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Lindegaard JC, Petric P, Tan LT, Hoskin P, Schmid MP, Jürgenliemk-Schulz I, Mahantshetty U, Kirisits C, Pötter R. Are we making progress in curing advanced cervical cancer-again? Int J Gynecol Cancer 2024:ijgc-2024-005572. [PMID: 38986568 DOI: 10.1136/ijgc-2024-005572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Major improvements in radiotherapy over the past two decades in the definitive treatment of locally advanced cervical cancer have significantly improved loco-regional control and survival, whereas little progress has been made with chemotherapy since the implementation of concomitant cisplatin 25 years ago. However, the randomized study INTERLACE (A phase III multicenter trial of weekly induction chemotherapy followed by standard chemoradiation versus standard chemoradiation alone in patients with locally advanced cervical cancer) of neoadjuvant chemotherapy presented recently, has shown significant improvement in survival with the use of six cycles of weekly carboplatin and paclitaxel. Although INTERLACE is yet to be published, neoadjuvant chemotherapy is already being advocated as the new standard, and studies are being designed with neoadjuvant chemotherapy followed by chemoradiation and brachytherapy as the standard arm. It is noteworthy that INTERLACE was initiated before the improvements in radiotherapy mentioned above were broadly implemented. The survival rate in the standard arm of INTERLACE was therefore inferior to the results obtained with the latest state-of-the-art external beam radiotherapy and image guided adaptive brachytherapy (EMBRACE, Magnetic Resonance Imaging (MRI)-Guided Brachytherapy in Locally Advanced Cervical Cancer). Moreover, patient selection impedes the comparison of INTERLACE with other studies as the patients included in INTERLACE were younger, had better performance status, and had less advanced disease than in other studies. Notably patients with involved para-aortic nodes were excluded. In this review, we discuss neoadjuvant chemotherapy in the frame of the EMBRACE studies and show how the impact of modern radiotherapy and patient selection affects the interpretation of the results of INTERLACE. This has led us to conclude that neoadjuvant chemotherapy is not needed for the majority of patients with cervical cancer treated with definitive modern radiotherapy, and may cause harm. However, it is possible that short course neoadjuvant chemotherapy may benefit a minor subgroup of patients who need to be identified. Comprehensive understanding, including cost utility analyses, are needed to draw conclusions regarding the potential benefit of neoadjuvant chemotherapy in low and middle income countries with limited access to modern radiotherapy.
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Affiliation(s)
| | - Primoz Petric
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Li-Tee Tan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Maximilian P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ina Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Umesh Mahantshetty
- Radiation Oncology, Homi Bhabha Cancer Hospital and Research Center, Visakhapatnam, India
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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2
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Sznurkowski JJ, Bodnar L, Szylberg Ł, Zołciak-Siwinska A, Dańska-Bidzińska A, Klasa-Mazurkiewicz D, Rychlik A, Kowalik A, Streb J, Bidziński M, Sawicki W. The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0). J Clin Med 2024; 13:4351. [PMID: 39124620 PMCID: PMC11313441 DOI: 10.3390/jcm13154351] [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: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
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Affiliation(s)
- Jacek J. Sznurkowski
- Profesor Sznurkowski Podmiot Leczniczy, ul. Stefana Żeromskiego 23A, 81-246 Gdynia, Poland
| | - Lubomir Bodnar
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, 08-110 Siedlce, Poland;
- Department of Clinical Oncology and Radiotherapy, Siedlce Cancer Center, 08-110 Siedlce, Poland
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
- Department of Obstetrics, Gynecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland
| | - Agnieszka Zołciak-Siwinska
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Anna Dańska-Bidzińska
- Department of Gynecologic Oncology, Second Clinic of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecological Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Agnieszka Rychlik
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Center, 25-734 Kielce, Poland;
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, 25-406 Kielce, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mariusz Bidziński
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Włodzimierz Sawicki
- Department of Obstetrics and Gynecological Oncology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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You J, Yuan Y, Gu X, Wang W, Li X. Pegylated recombinant human granulocyte colony-stimulating factor for primary prophylaxis of neutropenia in patients with cervical cancer receiving concurrent chemoradiotherapy: a prospective study. BMC Cancer 2024; 24:833. [PMID: 38997665 PMCID: PMC11241929 DOI: 10.1186/s12885-024-12556-4] [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: 09/28/2023] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) for primary prophylaxis of neutropenia in patients with cervical cancer receiving concurrent chemoradiotherapy. METHODS In this prospective, single-center, single-arm study, we enrolled patients (18-70 years) with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1r-IVA and IVB (distant metastasis only with inguinal lymph node metastasis) cervical cancer. Eligible patients should have normal function of the bone marrow (absolute neutrophil count (ANC) ≥ 2.0 × 109/L) and adequate hepatic and renal functions. Key exclusion criteria included: previous chemotherapy and/or radiotherapy; a history of bone marrow dysplasia or other hematopoietic abnormalities. All patients underwent radical radiotherapy (pelvic radiotherapy or extended-field irradiation) plus brachytherapy. The chemotherapy regimen included four cycles of 3-weekly paclitaxel and cisplatin. PEG-rhG-CSF was administered 48-72 h after each treatment cycle. Salvage granulocyte colony-stimulating factor (G-CSF) was only permitted in certain circumstances. The primary endpoint was the incidence of grade 3-4 neutropenia. The secondary endpoints included frequency of febrile neutropenia (FN), chemotherapy completion rate in cycles 2-4, time to complete radiotherapy, and safety. RESULTS Overall, 52 patients were enrolled in this study from July 2019 to October 2020. The incidence of grade 3-4 neutropenia was 28.8%, with an average duration of grade 3-4 neutropenia persistence of 3.85 days (1-7 days). The incidence rate of FN was 3.8%. The chemotherapy completion rate was 94.2%, 82.7%, and 75.0% for cycles 2-4, respectively. The incidences of grade 3-4 neutropenia for cycles 1-4 were 9.6% (5/52), 8.2% (4/49), 14.0% (6/43), and 2.6% (1/39), respectively. All patients completed radiotherapy within 8 weeks (median, 48 days; range: 41-56 days), except one patient who withdrew consent and did not receive radiotherapy. Severe non-hematologic toxicity was not observed in any patient. CONCLUSION PEG-rhG-CSF is an effective and safe prophylactic treatment for neutropenia in patients with cervical cancer undergoing concurrent chemoradiotherapy. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900024494. Date of Registration:13/July/2019.
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Affiliation(s)
- Jing You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Yidi Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Xiaoxuan Gu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China.
| | - Xiaofan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China.
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Vittrup Jakobsen A, Jensenius Skovhus Kronborg C, Kjer Oksen R, Mayland Havelund B, Lycke Wind K, Garm Spindler KL. Feasibility of weekly cisplatin and radiotherapy for localized anal cancer - A Danish anal cancer group report. Radiother Oncol 2024; 199:110422. [PMID: 39002571 DOI: 10.1016/j.radonc.2024.110422] [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: 02/08/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Chemoradiotherapy (CRT) with flourouracil and mitomycin is the standard treatment for squamous cell carcinomas of the anus (SCCA), however the associated acute toxicity often hinders compliance. Although weekly cisplatin is a well-established treatment for other squamous cell carcinomas, it has not been explored in SCCA. PURPOSE To investigate if radiotherapy (RT) with weekly cisplatin is a feasible option for SCCA and to report the acute toxicity. MATERIAL/METHODS Patients were treated with RT and weekly cisplatin 40 mg/m2 between 1998-2020. Retrospective data from medical records (n=65) and prospectively collected data from an observational study (n=51) comprising physician assessed toxicity (NCI-CTCAE 4.0), patient-reported outcomes (EORTC-QlQC30 + CR29) baseline, mid-therapy, end of treatment and 2-4 weeks post-treatment were included. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS We included 116 patients. T-stages were T1:4%, T2: 71%, T3: 17%, T4: 8% and 47% has N+ disease. RT doses were 53.75-64 Gy/45-51.2 Gy and the mean cumulative dose of cisplatin was 307.5 mg. The median overall treatment time was 43 days. Within 6 months after CRT 88.9 % had complete response. The median follow-up time was 4.5 years and 5-year DFS and OS were 77% (95%CI 68.7;84.5%) and 86.4% (95%CI 78.3;91.7%), respectively. Hospitalization occured in 20% with 2.6% being admitted due to febrile neutropenia. Hematological toxicity was low with 13.7% grade 3 and 3.9% grade 4. Anal pain, skin, gastrointestinal and urogenital toxicity were mild. CONCLUSION RT and weekly cisplatin for SCCA showed good outcome results and an acceptable acute toxicity profile.
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Affiliation(s)
- Anne Vittrup Jakobsen
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99 8200, Aarhus N, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, 8200, Denmark.
| | | | - Rikke Kjer Oksen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4 7100, Vejle, Denmark.
| | - Birgitte Mayland Havelund
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4 7100, Vejle, Denmark.
| | - Karen Lycke Wind
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99 8200, Aarhus N, Denmark.
| | - Karen-Lise Garm Spindler
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99 8200, Aarhus N, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, 8200, Denmark.
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Kushwaha VS, Srivastava K, Kumar S, Barik SK. Accelerated Radiotherapy Alone Versus Chemoradiation in Locally Advanced Carcinoma Cervix: Long-Term Outcomes. Cureus 2024; 16:e65154. [PMID: 39176309 PMCID: PMC11341070 DOI: 10.7759/cureus.65154] [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] [Accepted: 07/21/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Chemoradiation (CRT) is the standard of care for the treatment of carcinoma cervix, more benefits of CRT are seen in the early stage as compared to a locally advanced stage. Altered fractionation such as accelerated radiotherapy (ART) in locally advanced carcinoma cervix has not been explored much. Here, we have reported the long-term outcome of ART in comparison to conventional CRT in locally advanced cervical cancer patients. Methods From September 2011 to January 2014, 191 patients with locally advanced squamous cell carcinoma of the uterine cervix, FIGO stage IIB - IIIB were included in this study. They were randomized into two arms: the CRT arm (95 patients) versus the ART arm (96 patients). During external beam radiotherapy (EBRT), the patients in the CRT arm received conventional radiotherapy 50 Gy/25 fractions, 2 Gy/fraction, 5 fractions/week with cisplatin 40 mg/m2/week while patients in the ART arm received 50 Gy/25 fractions, 2 Gy/fraction, 6 fractions per week (Monday to Saturday) radiation alone. This was followed by three insertions of 6.5 Gy per fraction of high dose rate (HDR) brachytherapy at one-week intervals in both arms to keep the total treatment time 50 days in the CRT arm versus 45 days in the ART arm. Results The median follow-up of the study population was 57 months (range: 4-108 months). The patients with no residual disease (NRD) after EBRT and complete response (CR) at first follow-up were statistically less in the ART arm as compared to the CRT arm (30.2% versus 53.7% and 42.7% versus 63.2%; p = 0.006 and p = 0.024, respectively). However, there was no statistical difference in response at six months. High-grade acute toxicities hematological (9.5%) and gastrointestinal (15.8%) were more prevalent in the CRT arm in comparison to the ART arm, with no statistical significance (p>0.05) and Grade 1/2 genitourinary toxicity was significantly higher in the CRT arm. Late toxicities in both groups were equivalent. Recurrence, distant type of recurrence, and time to recurrence were similar in both groups. Five-year rates of overall survival (OS) and disease-free survival (DFS) were 51.2% versus 37.2% (p = 0.087) and 57.1% versus 46.3% (p = 0.223) in the CRT arm versus ART arm, respectively. Conclusion ART is a compelling alternative to concurrent chemoradiotherapy for locally advanced cervical cancer, particularly in patients with significant comorbidities, elderly women, and those in higher stages where concurrent chemotherapy's efficacy diminishes. It should be strongly considered when chemotherapy is contraindicated.
