.11 95% CI [1.04, 4.99], p < 0.0001; i2 = 6%. However, similar benefit was observed between both regimens in presence of a single intermediate risk factor OR 1.80 95% CI [0.96, 3.36], p = 0.07; i2 = 0%. Grade 3 or 4 haematological toxicity among patients receiving post-surgical adjuvant RT versus adjuvant CRT showed increased association of toxicity with adjuvant CRT with OR 7.73 95%CI [3.40, 17.59], p < 0.0001; i2 = 62%. Adjuvant CRT shows favourable RFS and OS in ESCC patients with multiple intermediate risk factors. CRT also showed greater incidence of grade 3 or 4 haematological and non-haematiological toxicity, however, the same could be well tolerated when used within the recommended dosage.
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Affiliation(s)
- Qingmin Guo
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China.
| | - Rui Wang
- Department of Reproductive Center, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Dongmei Jin
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Zhengfang Yin
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Bao Hu
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Ruifeng Li
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Dongyue Wu
- Department of Gynaecology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
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3
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Zhong L, Li K, Song L, Yin R. The effect of consolidation chemotherapy after concurrent chemoradiation on the prognosis of locally advanced cervical cancer: a systematic review and meta-analysis. J OBSTET GYNAECOL 2022; 42:830-837. [PMID: 35148230 DOI: 10.1080/01443615.2021.2012437] [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] [Indexed: 12/24/2022]
Abstract
To verify the role of consolidation chemotherapy after concurrent chemoradiotherapy for bulky and locally advanced cervical cancer, a meta-analysis was performed. Based on articles published up to Jun 2020 a literature search in PubMed, EMBASE and Cochrane Library was conducted to identify eligible studies. A total of 4 articles consisting of 1659 patients were enrolled. The pooled results revealed that overall survival (OS) of patients treated with consolidation chemotherapy after concurrent chemoradiotherapy (CCRT + CT) was significantly superior to concurrent chemoradiotherapy (CCRT) alone (HR = 0.78, 95% CI: 0.69-0.88, p < .0001). The meta-analysis reviewed that the progression-free survival rate (PFS) of patients treated with CCRT + CT was significantly superior to CCRT alone (HR = 0.80, 95% CI: 0.73-0.87, p < .00001). The pooled results revealed a significant reduction of local recurrence rate for the CCRT + CT group (RR = 0.66, 95% CI: 0.55-0.79, p < .00001). The pooled meta-analysis also showed a significant reduction of distant recurrence rate for the CCRT + CT group (RR = 0.55, 95% CI: 0.44-0.69, p < .00001). The pooled results of grade 3/4 bone marrow suppression were calculated as OR and presented with a 95% CI (OR = 15.85; 95% CI: 9.48, 26.5, p < .00001), indicating patients who received CCRT + CT are more likely to suffer 3/4 bone marrow suppression than those treated with CCRT alone. In conclusion, patients who received chemoradiation with consolidation chemotherapy showed a significantly longer PFS, longer OS, lower local recurrence rate and distant recurrence rate compared to traditional concurrent chemoradiotherapy.Impact statementWhat is already known on this subject? Since CCRT was recommended as the standard treatment for cervical cancer, there was still a 20-30% chance of local recurrence, and 18-25% of distant recurrence for cervical cancer patients. Aiming to completely eradicate potential undetected micrometastases, consolidation chemotherapy came into the area of interest. We conducted a meta-analysis to verify the role of consolidation chemotherapy in cervical cancer.What do the results of this study add? The addition of consolidation CT resulted in a longer overall survival rate (OS) and progression-free survival rate (PFS), mainly due to control of local and distant relapses, especially the latter one. Toxicity followed consolidation CT increased but still clinically manageable.What are the implications of these findings for clinical practice and/or further research? In the future, we need more clinical studies with high quality to verify the role of consolidation CT in cervical cancer, and further to optimise the criteria for it.