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Affiliation(s)
- Vandana Singh Kushwaha
- Radiation Oncology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
- Radiotherapy, King George's Medical University, Lucknow, IND
| | | | - Sunil Kumar
- Radiodiagnosis, King George's Medical University, Lucknow, IND
| | - Sandip Kumar Barik
- Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Achari RB, Chakraborty S, Ray S, Mahata A, Mandal S, Das J, Sarkar K, Mallick I, Bhaumik J, Chakraborti B, Ghosh A, Sen S, Chandra A, Chatterjee S, Arunsingh M, Bhattacharyya T. 18F-fluorodeoxyglucose PET-CT-guided pelvic chemoradiation therapy using helical tomotherapy for locally advanced carcinoma cervix without para-aortic nodal disease: Clinical and patient-reported outcomes from a prospective phase 2 study. J Med Imaging Radiat Oncol 2024. [PMID: 38874192 DOI: 10.1111/1754-9485.13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/23/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Locally advanced carcinoma cervix (LACC) is a heterogeneous disease with variable combinations of primary tumour extensions with or without nodal involvement. Metabolic information from 18 fluro-deoxyglucose positron emission tomography combined with contrast-enhanced computerized tomography (FDG PET-CT) may potentially augment treatment decision-making for LACC. This study ascertained FDG-PET CT influence on chemoradiation therapy (CTRT) decisions in LACC. We report oncologic and patient-reported outcome measures (PROMs). METHODS FDG PET-CT scans were reviewed independently by two nuclear medicine specialists and two radiation oncologists. Pelvic CTRT plan digressions were documented and therapy was adapted accordingly. Pelvis radiation (50 Gy/25#/5 weeks) using tomotherapy with weekly cisplatin was used in node-negative disease. Dose-escalated simultaneous integrated boost (SIB) 60 Gy/25#/5 weeks was delivered to involved pelvic nodes. All received brachytherapy. Post-treatment PET-CT scans were at 6 months. Functional assessment of cancer therapy scores were calculated at baseline, treatment completion, 3 months, 1 year and 3 years. RESULTS Between November 2015 and January 2018, 85 patients were screened, and 77 consented. Extrapelvic disease was seen in 12 (16%) patients (9 para-aortic nodes, 2 distant metastases and 1 synchronous carcinoma breast); 60 patients were included in the final analysis. Decision changes were seen in 10/77 (13%) screened, 8/60 (13%) included and 32 (53.3%) received SIB. Post-treatment, 27 (45%) had grade 2 GI/GU/GYN toxicity, one (2%) had grade 3 GI and five (8.3%) had grade 3 neutropenia. At median overall survival of 54.2 months (95% CI 52.8-58.3), 5-year local failure, pelvic nodal and para-aortic nodal-free survival were 86.8% (95% CI 78.0-96.6), 85.2% (95% CI 76.1-95.3) and 85.2% (95% CI 76.2-95.4). Functional assessment of cancer therapy trial outcome index (FACT TOI) improved by 10.43 at 3 months with no further decline. Grade 3 toxicity was noted for abdominal pain in one (1.7%), cystitis in four (6.7%) and lymphoedema in one (1.7%) at 5 years. CONCLUSION PET-CT resulted in major decision changes in 13%. PET-adapted CTRT was associated with acceptable toxicity, encouraging long-term survival and improvement in PROMS.
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Affiliation(s)
- Rimpa Basu Achari
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Santam Chakraborty
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | | | - Anurupa Mahata
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Samar Mandal
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Jayanta Das
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, India
| | - Kanishka Sarkar
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Indranil Mallick
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Jaydip Bhaumik
- Department of Gynecologic Oncosurgery, Tata Medical Center, Kolkata, India
| | | | - Anik Ghosh
- Department of Gynecologic Oncosurgery, Tata Medical Center, Kolkata, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Moses Arunsingh
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
| | - Tapesh Bhattacharyya
- Department of Radiation Oncology and Medical Physics, Tata Medical Center, Kolkata, India
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Hoskin P, Lee M, Dunkley D, Danh M, Wickens R, Saunders G, Northey J, Crabb S, McFarlane V, Sadozye A, Cooper R, Mathew T, Haslett K, Reeves K, Reed R, Bigos K, Williams KJ, Rowling E, Choudhury A, Dancer S, Smith D, Griffiths G. Dose escalation of tolinapant (ASTX660) in combination with standard radical chemoradiotherapy in cervical cancer : a study protocol for a phase 1b TiTE-CRM clinical trial (CRAIN) in UK secondary care centres. BMC Cancer 2024; 24:702. [PMID: 38849715 PMCID: PMC11162013 DOI: 10.1186/s12885-024-12310-w] [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: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer in women, with an estimated 342,000 deaths worldwide in 2020. Current standard of care in the UK for locally advanced cervical cancer is concurrent chemoradiotherapy with weekly cisplatin, yet 5-year overall survival rates are only 65% with a distant relapse rate of 50%. Inhibitors of Apoptosis Proteins (IAPs) are often overexpressed in cancer cells and associated with tumour progression and resistance to treatment. Tolinapant, developed by Astex Pharmaceuticals, is an IAP antagonist with an additional mechanism of action via down-regulation of NF-kB, an important regulator in cervical cancer. Preclinical studies performed using tolinapant in combination with cisplatin and radiotherapy showed inhibition of tumour growth and enhanced survival. There is therefore a strong rationale to combine tolinapant with chemoradiotherapy (CRT). METHODS CRAIN is a phase Ib open-label, dose escalation study to characterise the safety, tolerability and initial evidence for clinical activity of tolinapant when administered in combination with cisplatin based CRT. Up to 42 patients with newly diagnosed cervix cancer will be recruited from six UK secondary care sites. The number of participants and the duration of the trial will depend on toxicities observed and dose escalation decisions, utilising a TiTE-CRM statistical design. Treatment will constist of standard of care CRT with 45 Gy external beam radiotherapy given in 25 daily fractions over 5 weeks with weekly cisplatin 40mg/m2. This is followed by brachytherapy for which common schedules will be 28 Gy in 4 fractions high-dose-rate or 34 Gy in 2 fractions pulsed-dose-rate. Tolinapant will be administered in fixed dose capsules taken orally daily for seven consecutive days as an outpatient on alternate weeks (weeks 1, 3, 5) during chemoradiation. Dose levels for tolinapant which will be assessed are: 60 mg; 90 mg (starting level); 120 mg; 150 mg; 180 mg. Escalation will be guided by emerging safety data and decisions by the Safety Review Committee. DISCUSSION If this trial determines a recommended phase II dose and shows tolinapant to be safe and effective in combination with CRT, it would warrant future phase trials. Ultimately, we hope to provide a synergistic treatment option for these patients to improve outcome. TRIAL REGISTRATIONS EudraCT Number: 2021-006555-34 (issued 30th November 2021); ISRCTN18574865 (registered 30th August 2022).
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Affiliation(s)
- Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, UK.
| | - Marina Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Denise Dunkley
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Mary Danh
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Robin Wickens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Geoff Saunders
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Josh Northey
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Vicky McFarlane
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Azmat Sadozye
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Tony Mathew
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kate Haslett
- The Christie NHS Foundation Trust, Manchester, UK
| | - Kim Reeves
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Rachel Reed
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Kamilla Bigos
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Kaye J Williams
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Emily Rowling
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Sonia Dancer
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Deb Smith
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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8
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Ding L, Zheng Z, Cao Y, Wang Z, Zhu B, Miao G, Yuan W. Case report: Cervical brachytherapy technique for locally advanced cervical cancer in a patient with complete bicorporeal uterus. Front Oncol 2024; 14:1361562. [PMID: 38903713 PMCID: PMC11188395 DOI: 10.3389/fonc.2024.1361562] [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: 01/23/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose The purpose of this study was to describe an approach to cervical brachytherapy for a patient with a complete bicorporeal uterus and locally advanced cervical cancer (LACC). Materials and methods The patient was a 53-year-old woman with a complete bicorporeal uterus, diagnosed with stage IIB cervical squamous cell carcinoma due to contact bleeding. The patient underwent concurrent chemoradiotherapy (CCRT), external beam pelvic radiotherapy with 45 Gy/25 fractions, and weekly cisplatin (40 mg/m2). Brachytherapy was administered following the completion of external beam radiotherapy. Results The brachytherapy, which was CT (Computed Tomography)-guided using two CT-compatible tandems and two CT-compatible ovoids, delivered a prescription dose of HRCTV D90 was 6 Gy*5F, which achieved satisfactory dose coverage. The patient's final HRCTV D90 EQD210 was 84.9 Gy, and IRCTV D90 EQD210 was 63.5 Gy. Rectum D2cc EQD23 was 66.03 Gy, bladder D2cc EQD23 was 75.57 Gy, sigmoid D2cc EQD23 was 63.93 Gy, and intestine D2cc EQD23 was 65.86 Gy. Follow-up at 1 year was CR. Conclusions For patients with cervical cancer and a complete bicorporeal uterus, using double tandems combined with double ovoids is a feasible treatment method to ensure adequate dose coverage without causing additional damage. This method is also applicable to patients with endometrial cancer.
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Affiliation(s)
- Lipeng Ding
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Zhangcai Zheng
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
| | - Yueao Cao
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
| | - Zhenjiang Wang
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
| | - Baoyu Zhu
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
| | - Guoying Miao
- Department of Radiation Oncology, Gansu Provincial Maternity and Child-care Health Hospital, Lanzhou, China
| | - Wenzhen Yuan
- The Department of Oncology, The First Hospital of Lanzhou University, Lanzhou, China
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9
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Hua L, Wei M, Feng C, Li S, Wen X, Chen S. Nomogram for Predicting Survival in Locally Advanced Cervical Cancer with Concurrent Chemoradiotherapy plus or Not Adjuvant Chemotherapy: A Retrospective Analysis Based on 2018 FIGO Staging. Cancer Biother Radiopharm 2024. [PMID: 38828494 DOI: 10.1089/cbr.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Background: The comprehensive treatment mode of combining concurrent chemoradiotherapy (CCRT) with adjuvant chemotherapy (AC) is a commonly used mainstream model in the clinical practice of locally advanced cervical cancer (LACC). However, the necessity for AC after CCRT lacks sufficient evidence-based medical support. This study constructs a predictive model for the survival time dependence of CCRT ± AC for LACC based on the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging with internal validation, the prognosis was assessed with intensity-modulated radiotherapy (IMRT) and concurrent cisplatin, and provides guidance for future stratified treatment. Materials and Methods: The retrospective analysis included 482 patients with LACC who CCRT from January 2016 to January 2023. Patients who used the 2009 FIGO staging were all standardized for the 2018 FIGO staging. The 482 patients with LACC were divided into a training set (n = 290) and a validation set (n = 192) at a ratio of 6:4. COX multivariate regression model and LASSO regression were used to screen for independent prognostic factors affecting progression-free survival (PFS) and overall survival (OS), and a nomogram clinical prediction model was constructed based on these factors. Evaluate the effectiveness of the model through the receiver operating characteristic curve, calibration curve, decision curve, risk heat map, and survival curves for risk stratification. Results: The PFS and OS independent prognostic risk factors affecting the 2018 FIGO staging of LACC during CCRT were validated to be similar to the 2009 FIGO staging prediction model reported in previous literature. In the training cohort, area under the curve (AUC) values at 1, 3, and 5 years were 0.941, 0.882, and 0.885 for PFS, and 0.946, 0.946, and 0.969 for OS, respectively. When applied to a test cohort, the model also showed accurate prediction result (AUC at 1, 3, and 5 years were 0.869, 0.891, and 0.899 for PFS, and 0.891, 0.941 and 0.878 for OS, respectively). Subgroup analysis suggests that patients with LACC, adenocarcinoma, stage IVA, pelvic lymph node metastasis, pretreatment hemoglobin ≤100 g/l and residual tumor diameter >2 cm, who received CCRT in the 2018 FIGO stage, may benefit more from adjuvant chemtherapy. Conclusions: Based on the 2018 FIGO staging, a nomogram prediction model for PFS and OS in patients with LACC undergoing CCRT was developed. The model, established by combining weighted clinical and pathological factors, can provide more personalized treatment predictions in clinical practice. For patients with high-risk factors such as residual tumor diameter > 2 cm after CCRT for LACC, AC may bring benefits.