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Affiliation(s)
- Lan Zhong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
| | - Kemin Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
| | - Liang Song
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
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4
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Meixner E, Hoeltgen L, Hoegen P, König L, Arians N, Michel LL, Smetanay K, Fremd C, Schneeweiss A, Debus J, Hörner-Rieber J. Age-Dependent Hematologic Toxicity Profiles and Prognostic Serologic Markers in Postoperative Radiochemotherapy Treatment for Uterine Cervical Cancer. Technol Cancer Res Treat 2022; 21:15330338221118188. [PMID: 35950239 PMCID: PMC9379804 DOI: 10.1177/15330338221118188] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction: In the adjuvant setting for cervical cancer, classical
risk factors for postoperative radiochemotherapy have been established. However,
data on laboratory changes during therapy and the prognostic value of
serological markers are limited and further knowledge is needed to optimize the
toxic trimodal regimen. Methods: We retrospectively identified 69
women who underwent weekly postoperative radiochemotherapy with
40 mg/m2 of cisplatin for cervical cancer between 2010 and 2021
at a single center. Laboratory parameters were recorded before, at each cycle
and after radiochemotherapy. Kaplan-Meier and log-rank analyses were used to
calculate and compare survival, groups were compared using the Mann–Whitney
U, χ2, and variance tests. Results:
With a median follow-up of 17.7 months, the 1- and 5-year local control rates
were 94.0% and 73.7%, respectively, with significantly better rates for more
chemotherapy cycles and negative resection margins. Only 68.1% of patients
completed all cycles. The most common reasons for early discontinuation were
persistent asymptomatic leukopenia in women aged ≤ 50 years, and limiting
infections in women aged > 50 years. Leukopenia was more likely to occur
after the third cycle. Significantly worse survival was observed for
post-radiochemotherapy elevated C-reactive-protein and lactate dehydrogenase
levels, low pre-radiochemotherapy nutritional index, and raised
C-reactive-protein-levels; the latter were also predictable for local control.
The Glasgow prognostic score did not reliably predict survival.
Conclusion: Incomplete application of simultaneous chemotherapy
leads to inferior local control, and age-dependent limiting factors should be
identified at an early stage. In addition to classical risk factors, serological
markers (C-reactive-protein, lactate dehydrogenase, nutritional index) show
prognostic significance.
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Affiliation(s)
- Eva Meixner
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Fremd
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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5
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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6
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Wang SB, Liu JP, Lei KJ, Jia YM, Xu Y, Rong JF, Wang CX. The volume of 99m Tc sulfur colloid SPET-defined active bone marrow can predict grade 3 or higher acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy. Cancer Med 2019; 8:7219-7226. [PMID: 31621208 PMCID: PMC6885884 DOI: 10.1002/cam4.2601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
Background The purpose of the current study was to evaluate whether radiation dose‐volume metrics to technetium‐99m (99mTc) sulfur colloid single‐photon emission tomography (SPET)‐defined active bone marrow (ABM) subregions can more accurately predict acute hematologic toxicity in locally advanced cervical cancer patients who receive chemoradiotherapy than conventional dosimetric parameters. Methods and materials Thirty‐nine patients with stage IB2‐III cervical cancer who underwent 99mTc sulfur colloid SPET imaging before treatment with cisplatin‐based chemoradiation between January 2017 and March 2018 were analyzed. The total bone marrow (TBM) volume was defined as the external contours of all bones within the vertebral bodies from L4 to the coccyx, the pelvic bones, and the proximal femoral heads. The ABM volume was defined by SPET as the subregion of TBM with a nuclide uptake value greater than or equal to the mean total body nuclide uptake value. Student's t test was used to test for statistical significance between TBM and ABM dose‐volume metrics. Receiver operating characteristic (ROC) curves were generated to compare the predictors of grade 3 or higher (grade 3+) hematologic toxicity. Results The mean ABM‐V40 (23.22% ± 7.65%) and ABM‐V30 (45.28% ± 9.20%) were significantly lower than the mean TBM‐V40 (33.06% ± 6.72%) and TBM‐V30 (53.08% ± 7.77%), respectively (t = 5.78, P = .001) (t = 4.13, P = .001). The ABM volume (<387.5 cm3, AUC = 0.928, P = .001), ABM‐V30 (>46.5%, AUC = 0.875, P = .001), and ABM‐V40 (>23.5%, AUC = 0.858, P = .001) can predict the occurrence of grade 3+ hematologic toxicity. Among patients with an ABM volume < 387.5 cm3, 16/19 (84.2%) had grade 3+ hematologic toxicity compared to 3/20 (15%) with an ABM volume > 387.5 cm3. Conclusions The ABM volume (<387.5 cm3) may be a better predictor of hematologic toxicity than conventional dose‐volume metrics, but this finding needs to be further evaluated.
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Affiliation(s)
- Shan-Bing Wang
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Jia-Pei Liu
- Department of Laboratory Medicine, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Kai-Jian Lei
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Yu-Ming Jia
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Yan Xu
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Jin-Feng Rong
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
| | - Chun-Xiu Wang
- Department of Oncology, The Second People's Hospital of Yibin City, Yibin, Sichuan, China
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7
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Li M, Hu M, Wang Y, Yang X. Adjuvant chemoradiotherapy versus radiotherapy in cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 238:1-6. [DOI: 10.1016/j.ejogrb.2019.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/17/2019] [Accepted: 04/28/2019] [Indexed: 01/23/2023]
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8
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Aslebagh R, Channaveerappa D, Arcaro KF, Darie CC. Proteomics analysis of human breast milk to assess breast cancer risk. Electrophoresis 2018; 39:653-665. [PMID: 29193311 DOI: 10.1002/elps.201700123] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
Detection of breast cancer (BC) in young women is challenging because mammography, the most common tool for detecting BC, is not effective on the dense breast tissue characteristic of young women. In addition to the limited means for detecting their BC, young women face a transient increased risk of pregnancy-associated BC. As a consequence, reproductively active women could benefit significantly from a tool that provides them with accurate risk assessment and early detection of BC. One potential method for detection of BC is biochemical monitoring of proteins and other molecules in bodily fluids such as serum, nipple aspirate, ductal lavage, tear, urine, saliva and breast milk. Of all these fluids, only breast milk provides access to a large volume of breast tissue, in the form of exfoliated epithelial cells, and to the local breast environment, in the form of molecules in the milk. Thus, analysis of breast milk is a non-invasive method with significant potential for assessing BC risk. Here we analyzed human breast milk by mass spectrometry (MS)-based proteomics to build a biomarker signature for early detection of BC. Ten milk samples from eight women provided five paired-groups (cancer versus control) for analysis of dysregulatedproteins: two within woman comparisons (milk from a diseased breast versus a healthy breast of the same woman) and three across women comparisons (milk from a woman with cancer versus a woman without cancer). Despite a wide range in the time between milk donation and cancer diagnosis (cancer diagnosis occurred from 1 month before to 24 months after milk donation), the levels of some proteins differed significantly between cancer and control in several of the five comparison groups. These pilot data are supportive of the idea that molecular analysis of breast milk will identify proteins informative for early detection and accurate assessment of BC risk, and warrant further research. Data are available via ProteomeXchange with identifier PXD007066.