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Affiliation(s)
- Li Hua
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Mengzhuan Wei
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Chengjun Feng
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Shiting Li
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Xiaomin Wen
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Shaojun Chen
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
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10
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Bedi M, Kieft A, Joiner M, Miller S. Dramatic Radiographic Response of Pelvis-Filling Locally Advanced Cervical Cancer Treated With Radiation and Chemotherapy. Cureus 2024; 16:e61544. [PMID: 38962615 PMCID: PMC11219247 DOI: 10.7759/cureus.61544] [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] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Locally advanced cervical cancers are often treated with palliative intent due to concerns that the tumor is too far advanced or too large to be treated curatively. Also, patients greater than 65 years of age with cervical cancer are sometimes regarded as being too old or too frail to be cured with combined radiation and chemotherapy. These patients are often treated with radiation alone or with palliative therapy. Understanding the treatment modalities for cervical cancer is essential, as they can be complex and unique to each patient's specific diagnosis. This case report aims to describe the dramatic response to treatment with combined radiation and chemotherapy for a patient greater than 65 years of age with pelvis-filling cervical cancer with right-sided hydronephrosis. After a five-week course of concurrent chemoradiation, the cervical mass radiographically completely disappeared, with no evidence of disease noted on pelvic MRI.
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Affiliation(s)
- Mannat Bedi
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Aria Kieft
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Michael Joiner
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Steven Miller
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
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11
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Kok HP, Herrera TD, Crezee J. Biological treatment evaluation in thermoradiotherapy: application in cervical cancer patients. Strahlenther Onkol 2024; 200:512-522. [PMID: 38177701 PMCID: PMC11111588 DOI: 10.1007/s00066-023-02185-4] [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: 09/11/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Hyperthermia treatment quality is usually evaluated by thermal (dose) parameters, though hyperthermic radiosensitization effects are also influenced by the time interval between the two modalities. This work applies biological modelling for clinical treatment evaluation of cervical cancer patients treated with radiotherapy plus hyperthermia by calculating the equivalent radiation dose (EQDRT, i.e., the dose needed for the same effect with radiation alone). Subsequent analyses evaluate the impact of logistics. METHODS Biological treatment evaluation was performed for 58 patients treated with 23-28 fractions of 1.8-2 Gy plus 4-5 weekly hyperthermia sessions. Measured temperatures (T50) and recorded time intervals between the radiotherapy and hyperthermia sessions were used to calculate the EQDRT using an extended linear quadratic (LQ) model with hyperthermic LQ parameters based on extensive experimental data. Next, the impact of a 30-min time interval (optimized logistics) as well as a 4‑h time interval (suboptimal logistics) was evaluated. RESULTS Median average measured T50 and recorded time intervals were 41.2 °C (range 39.7-42.5 °C) and 79 min (range 34-125 min), respectively, resulting in a median total dose enhancement (D50) of 5.5 Gy (interquartile range [IQR] 4.0-6.6 Gy). For 30-min time intervals, the enhancement would increase by ~30% to 7.1 Gy (IQR 5.5-8.1 Gy; p < 0.001). In case of 4‑h time intervals, an ~ 40% decrease in dose enhancement could be expected: 3.2 Gy (IQR 2.3-3.8 Gy; p < 0.001). Normal tissue enhancement was negligible (< 0.3 Gy), even for short time intervals. CONCLUSION Biological treatment evaluation is a useful addition to standard thermal (dose) evaluation of hyperthermia treatments. Optimizing logistics to shorten time intervals seems worthwhile to improve treatment efficacy.
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Affiliation(s)
- H P Kok
- Dept. Radiation Oncology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Treatment and quality of life, Cancer biology and immunology, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - T D Herrera
- Dept. Radiation Oncology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Treatment and quality of life, Cancer biology and immunology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Crezee
- Dept. Radiation Oncology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Treatment and quality of life, Cancer biology and immunology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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12
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Xiao Y, Chen W, Long X, Li M, Zhang L, Liu C, Deng Y, Li C, He B, Chen J, Wang J. 3D MR elastography-based stiffness as a marker for predicting tumor grade and subtype in cervical cancer. Magn Reson Imaging 2024; 109:173-179. [PMID: 38484948 DOI: 10.1016/j.mri.2024.03.006] [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: 11/30/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Increasing evidence has indicated that high tissue stiffness (TS) may be a potential biomarker for evaluation of tumor aggressiveness. PURPOSE To investigate the value of magnetic resonance elastography (MRE)-based quantitative parameters preoperatively predicting the tumor grade and subtype of cervical cancer (CC). STUDY TYPE Retrospective. POPULATION Twenty-five histopathology-proven CC patients and 7 healthy participants. FIELD STRENGTH/SEQUENCE 3.0T, magnetic resonance imaging (MRI) (LAVA-flex) and MRE with a three-dimensional spin-echo echo-planar imaging. ASSESSMENT The regions of interest (ROIs) were manually drawn by two observers in tumors to measure mean TS, storage modulus (G'), loss modulus (G″) and damping ratio (DR) values. Surgical specimens were evaluated for tumor grades and subtypes. STATISTICAL TESTS Intraclass correlation coefficient (ICC) was expressed in terms of inter-observer agreements. t-test or Mann-Whitney nonparametric test was used to compare the complex modulus and apparent diffusion coefficient (ADC) values between different tumor groups. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the diagnostic performance. RESULTS The TS of endocervical adenocarcinoma (ECA) group was significantly higher than that in squamous cell carcinoma (SCC) group (5.27 kPa vs. 3.44 kPa, P = 0.042). The TS also showed significant difference between poorly and well/moderately differentiated CC (5.21 kPa vs. 3.47 kPa, P = 0.038), CC patients and healthy participants (4.18 kPa vs. 1.99 kPa, P < 0.001). The cutoff value of TS to discriminate ECA from SCC was 4.10 kPa (AUC: 0.80), while it was 4.42 kPa to discriminate poorly from well/moderately differentiated CC (AUC: 0.83), and 2.25 kPa to distinguish normal cervix from CC (AUC: 0.88), respectively. There were no significant difference in G″, DR and ADC values between any subgroups except for comparison of healthy participants and CC patients (P = 0.001, P = 0.004, P < 0.001, respectively). DATA CONCLUSION 3D MRE-assessed TS shows promise as a potential biomarker to preoperatively assess tumor grade and subtype of CC.
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Affiliation(s)
- Yuanqiang Xiao
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Wenying Chen
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Xi Long
- Department of Radiology, Meizhou People's Hospital (Huangtang Hospital), Meizhou 51403, China.
| | - Mengsi Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Lina Zhang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Chang Liu
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Ying Deng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Chao Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Bingjun He
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University (SYSU), Guangzhou, Guangdong 510630, China.
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13
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Mu Y, Wang H, Xu L, Shi L, Song R, Wang D, Gao Y, Yan H. Analysis of the therapeutic effect of synchronous integrated intensity modulated radiotherapy combined with chemotherapy in stage IIIc of cervical cancer. Front Oncol 2024; 14:1283991. [PMID: 38884092 PMCID: PMC11177616 DOI: 10.3389/fonc.2024.1283991] [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: 08/31/2023] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To explore the Therapeutic effect of synchronous Integrated intensity modulated radiotherapy combined with chemotherapy in stage IIIc of Cervical Cancer. Methods A total of 58 patients with stage IIIC cervical cancer (KPS ≥ 80) were analyzed in this study. They were admitted to our hospital between August 2017 and August 2022. Synchronous integrated boost intensity-modulated radiotherapy (SIB-IMRT) and sequential boost intensity-modulated radiotherapy (LCB-IMRT) were used to treat pelvic and/or para-aortic metastatic lymph nodes, with 30 cases in the SIB group and 28 cases in the LCB group. Comparison of short-term and long-term efficacy. Comparison of recurrence and metastasis rates, radiation dose to organs at risk and incidence of adverse drug reactions. Result 30 patients were treated with simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT), and 28 patients were treated with sequential boost intensity-modulated radiotherapy (LCB-IMRT). At the completion of radiotherapy and 3 months after radiotherapy, there was no significant difference in clinical efficacy observed between the two treatment groups. The median overall survival (OS), progression-free survival (PFS), and disease-free survival (DMR) in the SIB-IMRT group were significantly higher compared to the LCB-IMRT group. The SIB-IMRT group demonstrated significantly lower rates compared to the LCB-IMRT group. Furthermore, within 3 years and 5 years, the rates of lymph node recurrence, cervical and vaginal local recurrence, and distant metastasis within the radiotherapy field were significantly lower in the SIB-IMRT group compared to the LCB-IMRT group. There were no significant differences observed between the two groups in terms of the maximum dose to the small intestine (Dmax), dose received by 2cc of the small intestine (D2cc), maximum dose to the rectum (Dmax), and dose received by 1cc of the bladder (D1cc). The incidence of bone marrow toxicity in the SIB-IMRT group was significantly lower compared to the LCB-IMRT group. Moreover, the occurrence of grade III and IV bone marrow toxicity was also significantly lower in the SIB-IMRT group compared to the LCB-IMRT group. Conclusion The study has concluded that there is no significant differences in in terms of bladder associated adverse events and gastrointestinal toxicity in both Simultaneous Integrated Boost Intensity-Modulated Radiotherapy and Layered Conical Beam Intensity-Modulated Radiation Therapy.
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Affiliation(s)
- Yanru Mu
- Radiotherapy Department, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Hui Wang
- Radiotherapy Department, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Li Xu
- Radiotherapy Department, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Li Shi
- Gynaecology and Obstetrics, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Rui Song
- Gynaecology and Obstetrics, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Dezhi Wang
- Medical Imaging Department, Liaoning Health Industry Group Bengang General Hospital, Benxi, Liaoning, China
| | - Yuhua Gao
- Gynecology and Oncology Department, Liaoning Cancer Institute and Hospital, Shenyang, Liaoning, China
- Nuclear Medicine, Benxi Central Hospital, Benxi, Liaoning, China
| | - Haibo Yan
- Gynecology and Oncology Department, Liaoning Cancer Institute and Hospital, Shenyang, Liaoning, China
- Nuclear Medicine, Benxi Central Hospital, Benxi, Liaoning, China
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14
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Chen W, Zhang N, He Z, Li Q, Wang Y, Lou W, Di W. The efficacy of immune checkpoint inhibitors on low PD-L1 cervical cancer: A meta-analysis. Health Sci Rep 2024; 7:e2069. [PMID: 38706804 PMCID: PMC11066176 DOI: 10.1002/hsr2.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 05/07/2024] Open
Abstract
Background and Aims The effectiveness of immune checkpoint inhibitors (ICIs) in low programmed death ligand 1 (PD-L1) expression in cervical cancer (CC) patients remains unknown. We aimed to evaluate the efficacy of ICIs in low PD-L1 expression CC patients. Methods The study is an individual patient data (IPD)-based meta-analysis. IPD were compiled through KMSubtraction and IPDfromKM methodologies from high-quality randomized clinical trials and single-arm studies which reported overall survival (OS) or progression-free survival (PFS) stratified by PD-L1 expression. Kaplan-Meier curves and Cox regression analysis were employed to evaluate the survival benefits of ICIs. Results A total of eight studies and 1110 cases were included in the analysis. Within the low PD-L1 expression subgroup, ICI combination therapy, but not ICI monotherapy, demonstrated significant OS benefits over non-ICI treatment (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.36-1.04, p = 0.06). Concerning PFS, ICI monotherapy was associated with a negative effect compared to non-ICI treatment (HR = 4.59, 95% CI: 2.32-9.07, p < 0.001). Notably, both OS and PFS outcomes were unfavorable for ICI monotherapy compared to both non-ICI and ICI combination therapy in the combined positive score <1 subgroup (OS: HR = 2.60, 95% CI: 1.31-5.16, p = 0.008; PFS: HR = 7.59, 95% CI: 3.53-16.31, p < 0.001). Conclusion In patients with CC and low PD-L1 expression, ICI monotherapy may not be considered as the optimal treatment strategy when compared to non-ICI treatment or ICI combination therapy. Registration CRD42023395103.
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Affiliation(s)
- Wutao Chen
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Nan Zhang
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Zhihong He
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Qing Li
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - You Wang
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Weihua Lou
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Wen Di
- Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- Department of Obstetrics and Gynecology, School of Medicine, Renji HospitalShanghai Jiaotong UniversityShanghaiChina
- State Key Laboratory of Systems Medicine for CancerShanghaiChina
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15
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Bacorro W, Short M, Baldivia K, Mariano J, Bautista A, Amparo G, Tagayuna I, Jainar CJ, Antonio L, Dancel E, Ortin TS, Gonzalez G, Canlas R. Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review. JCO Glob Oncol 2024; 10:e2300486. [PMID: 38754049 DOI: 10.1200/go.23.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.