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Affiliation(s)
- Roshanak Aslebagh
- Biochemistry & Proteomics Group, Department of Chemistry & Biomolecular Science, Clarkson University, Potsdam, NY, USA
| | - Devika Channaveerappa
- Biochemistry & Proteomics Group, Department of Chemistry & Biomolecular Science, Clarkson University, Potsdam, NY, USA
| | - Kathleen F Arcaro
- Department of Veterinary & Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Costel C Darie
- Biochemistry & Proteomics Group, Department of Chemistry & Biomolecular Science, Clarkson University, Potsdam, NY, USA
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9
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Hodroj MH, Jardaly A, Abi Raad S, Zouein A, Rizk S. Andrographolide potentiates the antitumor effect of topotecan in acute myeloid leukemia cells through an intrinsic apoptotic pathway. Cancer Manag Res 2018; 10:1079-1088. [PMID: 29785137 PMCID: PMC5955015 DOI: 10.2147/cmar.s160924] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Topotecan (TP) is an anticancer drug acting as topoisomerase I inhibitor that is used in the treatment of many types of cancers including leukemia, but it has significant side effects. Andrographolide, a compound extracted from Andrographis paniculata, was recently proven to inhibit the growth of cancer cells and can induce apoptosis. The aim of this study is to investigate the possible synergism between TP and andrographolide in acute myeloid cells in vitro. Materials and methods U937 acute myeloid leukemic cells were cultured using Roswell Park Memorial Institute (RPMI) medium and then treated for 24 h with TP and andrographolide prepared through the dilution of dimethyl sulfoxide (DMSO) stocks with RPMI on the day of treatment. Cell proliferation was assessed using cell proliferation assay upon treatment with both compounds separately and in combination. Cell-cycle study and apoptosis detection were performed by staining the cells with propidium iodide (PI) stain and Annexin V/PI stain, respectively, followed by flow cytometry analysis. Western blotting was used to assess the expression of various proteins involved in apoptotic pathways. Results Both TP and andrographolide showed an antiproliferative effect in a dose-dependent manner when applied on U937 cells separately; however, pretreating the cells with andrographolide before applying TP exhibited a synergistic effect with lower inhibitory concentrations (half-maximal inhibitory concentration). Treating the cells with TP alone led to specific cell-cycle arrest at S phase that was more prominent upon pretreatment combination with andrographolide. Using Annexin V/PI staining to assess the proapoptotic effect following the pretreatment combination showed an increase in the number of apoptotic cells, which was supported by the Western blot results that manifested an upregulation of several proapoptotic proteins expression. Conclusion The pretreatment of U937 with andrographolide followed by low doses of TP showed an enhancement in inducing apoptosis when compared to the application of each compound separately.
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Affiliation(s)
| | - Achraf Jardaly
- Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
| | - Sarah Abi Raad
- Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
| | - Annalise Zouein
- Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
| | - Sandra Rizk
- Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
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10
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Atiq M, Atiq A, Iqbal K, Shamsi Q, Andleeb F, Buzdar SA. Evaluation of dose conformity and coverage of target volume for intensity-modulated radiotherapy of pelvic cancer treatment. Indian J Cancer 2017; 54:379-384. [PMID: 29199727 DOI: 10.4103/ijc.ijc_80_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Better conformity may help in delivering minimum dose to organs at risk (OARs) and maximum dose to planning target volume (PTV). As per the requirements of modern radiotherapy, 95% isodose should cover the PTV, so conformity indices (CIs) are used for evaluating quality of conformation of treatment plans. AIM This study aimed to investigate degree of conformity for pelvic patients using intensity-modulated radiotherapy (IMRT) technique. Three formulas of CIs described in literature were analyzed in this study. SETTINGS AND DESIGN This study was performed to evaluate degree of conformity of 18 patients treated with radiotherapy treatment plan using cumulative dose volume histogram. Effectiveness of different CIs was explored for IMRT plans using 15 MV photon beam. Doses delivered to OAR were also studied. STATISTICAL ANALYSIS USED CI suggested by the International Commission on Radiation Units and Measurements, radiation CI and CI prescription isodose to target volume (PITV) had mean ± standard deviation values of 1.02 ± 0.018, 0.98 ± 0.017, and 1.63 ± 0.333, respectively. RESULTS AND CONCLUSION Dose distribution for all patients was highly conformal and clinically acceptable. Values of CI PITV exceeded acceptable value for 27% patients with minor deviation. No statistically significant differences were observed for three CIs reported. Target volume lies between 95% and 107% of prescribed dose which shows ideal target coverage. This simple parameter is advantageous since it is easy to interpret and helped determine quality of treatment plan. This study clearly demonstrated that favorable dose distribution in PTV and OARs is achieved using IMRT technique, and hence, the risk of damage to normal tissues is reduced.
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Affiliation(s)
- M Atiq
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - A Atiq
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - K Iqbal
- Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan
| | - Q Shamsi
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - F Andleeb
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - S A Buzdar
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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The timing of caffeic acid treatment with cisplatin determines sensitization or resistance of ovarian carcinoma cell lines. Redox Biol 2016; 11:170-175. [PMID: 27951496 PMCID: PMC5153445 DOI: 10.1016/j.redox.2016.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 12/30/2022] Open
Abstract
Cisplatin is a widely used chemotherapeutic drug showing high efficiency in the treatment of primary tumors such as ovarian, testicular and cervical cancers. The major drawback of cisplatin is tumor resistance either acquired or intrinsic. Many mechanisms are involved in the resistance, among them is the Nrf2 pathway which regulates glutathione related enzymes. Caffeic acid, a non-toxic polyphenol which is abundant in many foods modulates glutathione S-transferase (GST) and glutathione reductase (GSR) activity, these enzymes were shown to be involved in resistance of cells towards cisplatin. Caffeic acid induces the Nrf2 pathway and can also inhibit the activity of GST and GSR. Our findings demonstrate that the co-treatment of cancer cells with cisplatin and caffeic acid can enhance cisplatin cytotoxicity and increases the amount of platinum bound to nuclear DNA. However, 6h of pre incubation with caffeic acid prior to cisplatin treatment led to acquired resistance to cisplatin and reduced DNA binding. In conclusion, the enzyme inhibitory action of caffeic acid is dominant when the two agents are co-administered leading to increased cytotoxicity, and the Nrf2 induction is dominant when the cells are treated with caffeic acid prior to cisplatin treatment leading to resistance. The use of caffeic acid as adjuvant for cisplatin should be carefully examined due to different pharmacokinetic profiles of caffeic acid and cisplatin. Thus, it is questionable if the two agents can reach the tumors at the right time frame in vivo.
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Falcetta FS, Medeiros LR, Edelweiss MI, Pohlmann PR, Stein AT, Rosa DD. Adjuvant platinum-based chemotherapy for early stage cervical cancer. Cochrane Database Syst Rev 2016; 11:CD005342. [PMID: 27873308 PMCID: PMC6473195 DOI: 10.1002/14651858.cd005342.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This is the second updated version of the original Cochrane review published in the Cochrane Library 2009, Issue 3. Most women with early cervical cancer (stages I to IIA) are cured with surgery or radiotherapy, or both. We performed this review originally because it was unclear whether cisplatin-based chemotherapy after surgery, radiotherapy or both, in women with early stage disease with risk factors for recurrence, was associated with additional survival benefits or risks. OBJECTIVES To evaluate the effectiveness and safety of adjuvant platinum-based chemotherapy after radical hysterectomy, radiotherapy, or both in the treatment of early stage cervical cancer. SEARCH METHODS For the original 2009 review, we searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library 2009, Issue 1), MEDLINE, Embase, LILACS, BIOLOGICAL ABSTRACTS and CancerLit, the National Research Register and Clinical Trials register, with no language restriction. We handsearched abstracts of scientific meetings and other relevant publications. We extended the database searches to November 2011 for the first update and to September 2016 for the second update. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing adjuvant cisplatin-based chemotherapy (after radical surgery, radiotherapy or both) with no adjuvant chemotherapy, in women with early stage cervical cancer (stage IA2-IIA) with at least one risk factor for recurrence. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently. Meta-analysis was performed using a random-effects model, with death and disease progression as outcomes. MAIN RESULTS For this second updated version we identified only one small trial reporting grade 4 toxicity results, without disease-free or overall survival data with a median follow-up of 16 months.From the first updated version, we identified three trials that were ongoing, and remain so in 2016.Four trials including 401 women with evaluable results with early cervical cancer were included in the meta-analyses. The median follow-up period in these trials ranged from 29 to 42 months. All women had undergone surgery first. Three trials compared chemotherapy combined with radiotherapy versus radiotherapy alone; and one trial compared chemotherapy followed by radiotherapy versus radiotherapy alone. It was not possible to perform subgroup analyses by stage or tumour size.Compared with adjuvant radiotherapy, chemotherapy combined with radiotherapy significantly reduced the risk of death (two trials, 297 women; hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.36 to 0.87) and disease progression (two trials, 297 women; HR = 0.47, 95% CI 0.30 to 0.74), with no heterogeneity between trials (I² = 0% for both meta-analyses). Acute grade 4 toxicity occurred significantly more frequently in the chemotherapy plus radiotherapy group than in the radiotherapy group (three trials, 321 women; risk ratio (RR) 6.26, 95% CI 2.50 to 15.67). We considered the evidence for all three outcomes to be of a moderate quality, using the GRADE approach due to small numbers and limited follow-up in the included studies. In addition, it was not possible to separate data for bulky early stage disease.In the one small trial that compared adjuvant chemotherapy followed by radiotherapy with adjuvant radiotherapy alone there was no difference in disease recurrence between the groups (one trial, 71 women; HR = 1.34; 95% CI 0.24 to 7.66) and overall survival was not reported. We considered this evidence to be of a low quality.No trials compared adjuvant platinum-based chemotherapy with no adjuvant chemotherapy after surgery for early cervical cancer with risk factors for recurrence. AUTHORS' CONCLUSIONS The addition of platinum-based chemotherapy to adjuvant radiotherapy (chemoradiation) may improve survival in women with early stage cervical cancer (IA2-IIA) and risk factors for recurrence. Adjuvant chemoradiation is associated with an increased risk of severe acute toxicity, although it is not clear whether this toxicity is significant in the long term due to a lack of long-term data. This evidence is limited by the small numbers and low to moderate methodological quality of the included studies. We await the results of three ongoing trials, which are likely to have an important impact on our confidence in this evidence.
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Affiliation(s)
- Frederico S Falcetta
- Oncology, Hospital de Clínicas de Porto Alegre, Av. Nilópolis, 125, ap. 303, Porto Alegre, Brazil, 90460-050
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13
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Meng F, Han N, Yeo Y. Organic nanoparticle systems for spatiotemporal control of multimodal chemotherapy. Expert Opin Drug Deliv 2016; 14:427-446. [PMID: 27476442 DOI: 10.1080/17425247.2016.1218464] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Chemotherapeutic drugs are used in combination to target multiple mechanisms involved in cancer cell survival and proliferation. Carriers are developed to deliver drug combinations to common target tissues in optimal ratios and desirable sequences. Nanoparticles (NP) have been a popular choice for this purpose due to their ability to increase the circulation half-life and tumor accumulation of a drug. Areas covered: We review organic NP carriers based on polymers, proteins, peptides, and lipids for simultaneous delivery of multiple anticancer drugs, drug/sensitizer combinations, drug/photodynamic therapy or drug/photothermal therapy combinations, and drug/gene therapeutics with examples in the past three years. Sequential delivery of drug combinations, based on either sequential administration or built-in release control, is introduced with an emphasis on the mechanistic understanding of such control. Expert opinion: Recent studies demonstrate how a drug carrier can contribute to co-localizing drug combinations in optimal ratios and dosing sequences to maximize the synergistic effects. We identify several areas for improvement in future research, including the choice of drug combinations, circulation stability of carriers, spatiotemporal control of drug release, and the evaluation and clinical translation of combination delivery.