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Affiliation(s)
- Warren Bacorro
- Graduate School, University of Santo Tomas, Manila, Philippines
- 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
| | - Michala Short
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kathleen Baldivia
- Department of Radiation Oncology, 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
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Aida Bautista
- Department of Obstetrics and Gynecology, Manila Doctors Hospital, Manila, Philippines
| | - Genalin Amparo
- Department of Obstetrics and Gynecology, Our Lady of Lourdes Hospital, Manila, Philippines
| | - Irene Tagayuna
- Department of Obstetrics and Gynecology, De Los Santos Medical Center, Quezon City, Philippines
| | - Carl Jay Jainar
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Linda Antonio
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Evelyn Dancel
- Department of Radiation Oncology, 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
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Rodel Canlas
- Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Psychology, University of Santo Tomas-College of Science, Manila, Philippines
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16
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Li W, Ma L, Li F, Li K, Zhang Y, Ren H, Bao X, Guo Y, Guo Y, Wang M, Li D, Duan Y, Ma X, Wang Z, Wang Y, Yin R. Effects of bone marrow sparing radiotherapy on acute hematologic toxicity for patients with locoregionally advanced cervical cancer: a prospective phase II randomized controlled study. Radiat Oncol 2024; 19:46. [PMID: 38594678 PMCID: PMC11005132 DOI: 10.1186/s13014-024-02432-7] [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: 04/16/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE To evaluate effects of bone marrow sparing (BMS) radiotherapy on decreasing the incidence of acute hematologic toxicity (HT) for locoregionally advanced cervical cancer (LACC) patients treated by pelvic irradiation. MATERIALS AND METHODS LACC patients were recruited prospectively from May 2021 to May 2022 at a single center and were evenly randomized into the BMS group and the control group. All patients received pelvic irradiation with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy and BM V40 < 25% in the BMS group was additionally prescribed. Acute HT was assessed weekly. Binary logistic regression model and receiver operating characteristic (ROC) curve were used for predictive value analysis. The trial was registered with Chinese clinical trial registry (ChiCTR2200066485). RESULTS A total of 242 patients were included in the analysis. Baseline demographic, disease and treatment characteristics were balanced between the two groups. In the intention-to-treat population, BMS was associated with a lower incidence of grade ≥ 2 and grade ≥ 3 acute HT, leukopenia and neutropenia s(72.70% v 90.90%, P < 0.001*; 16.50% vs. 65.30%, P < 0.001*; 66.10% vs. 85.10%, P = 0.001*; 13.20% vs. 54.50%, P < 0.001*; 37.20% vs. 66.10%, P < 0.001*; 10.70% vs. 43.80%, P < 0.001*). BMS also resulted in decreased dose delivered to the organs at risk (OARs) including rectum, bladder and left and right femoral head. Univariate and multivariate analyses showed that BM V40 was an independent risk factor for grade ≥ 3 acute HT (odds ratio [OR] = 2.734, 95% confidence interval [CI] = 1.959-3.815, P < 0.001*). Cutoff value was 25.036% and area under the curve (AUC) was 0.786. The nomogram was constructed, which was rigorously evaluated and internally cross-validated, showing good predictive performance. CONCLUSIONS Receiving BMS pelvic irradiation could reduce the incidence of acute HT in LACC patients, and BM V40 < 25% may be a significant factor in reducing the risks of acute HT.
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Affiliation(s)
- Wen Li
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Lan Ma
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Fang Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Kemin Li
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Yang Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Hongtao Ren
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Xing Bao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yuyan Guo
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Ya Guo
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Mincong Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Dan Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yuanqiong Duan
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China
| | - Xiulong Ma
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Zhongwei Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China
| | - Yali Wang
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi' An Jiao Tong University, 710004, Xi'An, China.
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China University Hospital 2, Sichuan University, 610041, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry Education, Sichuan University, 610041, Chengdu, China.
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17
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Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P, Acevedo A, Sukhin V, Cloven N, Pereira de Santana Gomes AJ, Contreras Mejía F, Reiss A, Ayhan A, Lee JY, Saevets V, Zagouri F, Gilbert L, Sehouli J, Tharavichitkul E, Lindemann K, Lazzari R, Chang CL, Lampé R, Zhu H, Oaknin A, Christiaens M, Polterauer S, Usami T, Li K, Yamada K, Toker S, Keefe SM, Pignata S, Duska LR. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet 2024; 403:1341-1350. [PMID: 38521086 DOI: 10.1016/s0140-6736(24)00317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Pembrolizumab has shown efficacy in persistent, recurrent, or metastatic cervical cancer. The effect of chemoradiotherapy might be enhanced by immunotherapy. In this phase 3 trial, we assessed the efficacy and safety of adding pembrolizumab to chemoradiotherapy in locally advanced cervical cancer. METHODS In this randomised, double-blind, placebo-controlled, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 clinical trial, adults (age ≥18 years) at 176 medical centres in 30 countries with newly diagnosed, high-risk, locally advanced cervical cancer were randomly assigned (1:1) using an interactive voice-response system with integrated web response to receive 5 cycles of pembrolizumab (200 mg) or placebo every 3 weeks plus chemoradiotherapy, followed by 15 cycles of pembrolizumab (400 mg) or placebo every 6 weeks. Randomisation was stratified by planned external beam radiotherapy type (intensity-modulated radiotherapy or volumetric-modulated arc therapy vs non-intensity-modulated radiotherapy or non-volumetric-modulated arc therapy), cervical cancer stage at screening (International Federation of Gynecology and Obstetrics 2014 stage IB2-IIB node positive vs stage III-IVA), and planned total radiotherapy (external beam radiotherapy plus brachytherapy) dose (<70 Gy vs ≥70 Gy equivalent dose in 2 Gy fractions). Primary endpoints were progression-free survival per Response Evaluation Criteria in Solid Tumours version 1.1-by investigator or by histopathologic confirmation of suspected disease progression-and overall survival. Primary analysis was conducted in the intention-to-treat population, which included all randomly allocated participants. Safety was assessed in the as-treated population, which included all randomly allocated patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04221945, and is closed to new participants. FINDINGS Between June 9, 2020, and Dec 15, 2022, 1060 participants were randomly assigned to treatment, with 529 assigned to the pembrolizumab-chemoradiotherapy group and 531 to the placebo-chemoradiotherapy group. At data cutoff (Jan 9, 2023), median follow-up was 17·9 months (IQR 11·3-22·3) in both treatment groups. Median progression-free survival was not reached in either group; rates at 24 months were 68% in the pembrolizumab-chemoradiotherapy group versus 57% in the placebo-chemoradiotherapy group. The hazard ratio (HR) for disease progression or death was 0·70 (95% CI 0·55-0·89, p=0·0020), meeting the protocol-specified primary objective. Overall survival at 24 months was 87% in the pembrolizumab-chemoradiotherapy group and 81% in the placebo-chemoradiotherapy group (information fraction 42·9%). The HR for death was 0·73 (0·49-1·07); these data have not crossed the boundary of statistical significance. Grade 3 or higher adverse event rates were 75% in the pembrolizumab-chemoradiotherapy group and 69% in the placebo-chemoradiotherapy group. INTERPRETATION Pembrolizumab plus chemoradiotherapy significantly improved progression-free survival in patients with newly diagnosed, high-risk, locally advanced cervical cancer. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co (MSD).
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Affiliation(s)
- Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy.
| | - Yang Xiang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Manuel Leiva
- Instituto de Oncologia y Radioterapia Clinica Ricardo Palma, Lima, Peru
| | - Pier Ramos-Elias
- Integra Cancer Institute, Edificio Integra Medical Center, Guatemala City, Guatemala
| | | | - Vladyslav Sukhin
- Grigoriev Institute for Medical Radiology and Oncology NAMS Ukraine, Kharkiv, Ukraine
| | - Noelle Cloven
- Texas Oncology-Fort Worth Cancer Center, Fort Worth, TX, USA
| | | | | | - Ari Reiss
- Rambam Medical Center, Gyneco-oncology Unit, Haifa, Israel
| | - Ali Ayhan
- Turkish Society of Gynecologic Oncology, Başkent University, Ankara, Türkiye
| | - Jung-Yun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Valeriya Saevets
- Chelyabinsk Regional Clinical Center for Oncology and Nuclear Medicine, Chelyabinsk, Russia
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Jalid Sehouli
- Charité Universitätsmedizin, Berlin, Germany; North-Eastern German Society of Gynecological Oncology, Berlin, Germany
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Nordic Society of Gynaecological Oncology Clinical Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roberta Lazzari
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Italy
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Hunan, China
| | - Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Melissa Christiaens
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; AGO Austria, Austria
| | | | - Kan Li
- Merck & Co, Rahway, NJ, USA
| | | | | | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Naples, Italy
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA
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18
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Wu KC, Chen SW, Hsieh TC, Yen KY, Chang CJ, Kuo YC, Chang RF, Chia-Hung K. Early prediction of distant metastasis in patients with uterine cervical cancer treated with definitive chemoradiotherapy by deep learning using pretreatment [ 18 F]fluorodeoxyglucose positron emission tomography/computed tomography. Nucl Med Commun 2024; 45:196-202. [PMID: 38165173 DOI: 10.1097/mnm.0000000000001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES A deep learning (DL) model using image data from pretreatment [ 18 F]fluorodeoxyglucose ([ 18 F] FDG)-PET or computed tomography (CT) augmented with a novel imaging augmentation approach was developed for the early prediction of distant metastases in patients with locally advanced uterine cervical cancer. METHODS This study used baseline [18F]FDG-PET/CT images of newly diagnosed uterine cervical cancer patients. Data from 186 to 25 patients were analyzed for training and validation cohort, respectively. All patients received chemoradiotherapy (CRT) and follow-up. PET and CT images were augmented by using three-dimensional techniques. The proposed model employed DL to predict distant metastases. Receiver operating characteristic (ROC) curve analysis was performed to measure the model's predictive performance. RESULTS The area under the ROC curves of the training and validation cohorts were 0.818 and 0.830 for predicting distant metastasis, respectively. In the training cohort, the sensitivity, specificity, and accuracy were 80.0%, 78.0%, and 78.5%, whereas, the sensitivity, specificity, and accuracy for distant failure were 73.3%, 75.5%, and 75.2% in the validation cohort, respectively. CONCLUSION Through the use of baseline [ 18 F]FDG-PET/CT images, the proposed DL model can predict the development of distant metastases for patients with locally advanced uterine cervical cancer treatment by CRT. External validation must be conducted to determine the model's predictive performance.
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Affiliation(s)
- Kuo-Chen Wu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei
- Artificial Intelligence Center, China Medical University Hospital
- Department of Radiation Oncology, China Medical University Hospital
| | - Shang-Wen Chen
- Artificial Intelligence Center, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University, Taichung
- School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Department of Radiation Oncology, China Medical University Hospital
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung
| | - Chao-Jen Chang
- Artificial Intelligence Center, China Medical University Hospital
| | - Yu-Chieh Kuo
- Artificial Intelligence Center, China Medical University Hospital
| | - Ruey-Feng Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei
- Artificial Intelligence Center, China Medical University Hospital
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei
| | - Kao Chia-Hung
- Artificial Intelligence Center, China Medical University Hospital
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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19
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Song J, Pang W, Yi H, Ji J, Ye X, Li L. Tumor and metastatic lymph nodes metabolic activity on 18F-FDG-PET/CT to predict progression-free survival in locally advanced cervical cancer. Abdom Radiol (NY) 2024; 49:975-984. [PMID: 38302763 DOI: 10.1007/s00261-023-04158-8] [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: 04/12/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study investigated the predictive diseases progression value of preoperative fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with local advanced cervical cancer (LACC). METHODS In total, 267 patients [median age 58 (range: 27-85) years old] with LACC underwent 18F-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesion and metastatic lymph nodes were measured on PET/CT and correlated with clinicopathological features and progression-free survival (PFS). RESULTS The median follow-up was 36.52 (range: 3.09-61.29) months. During the observation period, 80 (30.0%) patients exhibited disease progression. Univariate analysis showed that FIGO stage, concurrent chemoradiotherapy (CRT), serum level of carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag), primary tumor MTV (pMTV) and TLG (pTLG), lymph nodes SUVmax (nSUVmax) and TLG (nTLG), and total metabolic activity (sMTV, sTLG) were associated with PFS. nSUVmax ≥ 5.29, CEA ≥ 7.11 ng/ml and deficiency of concurrent CRT were independent risk factor for PFS (p = 0.006, p = 0.008, p = 0.014). The 3-year PFS for patients with high nSUVmax were 42.2% compared to 56.3% for low nSUVmax values. CONCLUSION Pretreatment cervical and lymph nodes metabolic parameters were associated with PFS in patients with LACC.
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Affiliation(s)
- Jinling Song
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Weiqiang Pang
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Heqing Yi
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Jianfeng Ji
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Xuemei Ye
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Linfa Li
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China.
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20
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Medici F, Ferioli M, Cammelli S, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Bazzocchi A, Rizzo S, Arcelli A, Morganti AG. Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project). Cancers (Basel) 2024; 16:929. [PMID: 38473291 DOI: 10.3390/cancers16050929] [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: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m2, have been identified as potential prognostic factors, yet their overall impact remains underexplored. This study assessed the relationship between these anthropometric parameters alongside clinical prognostic factors on the prognosis of 173 cervical cancer patients. Survival outcomes in terms of local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were analyzed using Kaplan regression methods-Meier and Cox. Older age, lower hemoglobin levels, higher FIGO (International Federation of Gynecology and Obstetrics) stages, and lower total radiation doses were significantly associated with worse outcomes. Univariate analysis showed a significant correlation between BMI and the outcomes examined, revealing that normal-weight patients show higher survival rates, which was not confirmed by the multivariate analysis. Sarcopenia was not correlated with any of the outcomes considered, while sarcopenic obesity was identified as an independent negative predictor of DFS (HR: 5.289, 95% CI: 1.298-21.546, p = 0.020) and OS (HR: 2.645, 95% CI: 1.275-5.488, p = 0.009). This study highlights the potential of sarcopenic obesity as an independent predictor of clinical outcomes. These results support their inclusion in prognostic assessments and treatment planning for patients with advanced cervical cancer.
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Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ludovica Forlani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Anna Myriam Perrone
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), CH-6500 Lugano, Switzerland
| | - Alessandra Arcelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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21
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Olthof EP, Wenzel HHB, van der Velden J, Stalpers LJA, Mom CH, van der Aa MA. Treatment Strategies Guided by [18F]FDG-PET/CT in Patients with Locally Advanced Cervical Cancer and [18F]FDG-Positive Lymph Nodes. Cancers (Basel) 2024; 16:717. [PMID: 38398108 PMCID: PMC10887300 DOI: 10.3390/cancers16040717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Modern treatment guidelines for women with advanced cervical cancer recommend staging using 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography ([18F]FDG-PET/CT). However, the risk of false-positive nodes and therapy-related adverse events requires caution in treatment planning. Using data from the Netherlands Cancer Registry (NCR), we estimated the impact of [18F]FDG-PET/CT on treatment management in women with locally advanced cervical cancer, i.e., on nodal boosting, field extension, and/or debulking in cases of suspected lymph nodes. METHODS Women diagnosed between 2009 and 2017, who received chemoradiotherapy for International Federation of Gynaecology and Obstetrics (2009) stage IB2, IIA2-IVB cervical cancer with an [18F]FDG-positive node, were retrospectively selected from the NCR database. Patients with pathological nodal examination before treatment were excluded. The frequency of nodal boosting, extended-field radiotherapy, and debulking procedures applied to patients with [18F]FDG-positive lymph nodes was evaluated. RESULTS Among the 434 eligible patients with [18F]FDG-positive nodes, 380 (88%) received interventions targeting these lymph nodes: 84% of these 380 patients received nodal boosting, 78% extended-field radiotherapy, and 12% debulking surgery. [18F]FDG-positive nodes in patients receiving these treatments were more likely to be classified as suspicious than inconclusive (p = 0.009), located in the para-aortic region (p < 0.001), and larger (p < 0.001) than in patients who did not receive these treatments. CONCLUSION While existing guidelines advocate [18F]FDG-PET/CT-guided treatment planning for the management of advanced cervical cancer, this study highlights that not all cases of [18F]FDG-positive nodes received an intervention, possibly due to the risk of false-positive results. Improvement of nodal staging may reduce suboptimal treatment planning.
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Affiliation(s)
- Ester P. Olthof
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Hans H. B. Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
| | - Jacobus van der Velden
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Lukas J. A. Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centre, 1055 AZ Amsterdam, The Netherlands;
| | - Constantijne H. Mom
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Maaike A. van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
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22
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Pan XB, Lu Y, Wei YS, Yao DS. Efficacy of treatment patterns based on concurrent chemoradiotherapy in patients with stage IIB cervical squamous cell carcinoma. BMC Cancer 2024; 24:106. [PMID: 38238689 PMCID: PMC10797798 DOI: 10.1186/s12885-023-11372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/04/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To assess survival of treatment patterns based on concurrent chemoradiotherapy (CCRT) in patients with stage IIB cervical squamous cell carcinoma (CSCC). MATERIALS AND METHODS Patients with stage IIB CSCC receiving CCRT were investigated from June 2012 to June 2019 in Guangxi Medical University Cancer Hospital. Baseline characteristics and treatment patterns were described. Survival between treatment patterns were compared using Kaplan-Meier methods. RESULTS A total of 232 patients were included: 39.7% of patients received CCRT alone, 6.5% of patients received neoadjuvant chemotherapy (NACT) + CCRT, 45.6% of patients received CCRT + adjuvant chemotherapy (AC), and 8.2% of patients received NACT + CCRT + AC. CCRT + AC showed similar overall survival (OS; hazard ratio [HR] = 0.95, 95% confidence interval [CI]: 0.41-2.17; P = 0.894) and locoregional-free survival (LRFS; HR = 2.39, 95% CI: 0.45-12.63; P = 0.303) compared with CCRT. However, CCRT + AC had a worse distant metastasis-free survival (DMFS; HR = 5.39, 95% CI: 1.14-25.57; P = 0.034). After propensity score matching, CCRT + AC had comparable OS (HR = 0.89, 95% CI: 0.29-2.70; P = 0.833), LRFS (HR = 3.26, 95% CI: 0.30-35.38; P = 0.331), and DMFS (HR = 4.80, 95% CI: 0.55-42.26; P = 0.157) compared to CCRT. CONCLUSION AC did not improve survival in patients with stage IIB CSCC receiving CCRT.
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Affiliation(s)
- Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 530021, Nanning, Guangxi, P.R. China
| | - Yan Lu
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 530021, Nanning, Guangxi, P.R. China
| | - You-Sheng Wei
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 530021, Nanning, Guangxi, P.R. China
| | - De-Sheng Yao
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, 530021, Nanning, Guangxi, P.R. China.
- , No. 71 Hedi Road, Qingxiu District, 530021, Nanning, Guangxi, P.R. China.
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23
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Jeong S, Yu H, Park SH, Woo D, Lee SJ, Chong GO, Han HS, Kim JC. Comparing deep learning and handcrafted radiomics to predict chemoradiotherapy response for locally advanced cervical cancer using pretreatment MRI. Sci Rep 2024; 14:1180. [PMID: 38216687 PMCID: PMC10786874 DOI: 10.1038/s41598-024-51742-z] [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: 07/06/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024] Open
Abstract
Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced cervical cancer (LACC), but its responsiveness varies among patients. A reliable tool for predicting CRT responses is necessary for personalized cancer treatment. In this study, we constructed prediction models using handcrafted radiomics (HCR) and deep learning radiomics (DLR) based on pretreatment MRI data to predict CRT response in LACC. Furthermore, we investigated the potential improvement in prediction performance by incorporating clinical factors. A total of 252 LACC patients undergoing curative chemoradiotherapy are included. The patients are randomly divided into two independent groups for the training (167 patients) and test datasets (85 patients). Contrast-enhanced T1- and T2-weighted MR scans are obtained. For HCR analysis, 1890 imaging features are extracted and a support vector machine classifier with a five-fold cross-validation is trained on training dataset to predict CRT response and subsequently validated on test dataset. For DLR analysis, a 3-dimensional convolutional neural network was trained on training dataset and validated on test dataset. In conclusion, both HCR and DLR models could predict CRT responses in patients with LACC. The integration of clinical factors into radiomics prediction models tended to improve performance in HCR analysis. Our findings may contribute to the development of personalized treatment strategies for LACC patients.
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Affiliation(s)
- Sungmoon Jeong
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hosang Yu
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shin-Hyung Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea.
- Cardiovascular Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Dongwon Woo
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seoung-Jun Lee
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun Oh Chong
- Department of Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyung Soo Han
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Chul Kim
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
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24
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Liu F, Chen W, Pan Y, Wang C, Tang Y, Chou H, Chao A, Yang L, Lai C. Clinical factor-based risk stratification for precision therapy in locally advanced squamous cell carcinoma of the uterine cervix. Cancer Med 2024; 13:e6746. [PMID: 38192162 PMCID: PMC10807568 DOI: 10.1002/cam4.6746] [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: 05/18/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the standard of care for locally advanced cervical cancer. In this study, we analyzed the pretreatment clinical and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) characteristics of patients with locally advanced cervical squamous cell carcinoma (SCC) to develop a scoring prototype for risk stratification. METHODS Two cohorts were constructed in this study. Cohort 1 comprised patients with cervical SCC with 2009 FIGO stage III-IVA or stage I-II with positive pelvic or para-aortic lymph node (PALN) on PET/CT from AGOG09-001 trial. Cohort 2 comprised patients with similar characteristics who had received adequate therapy in our hospital between 2016 and 2021. Pretreatment patient characteristics and PET/CT parameters including maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) of primary tumor and nodal SUVmax were assessed for cancer-specific survival (CSS) using multivariate Cox regression. RESULTS Analysis of combined data from cohorts 1 (n = 55) and 2 (n = 128) indicated age ≥ 66 years, primary tumor MTV ≥87 mL, and positive PALN on PET/CT to be independently significant adverse predictors for CSS (p < 0.001, p = 0.014, and p = 0.026, respectively) with a median follow-up duration of 51 months. Assigning a score of 1 to each adverse predictor, patients with cumulative risk scores of 0, 1, 2, and 3 were discovered to have a 5-year CSS of 86.9%, 71.0%, 32.2%, and 0%, respectively (p < 0.001). CONCLUSION Age, primary tumor MTV, and positive PALN on PET/CT may serve as independent predictors of poor survival in patients with locally advanced cervical SCC. Our findings indicate that patients without any adverse factors can receive standard CCRT, whereas those with at least one adverse factor can consider novel combination therapies or clinical trials.
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Affiliation(s)
- Feng‐Yuan Liu
- Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- School of Medicine, National Tsing Hua UniversityHsinchuTaiwan
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Wei‐Chun Chen
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyNew Taipei City Municipal Tucheng HospitalNew Taipei CityTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Yu‐Bin Pan
- Clinical Trial Center, Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Chun‐Chieh Wang
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Radiation OncologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Yun‐Hsin Tang
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Hung‐Hsueh Chou
- School of Medicine, National Tsing Hua UniversityHsinchuTaiwan
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Angel Chao
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Lan‐Yan Yang
- Clinical Trial Center, Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Chyong‐Huey Lai
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
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25
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Li F, Mei F, Yin S, Du Y, Hu L, Hong W, Li J. Improving the efficacy and safety of concurrent chemoradiotherapy by neoadjuvant chemotherapy: a randomized controlled study of locally advanced cervical cancer with a large tumor. J Gynecol Oncol 2024; 35:e10. [PMID: 37857565 PMCID: PMC10792203 DOI: 10.3802/jgo.2024.35.e10] [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: 05/16/2023] [Revised: 08/05/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of neoadjuvant chemotherapy combined with concurrent chemoradiotherapy (NACT+CCRT) vs. concurrent chemoradiotherapy (CCRT) in locally advanced cervical cancer (LACC) patients with large tumor masses. METHODS LACC patients with localized tumor diameter >4 cm, were randomly allocated in an unblinded 1:1 ratio to NACT+CCRT or CCRT groups. Patients in the NACT+CCRT group were given paclitaxel combined with cisplatin (TP) NACT every 3 weeks for 2 cycles, followed by CCRT, with the chemotherapy regimen the same as for NACT. CCRT group were given CCRT with the same as for NACT. RESULTS From March 1, 2019, to June 30, 2021, 146 patients were included in the final analysis. Sixty-eight (93.2%) patients in the NACT+CCRT group and 66 (90.4%) patients in the CCRT group completed the expected treatment course. The complete response (CR) rate in the NACT+CCRT group was significantly higher than in the CCRT group (87.7% vs. 67.6%, χ²=54.540, p=0.000). In the NACT+CCRT group, the 1- and 2-year overall survival (OS) rates were significantly higher than those in the CCRT group (96% vs. 89% and 89% vs. 79%, χ²=5.737, p=0.017). Additionally, the rate of recurrences and distant metastases was significantly lower in the NACT+CCRT group than in the CCRT group (4.11% vs. 7.35%, χ²=4.059, p=0.021). Most treatment-related adverse events in both groups were grade 3. CONCLUSION Compared to CCRT, NACT+CCRT might improve the treatment completion rate, increase CR rate and 1- and 2-year OS rates, and reduce distant metastases rate for LACC patients with large tumor masses.