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Affiliation(s)
- Fanfei Meng
- a Department of Industrial and Physical Pharmacy , Purdue University , West Lafayette , IN , USA.,b Department of Pharmaceutics, State Key Laboratory of Natural Medicines , China Pharmaceutical University , Nanjing , China
| | - Ning Han
- a Department of Industrial and Physical Pharmacy , Purdue University , West Lafayette , IN , USA.,c Department of Pharmaceutics, School of Pharmacy , Shenyang Pharmaceutical University , Shenyang , China
| | - Yoon Yeo
- a Department of Industrial and Physical Pharmacy , Purdue University , West Lafayette , IN , USA.,d Weldon School of Biomedical Engineering , Purdue University , West Lafayette , IN , USA
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14
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Li L, Song X, Liu R, Li N, Zhang Y, Cheng Y, Chao H, Wang L. Chemotherapy versus radiotherapy for FIGO stages IB1 and IIA1 cervical carcinoma patients with postoperative isolated deep stromal invasion: a retrospective study. BMC Cancer 2016; 16:403. [PMID: 27387204 PMCID: PMC4936260 DOI: 10.1186/s12885-016-2447-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background The adjuvant treatment for patients with isolated stromal invasion after radical hysterectomy and pelvic lymph node dissection (PLND) in FIGO stage IB1 and IIA1 cervical carcinoma has not been established. This study assessed the survival outcomes and recurrent patterns in this particular group of patients treated with chemotherapy or radiation-based adjuvant therapy. Methods The records 133 IB1 and IIA1 postoperative cervical carcinoma patients with histopathology-confirmed isolated deep stromal invasion (DSI) without any other unfavorable pathological finding between June 2010 and March 2013 were analyzed. Sixty-five patients received postoperative adjuvant four to six cycles of cisplatin-based chemotherapy (CT group) and Sixty-eight received postoperative received postoperative adjuvant radiotherapy (RT group). Treatment-related toxicities were evaluated and disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and statistical significance was determined using the log-rank test. Results With a median follow-up of 33.7 months (range 10–62 months), RT group had a significantly improved in DFS rate (P = 0.044), but there was no significant difference in overall survival (P = 0.437). Upon further analysis, patients with outer 1/3 to full-thickness invasion in chemotherapy group exhibited significantly higher recurrence rates compared to the radiotherapy group. Leukocytopenia, nausea and vomiting were the most frequent short-term complications of chemotherapy, whereas colitis/proctitis and cystitis were more frequent in the radiotherapy group (P = 0.000 respectively). No significant differences were found regards to other acute toxicities, including hemoglobin, platelets and ALT/AST, colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively). Fewer late severe side effects in the chemotherapy group were observed compared with the radiation group and significant differences were found at colitis/proctitis, cystitis and dermatitis (P = 0.000 respectively). Conclusion Compared to chemotherapy alone, postoperative RT to FIGO stages IB1 and IIA1 cervical carcinoma patients with isolated DSI can reduce risk of recurrence and with acceptable morbidity.
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Affiliation(s)
- Lei Li
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China.
| | - XiaoYan Song
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - RuoNan Liu
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Nan Li
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Ye Zhang
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Yan Cheng
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - HongTu Chao
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - LiYing Wang
- Department of Gynecologic Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
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Zhang P, Yang B, Yao YY, Zhong LX, Chen XY, Kong QY, Wu ML, Li C, Li H, Liu J. PIAS3, SHP2 and SOCS3 Expression patterns in Cervical Cancers: Relevance with activation and resveratrol-caused inactivation of STAT3 signaling. Gynecol Oncol 2015; 139:529-35. [DOI: 10.1016/j.ygyno.2015.09.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 01/19/2023]
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