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Affiliation(s)
- Fenghu Li
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Fan Mei
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Shuishui Yin
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Yanjun Du
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Lili Hu
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Wei Hong
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Jiehui Li
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecological Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China.
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26
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Mileshkin LR. The challenge of improving outcomes in locally advanced cervical cancer. Lancet Oncol 2023; 24:1289-1291. [PMID: 38039987 DOI: 10.1016/s1470-2045(23)00532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne 3000, VIC, Australia.
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27
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Morcet-Delattre R, Espenel S, Tas P, Chargari C, Escande A. Role of radiotherapy in the management of rare gynaecological cancers. Cancer Radiother 2023; 27:778-788. [PMID: 37925347 DOI: 10.1016/j.canrad.2023.08.006] [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: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 11/06/2023]
Abstract
There are a large number of gynaecological cancers with rare histologies, for which the available data are limited and usually retrospective. Because of their rarity and poor prognosis, the management of these cancers must be centralized in expert centres, for both histological diagnosis and treatment. With the exception of sarcomas, most endometrial or cervical cancers with rare histologies respond to the same radiation treatment modalities than cancers with more common histologies, although there are some specificities regarding treatments such as neuroendocrine carcinomas (chemotherapy with platinum and etoposide, major role of surgery). For localized or locally advanced ovarian cancer, external beam radiotherapy has a role in the management of hypercalcaemic small cell carcinoma of the ovary. This article summarizes the current role of external beam radiotherapy and brachytherapy in the management of cancers of the uterine cervix, uterine corpus and ovaries, with rare or very rare histologies, and with localized or locally advanced stages.
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Affiliation(s)
- R Morcet-Delattre
- Radiation oncology department, centre Eugène-Marquis, Rennes, France.
| | - S Espenel
- Radiation oncology department, Gustave-Roussy Cancer Campus, Villejuif, France
| | - P Tas
- Anatomopathology department, Ouest pathologie, Rennes, France
| | - C Chargari
- Radiation oncology department, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - A Escande
- Radiation oncology department, centre Léonard-de-Vinci, Dechy, France; Laboratoire CRIStAL UMR9189, université de Lille, CNRS, Lille, France
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28
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Moloudi K, Khani A, Najafi M, Azmoonfar R, Azizi M, Nekounam H, Sobhani M, Laurent S, Samadian H. Critical parameters to translate gold nanoparticles as radiosensitizing agents into the clinic. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1886. [PMID: 36987630 DOI: 10.1002/wnan.1886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 03/30/2023]
Abstract
Radiotherapy is an inevitable choice for cancer treatment that is applied as combinatorial therapy along with surgery and chemotherapy. Nevertheless, radiotherapy at high doses kills normal and tumor cells at the same time. In addition, some tumor cells are resistant to radiotherapy. Recently, many researchers have focused on high-Z nanomaterials as radiosensitizers for radiotherapy. Among them, gold nanoparticles (GNPs) have shown remarkable potential due to their promising physical, chemical, and biological properties. Although few clinical trial studies have been performed on drug delivery and photosensitization with lasers, GNPs have not yet received Food and Drug Administration approval for use in radiotherapy. The sensitization effects of GNPs are dependent on their concentration in cells and x-ray energy deposition during radiotherapy. Notably, some limitations related to the properties of the GNPs, including their size, shape, surface charge, and ligands, and the radiation source energy should be resolved. At the first, this review focuses on some of the challenges of using GNPs as radiosensitizers and some biases among in vitro/in vivo, Monte Carlo, and clinical studies. Then, we discuss the challenges in the clinical translation of GNPs as radiosensitizers for radiotherapy and proposes feasible solutions. And finally, we suggest that certain areas be considered in future research. This article is categorized under: Therapeutic Approaches and Drug Discovery > NA.
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Affiliation(s)
- Kave Moloudi
- Department of Radiology and Nuclear Medicine, Alley School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Ali Khani
- Department of Radiation Sciences, Alley School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Najafi
- Department of Radiology and Nuclear Medicine, Alley School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasool Azmoonfar
- Department of Radiology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Azizi
- Department of Tissue Engineering and Biomaterials, School of Advanced Medical Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran
- Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Houra Nekounam
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahsa Sobhani
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sophie Laurent
- Department of General, Organic and Biomedical Chemistry, Faculty of Medicine and Pharmacy, NMR and Molecular Imaging Laboratory, University of Mons, Mons, Belgium
| | - Hadi Samadian
- Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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29
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Medici F, Ferioli M, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Arcelli A, Morganti AG. Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study). Cancers (Basel) 2023; 15:5056. [PMID: 37894423 PMCID: PMC10605166 DOI: 10.3390/cancers15205056] [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: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation indices (IIs) is unclear. This study aims to assess the correlation between IIs and prognosis in a large patient cohort considering several clinical data. We retrospectively analyzed pretreatment IIs (NLR, PLR, MLR, SII, LLR, COP-NLR, APRI, ALRI, SIRI, and ANRI) in 173 LACC patients. Patient, tumor, and treatment characteristics were also considered. Univariate and multivariate Cox's regressions were conducted to assess associations between IIs and clinical factors with local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Univariate analysis showed significant correlations between age, HB levels, tumor stage, FIGO stage, and CRT dose with survival outcomes. Specific pretreatment IIs (NLR, PLR, APRI, ANRI, and COP-NLR) demonstrated associations only with LC. The multivariate analysis confirmed Hb levels, CRT dose, and age as significant predictors of OS, while no II was correlated with any clinical outcome. The study findings contradict some prior research on IIs in LACC, emphasizing the need for comprehensive assessments of potential confounding variables.
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Affiliation(s)
- Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Anna Myriam Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Anghel B, Serboiu C, Marinescu A, Taciuc IA, Bobirca F, Stanescu AD. Recent Advances and Adaptive Strategies in Image Guidance for Cervical Cancer Radiotherapy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1735. [PMID: 37893453 PMCID: PMC10608436 DOI: 10.3390/medicina59101735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
The standard of care for locally advanced cervical cancer is external beam radiotherapy (EBRT) with simultaneous chemotherapy followed by an internal radiation boost. New imaging methods such as positron-emission tomography and magnetic resonance imaging have been implemented into daily practice for better tumor delineation in radiotherapy planning. The method of delivering radiation has changed with technical advances in qualitative imaging and treatment delivery. Image-guided radiotherapy (IGRT) plays an important role in minimizing treatment toxicity of pelvic radiation and provides a superior conformality for sparing the organs at risk (OARs) such as bone marrow, bowel, rectum, and bladder. Similarly, three-dimensional image-guided adaptive brachytherapy (3D-IGABT) with computed tomography (CT) or magnetic resonance imaging (MRI) has been reported to improve target coverage and reduce the dose to normal tissues. Brachytherapy is a complementary part of radiotherapy treatment for cervical cancer and, over the past 20 years, 3D-image-based brachytherapy has rapidly evolved and established itself as the gold standard. With new techniques and adaptive treatment in cervical cancer, the concept of personalized medicine is introduced with an enhanced comprehension of the therapeutic index not only in terms of volume (three-dimensional) but during treatment too (four-dimensional). Current data show promising results with integrated IGRT and IGABT in clinical practice and, therefore, better local control and overall survival while reducing treatment-related morbidity. This review gives an overview of the substantial impact that occurred in the progress of image-guided adaptive external beam radiotherapy and brachytherapy.
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Affiliation(s)
- Beatrice Anghel
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Radiation Oncology, Sanador Oncology Centre, 010991 Bucharest, Romania
| | - Crenguta Serboiu
- Department of Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Marinescu
- Radiology and Imaging Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Iulian-Alexandru Taciuc
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Nuclear Medicine Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Florin Bobirca
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- General Surgery Department, Cantacuzino Clinical Hospital, 73206 Bucharest, Romania
| | - Anca Daniela Stanescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Obstetrics and Gynecology, St. John Emergency Hospital, Bucur Maternity, 040292 Bucharest, Romania
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Bacorro W, Baldivia K, Mariano J, Dancel E, Antonio L, Gonzalez G, Ortin TS, Canlas R. Patient Decision Aid for Chemotherapy or Exclusion in Cisplatin-Intolerant Patients With Locally Advanced Cervical Cancer: Development, Alpha Testing, and Peer Validation. JCO Glob Oncol 2023; 9:e2300096. [PMID: 37677124 PMCID: PMC10581640 DOI: 10.1200/go.23.00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/15/2023] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE In locally advanced cervical cancer (LACC), adding cisplatin to radiotherapy (RT) improves survival but increases toxicity. Among patients with cisplatin contraindications, RT compliance may be compromised by toxicity because of cisplatin or a substitute. In shared decision making, a patient decision aid (PtDA) may decrease decisional conflict and attitudinal barriers, thereby improving treatment compliance. METHODS Following International Patient Decision Aid Standards (IPDAS) guidelines, a steering committee of two radiation oncologists, a gynecologic oncologist, an oncology nurse, a clinical psychologist, a cancer survivor, and a caregiver developed the chemotherapy or exclusion in cisplatin-intolerant patients with LACC (CECIL) prototype, a PtDA for cisplatin-intolerant patients with LACC deciding about adding chemotherapy to RT. The prototype was alpha-tested using the e-Delphi method. The patient decision aid research group Ottawa Acceptability Questionnaire was used to evaluate comprehensibility, length, amount of information, neutrality, and overall suitability for decision making. The prototype was then independently evaluated by local internal, local external, and international reviewers using the IPDAS checklist version 4, which encompasses information, probabilities, values, guidance, development, evidence, disclosure, plain language, and evaluation. RESULTS Alpha testing showed high practitioner acceptability (all items with mean and median scores ≥4; overall mean score 4.70 of 5.00) and good patient acceptability (all items rated good to excellent). Content validation showed that the PtDA satisfied all IPDAS six qualifying and six certification criteria, with high overall mean score (3.63 of 4.00) for all 17 applicable quality criteria. CONCLUSION The CECIL prototype shows good practitioner and patient acceptability, and content validity on peer review. Clinical testing to determine its effectiveness in reducing decisional conflict is ongoing.
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Affiliation(s)
- Warren Bacorro
- The Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Kathleen Baldivia
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Jocelyn Mariano
- Department of Obstetrics and Gynecology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- Gynecologic Oncology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Evelyn Dancel
- Department of Nursing Services, University of Santo Tomas Hospital, Manila, Philippines
| | - Linda Antonio
- Department of Nursing Services, University of Santo Tomas Hospital, Manila, Philippines
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- Gynecologic Oncology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Teresa Sy Ortin
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Rodel Canlas
- The Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Psychology, College of Science, University of Santo Tomas, Manila, Philippines
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Sagae S, Toita T, Matsuura M, Saito M, Matsuda T, Sato N, Shimizu A, Endo T, Fujii M, Gaffney DK, Small W. Improvement in radiation techniques for locally advanced cervical cancer during the last two decades. Int J Gynecol Cancer 2023; 33:1295-1303. [PMID: 37041022 PMCID: PMC10423558 DOI: 10.1136/ijgc-2022-004230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 04/13/2023] Open
Abstract
Since the National Cancer Institute (NCI) alert of concurrent chemoradiotherapy, radiotherapy has been changed from external beam radiotherapy plus brachytherapy to platinum-based concurrent chemoradiotherapy. Therefore, concurrent chemoradiotherapy plus brachytherapy has become a standard treatment for locally advanced cervical cancer. Simultaneously, definitive radiotherapy has been changed gradually from external beam radiotherapy plus low-dose-rate intracavitary brachytherapy to external beam radiotherapy plus high-dose-rate intracavitary brachytherapy. Cervix cancer is uncommon in developed countries; hence, international collaborations have been critical in large-scale clinical trials. The Cervical Cancer Research Network (CCRN), created from the Gynecologic Cancer InterGroup (GCIG), has investigated various concurrent chemotherapy regimens and sequential methods of radiation and chemotherapy. Most recently, many clinical trials of combining immune checkpoint inhibitors with radiotherapy have been ongoing for sequential or concurrent settings. During the last decade, the method of standard radiation therapy has changed from three-dimensional conformal radiation therapy to intensity-modulated radiation therapy for external beam radiotherapy and from two-dimensional to three-dimensional image-guided approaches for brachytherapy. Recent improvements include stereotactic ablative body radiotherapy and MRI-guided linear accelerator (MRI-LINAC) using adaptive radiotherapy. Here we review the current progress of radiation therapy during the last two decades.
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Affiliation(s)
- Satoru Sagae
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Manabu Saito
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takuma Matsuda
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Nanaka Sato
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Ayumi Shimizu
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Toshiaki Endo
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Miho Fujii
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois, USA
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Ferioli M, Benini A, Malizia C, Forlani L, Medici F, Laghi V, Ma J, Galuppi A, Cilla S, Buwenge M, Macchia G, Zamagni C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Morganti AG, Arcelli A. Classical Prognostic Factors Predict Prognosis Better than Inflammatory Indices in Locally Advanced Cervical Cancer: Results of a Comprehensive Observational Study including Tumor-, Patient-, and Treatment-Related Data (ESTHER Study). J Pers Med 2023; 13:1229. [PMID: 37623479 PMCID: PMC10456032 DOI: 10.3390/jpm13081229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical cancer (LACC) including patient-, tumor-, and treatment-related potential prognostic factors. All patients underwent definitive chemoradiation and pretreatment values of several inflammatory indices (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, systemic immune inflammation index (SII), leukocyte/lymphocyte ratio, combination of platelet count and NLR, aspartate aminotransferase/platelet ratio index, aspartate aminotransferase/lymphocyte ratio index, systemic inflammatory response index, and aspartate transaminase/neutrophil ratio index) were calculated. Their correlation with local control (LC), distant metastasis-free (DMFS), disease-free (DFS), and overall survival (OS) was analyzed. One hundred and seventy-three patients were included. At multivariable analysis significant correlations were recorded among clinical outcomes and older age, advanced FIGO stage, lower hemoglobin levels, larger tumor size, and higher body mass index values. The multivariate analysis showed only the significant correlation between higher SII values and lower DMFS rates (p < 0.01). Our analysis showed no significant correlation between indices and DSF or OS. Further studies are needed to clarify the role of inflammation indices as candidates for inclusion in predictive models in this clinical setting.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
| | - Anna Benini
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Viola Laghi
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Johnny Ma
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy;
| | - Claudio Zamagni
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Luca Tagliaferri
- Gemelli ART (Advanced Radiation Therapy)—Interventional Oncology Center (IOC), Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy;
| | - Anna Myriam Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (A.B.); (L.F.); (F.M.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.G.M.); (A.A.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Kibret YM, Tigeneh W, Jemal A, Kantelhardt EJ. Implementation of Brachytherapy for Patients With Cervical Cancer in Ethiopia: A 3-Year Practice Report. JCO Glob Oncol 2023; 9:e2200407. [PMID: 37595167 PMCID: PMC10581656 DOI: 10.1200/go.22.00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Although cervical cancer is the second most commonly diagnosed cancer in Ethiopia, brachytherapy (BT) was not a component in patient treatment until 2015. The purpose of this study was to identify the patterns of utilization as well as to describe the practice of BT in Ethiopia. MATERIALS AND METHODS A retrospective descriptive data analysis of 138 patients with cervical cancer treated with a curative potential using BT from 2015 to 2018 at Tikur Anbassa Specialized Hospital, which housed the only BT facility in Ethiopia during the study period. RESULTS During the first 3-year period of BT service commencement, each year n = 37, n = 36, and n = 65 patients with cervical cancer were treated, respectively, with curative intention treatment. The median age of these 138 patients was 50 years (range, 22-75). All the patients were in International Federation of Gynecology and Obstetrics stage Ib-IIIb group, and stage IIb (66.4%) was the predominant. Majority (79%) of the patients were treated primarily with radiotherapy (RT), while 21% received RT after surgery. More than half of these patients (62%) received a total RT dose of 82 Gy in equivalent dose in 2 Gy fractions (EQD2), while the rest received a dose ranging from 76 to 86 Gy. Concurrent cisplatin with RT was given only for 36% of the patients for undocumented reasons. The overall treatment time including both external-beam RT and BT was greater than 8 weeks in 21% of the patients. CONCLUSION The utilization of BT service increased gradually and BT enabled the delivery of a higher RT dose to patients with cervical cancer (mostly stage IIB). However, there was protracted treatment duration and low concurrent chemotherapy utilization.
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Affiliation(s)
- Yitbarek M. Kibret
- Oncology Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Germany
| | | | - Ahmedin Jemal
- Surveillance and Health Service Research, American Cancer Society, Atlanta, GA
| | - Eva J. Kantelhardt
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Yan C, Ma Y, Li J, Chen X, Ma J. Identification of key immune cell-related genes involved in tumorigenesis and prognosis of cervical squamous cell carcinoma. Hum Vaccin Immunother 2023; 19:2254239. [PMID: 37799074 PMCID: PMC10561582 DOI: 10.1080/21645515.2023.2254239] [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: 02/19/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
The infiltration of immune cells can significantly affect the prognosis and immune therapy of patients with cervical squamous cell carcinoma (CSCC). This study aimed to explore key immune cell-related genes in the tumorigenesis and prognosis of CSCC. The module significantly related to immunity was screened by weighted gene co-expression network analysis (WGCNA) and ESTIMATE analysis, followed by correlation analysis with clinical traits. Key candidate genes were intersected with the protein-protein interaction (PPI) network genes for immune-related genes. The relationship between immune cell infiltration and key genes was analyzed. Tumor immune dysfunction and exclusion (TIDE) and immunophenoscore (IPS) predicted the response to immunotherapy in CSCC patients. Clinically, quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry were manipulated for analyzing the changes in mRNA and protein expression of key genes in cancer. Western blot was conducted to assess the correlation between key genes and immune infiltration. The brown module was notably associated with the immune microenvironment of CSCC, from which three immune-related key genes (TYROBP, CCL5, and HLA-DRA) were obtained. High expression of these genes was significantly positively associated with the infiltration abundance of T cells, B cells, and other immune cells. High expression levels of three key genes were confirmed in para-cancer tissue and correlated with the abundance of immune cells. The high-expression group of key genes was more sensitive to immunotherapy. We provide a theoretical basis for searching for potential targets for effective treatment and diagnosis of CSCC and provide new ideas for developing novel immunotherapy strategies.
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Affiliation(s)
- Chunxiao Yan
- School of Medicine, Department of Gynecology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanyan Ma
- School of Medicine, Department of Gynecology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Junyan Li
- School of Medicine, Department of Gynecology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xuejun Chen
- School of Medicine, Department of Gynecology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiong Ma
- School of Medicine, Department of Gynecology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Wang YN, Zhong ML, Liang MR, Yang JT, Zeng SY. The Therapeutic Value of Adjuvant Chemotherapy after Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer. Gynecol Obstet Invest 2023; 88:286-293. [PMID: 37497957 DOI: 10.1159/000533122] [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: 09/27/2022] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the therapeutic value and treatment-related complications of adjuvant chemotherapy after concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). DESIGN The medical records of LACC patients who underwent CCRT were reviewed retrospectively. METHODS A total of 1,138 patients with LACC who had been treated at our hospital between January 2013 and December 2017 were included in the study and classified into two groups: the CCRT group, comprising 726 patients who had received only CCRT, and the CCRT + adjuvant chemotherapy (ACT) group, comprising 412 patients who had received three cycles of adjuvant chemotherapy after CCRT. 39 patients in the CCRT group and 50 patients in the CCRT + ACT group had undergone lymphadenectomy, which revealed pathology-positive lymph nodes in 22 patients and 35 patients, respectively. Progression-free survival (PFS), overall survival (OS), and adverse events were compared. RESULTS The median follow-up time was 61 months (range: 2-96 months). No significant differences in PFS and OS were found between the two groups (p > 0.05), but more grade 3-4 acute hematologic toxicities were observed in the CCRT + ACT group than in the CCRT group (24.8% vs. 31.8%, p = 0.01). A subgroup analysis of patients with pathology-positive lymph nodes showed that the 5-year PFS and OS rates were 76.5% and 74.9%, respectively, for the CCRT + ACT group and 45.0% and 49.2%, respectively, for the CCRT group; the differences were statistically significant (p = 0.015 and 0.042, respectively). LIMITATIONS First, the sample size of the subgroup of patients with pathology-positive lymph nodes was too small for a confirmative conclusion. The heterogeneous population and the selection bias resulting from the retrospective design were the other flaws of our study. CONCLUSION The application of adjuvant chemotherapy after CCRT may be worth investigating further for women with LACC and pathology-positive lymph nodes, but this approach is associated with an increase in acute hematology toxicities.
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Affiliation(s)
- Ya-Nan Wang
- Graduate Department of the Medical College of Nanchang University, Nanchang, China
| | - Mei-Ling Zhong
- Oncology Department of Jiangxi Maternal and Child Health Care Hospital, Nanchang, China,
| | - Mei-Rong Liang
- Oncology Department of Jiangxi Maternal and Child Health Care Hospital, Nanchang, China
| | - Jian-Tong Yang
- Oncology Department of Jiangxi Maternal and Child Health Care Hospital, Nanchang, China
| | - Si-Yuan Zeng
- Graduate Department of the Medical College of Nanchang University, Nanchang, China
- Oncology Department of Jiangxi Maternal and Child Health Care Hospital, Nanchang, China
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Nanda R, Katke A, Thejaswini B, Giri GV, Pawar Y, Manjula MV, Babu G. Ten years survival results of randomized study comparing weekly vs. triweekly cisplatin with concurrent radiation in locally advanced carcinoma cervix. Rep Pract Oncol Radiother 2023; 28:322-331. [PMID: 37795405 PMCID: PMC10547408 DOI: 10.5603/rpor.a2023.0031] [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: 08/25/2022] [Accepted: 05/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background The current standard of treatment for locally advanced cervical cancer is concurrent chemo-radiation with improved overall survival (OS) by 6% with manageable toxicities. The cisplatin 40 mg/m2 given weekly is the widely practiced regimen for 4-6 cycles concurrently with irradiation. Materials and methods Two hundred and twelve patients with histologically proven squamous cell carcinoma of cervix with stages IIB to IIIB were enrolled between 2007-2011. External beam radiation dose of 45 Gy in 25 fractions was delivered over 5 weeks. Brachytherapy was delivered by manual afterloading cesium-137 (Cs137) low dose brachytherapy (LDR) using modified Fletcher suit intracavitary applicators to a total dose of 30 Gy to Point A or interstitial template to dose of 21 Gy/3 fractions with remote afterloading iridium-192 (Ir192) high dose brachytherapy (HDR). Patients were randomized to arm A receiving 40 mg/m2 of concurrent cisplatin weekly and arm B receiving 100 mg/m2 of concurrent cisplatin triweekly. Results One hundred and nine patients were randomized to weekly cisplatin and one hundred and three patients to triweekly cisplatin at the end of recruitment. At ten years, the OS was higher in the weekly arm (79.8%) compared to triweekly arm (70.9%). Disease free survival (DFS) was almost equal (76.1% and 73.8%) in the weekly and three-weekly arms. There is definite significance in overall DFS with patients receiving the cumulative cisplatin doses of more than 250 mg (p = 0.028). The patients with more than 45 years of age had better overall survival (OS) (79%) with statistical significance 31 (p = 0.020). Conclusion Both cisplatin based triweekly and weekly concurrent chemotherapy are equally effective in terms of OS and DFS.
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Affiliation(s)
- R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Yashwant Pawar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - M V Manjula
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Govind Babu
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Li J, Feng X, Zhu C, Jiang Y, Liu H, Feng W, Lu H. Intact glycopeptides identified by LC-MS/MS as biomarkers for response to chemotherapy of locally advanced cervical cancer. Front Oncol 2023; 13:1149599. [PMID: 37519786 PMCID: PMC10373866 DOI: 10.3389/fonc.2023.1149599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Objective For locally advanced cervical cancer (LACC), patients who respond to chemotherapy have a potential survival advantage compared to nonresponsive patients. Thus, it is necessary to explore specific biological markers for the efficacy of chemotherapy, which is beneficial to personalized treatment. Methods In the present study, we performed a comprehensive screening of site-specific N-glycopeptides in serum glycoproteins to identify glycopeptide markers for predicting the efficacy of chemotherapy, which is beneficial to personalized treatment. In total, 20 serum samples before and after neoadjuvant chemotherapy (NACT) from 10 LACC patients (NACT response, n=6) and NACT nonresponse, n=4) cases) were analyzed using LC-MS/MS, and 20 sets of mass spectrometry (MS) data were collected using liquid chromatography coupled with high-energy collisional dissociation tandem MS (LC-HCD-MS/MS) for quantitative analysis on the novel software platform, Byos. We also identified differential glycopeptides before and after chemotherapy in chemo-sensitive and chemo-resistant patients. Results In the present study, a total of 148 glycoproteins, 496 glycosylation sites and 2279 complete glycopeptides were identified in serum samples of LACC patients. Before and after chemotherapy, there were 13 differentially expressed glycoproteins, 654 differentially expressed glycopeptides and 93 differentially expressed glycosites in the NACT responsive group, whereas there were 18 differentially expressed glycoproteins, 569 differentially expressed glycopeptides and 99 differentially expressed glycosites in the NACT nonresponsive group. After quantitative analysis, 6 of 570 glycopeptides were identified as biomarkers for predicting the sensitivity of neoadjuvant chemotherapy in LACC. The corresponding glycopeptides included MASP1, LUM, ATRN, CO8A, CO8B and CO6. The relative abundances of the six glycopeptides, including MASP1, LUM, ATRN, CO8A, CO8B and CO6, were significantly higher in the NACT-responsive group and were significantly decreased after chemotherapy. High levels of these six glycopeptides may indicate that chemotherapy is effective. Thus, these glycopeptides are expected to serve as biomarkers for predicting the efficacy of neoadjuvant chemotherapy in locally advanced cervical cancer. Conclusion The present study revealed that the N-glycopeptide of MASP1, LUM, ATRN, CO8A, CO8B and CO6 may be potential biomarkers for predicting the efficacy of chemotherapy for cervical cancer.
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Affiliation(s)
- Jing Li
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoxiao Feng
- Department of Chemistry and NHC Key Laboratory of Glycoconjugates Research, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Chongying Zhu
- Department of Laboratory of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yahui Jiang
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hua Liu
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Feng
- Department of Obstetrics and Gynecology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haojie Lu
- Department of Chemistry and NHC Key Laboratory of Glycoconjugates Research, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
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Cheon W, Han M, Jeong S, Oh ES, Lee SU, Lee SB, Shin D, Lim YK, Jeong JH, Kim H, Kim JY. Feature Importance Analysis of a Deep Learning Model for Predicting Late Bladder Toxicity Occurrence in Uterine Cervical Cancer Patients. Cancers (Basel) 2023; 15:3463. [PMID: 37444573 DOI: 10.3390/cancers15133463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
(1) In this study, we developed a deep learning (DL) model that can be used to predict late bladder toxicity. (2) We collected data obtained from 281 uterine cervical cancer patients who underwent definitive radiation therapy. The DL model was trained using 16 features, including patient, tumor, treatment, and dose parameters, and its performance was compared with that of a multivariable logistic regression model using the following metrics: accuracy, prediction, recall, F1-score, and area under the receiver operating characteristic curve (AUROC). In addition, permutation feature importance was calculated to interpret the DL model for each feature, and the lightweight DL model was designed to focus on the top five important features. (3) The DL model outperformed the multivariable logistic regression model on our dataset. It achieved an F1-score of 0.76 and an AUROC of 0.81, while the corresponding values for the multivariable logistic regression were 0.14 and 0.43, respectively. The DL model identified the doses for the most exposed 2 cc volume of the bladder (BD2cc) as the most important feature, followed by BD5cc and the ICRU bladder point. In the case of the lightweight DL model, the F-score and AUROC were 0.90 and 0.91, respectively. (4) The DL models exhibited superior performance in predicting late bladder toxicity compared with the statistical method. Through the interpretation of the model, it further emphasized its potential for improving patient outcomes and minimizing treatment-related complications with a high level of reliability.
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Affiliation(s)
- Wonjoong Cheon
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Seonghoon Jeong
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Eun Sang Oh
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Sung Uk Lee
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Se Byeong Lee
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Dongho Shin
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Jong Hwi Jeong
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Haksoo Kim
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Joo Young Kim
- Proton Therapy Center, National Cancer Center, Goyang-si 10408, Republic of Korea
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Okonogi N, Murata K, Yamada S, Habu Y, Hori M, Kurokawa T, Inaba Y, Fujiwara T, Fujii Y, Hanawa M, Kawasaki Y, Hattori Y, Suzuki K, Tsuyuki K, Wakatsuki M, Koto M, Hasegawa S, Ishikawa H, Hanaoka H, Shozu M, Tsuji H, Usui H. A Phase Ib Study of Durvalumab (MEDI4736) in Combination with Carbon-Ion Radiotherapy and Weekly Cisplatin for Patients with Locally Advanced Cervical Cancer (DECISION Study): The Early Safety and Efficacy Results. Int J Mol Sci 2023; 24:10565. [PMID: 37445743 DOI: 10.3390/ijms241310565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
We conducted a phase Ib study to examine the safety of a combination of carbon-ion RT (CIRT) with durvalumab (MEDI4736; AstraZeneca) in patients with locally advanced cervical cancer. This was an open-label, single-arm study with a modified 3 + 3 design. Patients with newly diagnosed histologically proven locally advanced cervical cancer were enrolled. All patients received 74.4 Gy of CIRT in 20 fractions and concurrent weekly cisplatin (chemo-CIRT) at a dose of 40 mg/m2. Durvalumab was administered (1500 mg/body) at weeks two and six. The primary endpoint was the incidence of adverse events (AEs) and serious AEs (SAEs), including dose-limiting toxicity (DLT). All three enrolled patients completed the treatment without interruption. One patient developed hypothyroidism after treatment and was determined to be an SAE. No other SAEs were observed. The patient recovered after levothyroxine sodium hydrate treatment. None of the AEs, including hypothyroidism, were associated with DLT in the present study. All three patients achieved complete responses within the CIRT region concerning treatment efficacy. This phase 1b trial demonstrates the safety of combining chemo-CIRT and durvalumab for locally advanced cervical cancer in the early phase. Further research is required as only three patients were included in this study.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yuji Habu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-Ku, Tokyo 150-0012, Japan
| | - Yoko Hattori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Kazuko Suzuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kyoko Tsuyuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Sumitaka Hasegawa
- Department of Charged Particle Therapy Research, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Krishna A, Sathya M, Mukesh S, Athiyamaan MS, Banerjee S, Sunny J, Srinivas C, Lobo D, Makkapatti BS, Jawahar V. Efficacy and safety of EGFR inhibitor gefitinib in recurrent or metastatic cervical cancer: a preliminary report. Med Oncol 2023; 40:203. [PMID: 37310466 DOI: 10.1007/s12032-023-02070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
There has been growing interest in the use of epidermal growth factor receptor inhibitors in various cancers. The study was conducted to evaluate the efficacy and safety of gefitinib as a monotherapy in patients with recurrent or metastatic cervical cancer. Patients with cervical carcinoma who experienced locoregional recurrence or distant metastases either at presentation or after definitive combined chemoradiotherapy or postoperative radiotherapy were enrolled. Gefitinib was administered orally at a dose of 250 mg/d to eligible patients. Treatment with Gefitinib was continued until disease progression, intolerable adverse effects were developed, or consent was withdrawn. Clinical and radiological investigations were used to verify the disease response. Toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. The study enrolled 32 patients who met the eligibility criteria. Thirty patients were available for the analysis. The majority of the patients included in the analysis had FIGO stage IIIB disease at their initial presentation. The median follow-up time was 6 months (3-15 months). Two patients (7%) had a complete clinical response, 7 patients (23%) had a partial response, 5 patients (17%) showed a stable disease and 16 patients had progressive disease (53%). The disease control rate was 47%. The median PFS was noted to be 4.5 months and the 1-year PFS was 20%. None of the individuals experienced toxicity of grade 3 or higher. All toxicities were managed conservatively. The study suggests that gefitinib may be a promising therapeutic option for patients with advanced cervical cancer who have limited treatment alternatives.
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Affiliation(s)
- Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India.
| | - M Sathya
- Department of Radiation Oncology, Mysore Medical College and Research Institute, Mysore, India
| | - S Mukesh
- Department of Radiation Oncology, Mysore Medical College and Research Institute, Mysore, India
| | - M S Athiyamaan
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | - Sourjya Banerjee
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | | | - Dilson Lobo
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
| | | | - Vaishak Jawahar
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, India
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Wang X, Cao C, Tan X, Liao X, Du X, Wang X, Liu T, Gong D, Hu Z, Tian X. SETD8, a frequently mutated gene in cervical cancer, enhances cisplatin sensitivity by impairing DNA repair. Cell Biosci 2023; 13:107. [PMID: 37308924 DOI: 10.1186/s13578-023-01054-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/17/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Cisplatin is commonly used to treat cervical cancer while drug resistance limits its effectiveness. There is an urgent need to identify strategies that increase cisplatin sensitivity and improve the outcomes of chemotherapy. RESULTS We performed whole exome sequencing (WES) of 156 cervical cancer tissues to assess genomic features related to platinum-based chemoresistance. By using WES, we identified a frequently mutated locus SETD8 (7%), which was associated with drug sensitivity. Cell functional assays, in vivo xenografts tumor growth experiments, and survival analysis were used to investigate the functional significance and mechanism of chemosensitization after SETD8 downregulation. Knockdown of SETD8 increased the responsiveness of cervical cancer cells to cisplatin treatment. The mechanism is exerted by reduced binding of 53BP1 to DNA breaks and inhibition of the non-homologous end joining (NHEJ) repair pathway. In addition, SETD8 expression was positively correlated with resistance to cisplatin and negatively associated with the prognosis of cervical cancer patients. Further, UNC0379 as a small molecule inhibitor of SETD8 was found to enhance cisplatin sensitivity both in vitro and in vivo. CONCLUSIONS SETD8 was a promising therapeutic target to ameliorate cisplatin resistance and improve the efficacy of chemotherapy.
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Affiliation(s)
- Xin Wang
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Chen Cao
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
| | - Xiangyu Tan
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xueyao Liao
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
| | - Xiaofang Du
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
| | - Xueqian Wang
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ting Liu
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
| | - Danni Gong
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China
| | - Zheng Hu
- Department of Gynecologic Oncology, Women and Children's Hospital Affiliated to Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
| | - Xun Tian
- Department of Obstetrics and Gynecology, Academician Expert Workstation, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430014, China.
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Lin LL, Msadabwe SC, Chiao E. Improving Access to Radiation Therapy Globally To Meet World Health Organization Goals To Eliminate Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 116:459-462. [PMID: 37179093 PMCID: PMC10172026 DOI: 10.1016/j.ijrobp.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Lilie L Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas.
| | | | - Elizabeth Chiao
- Departments of Epidemiology and General Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
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Lin LL, Ndlovu N, Lowenstein J, Wirth M, Lee J, Stier EA, Garg M, Kotzen J, Kadzatsa W, Palefsky J, Krown SE, Einstein MH. Quality Assurance in Clinical Trials Requiring Radiation Therapy in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 116:439-447. [PMID: 36493958 PMCID: PMC10360026 DOI: 10.1016/j.ijrobp.2022.11.042] [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: 08/21/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Given the increasing availability of radiation therapy in sub-Saharan Africa, clinical trials that include radiation therapy are likely to grow. Ensuring appropriate delivery of radiation therapy through rigorous quality assurance is an important component of clinical trial execution. We reviewed the process for credentialing radiation therapy sites and radiation therapy quality assurance through the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center for AIDS Malignancy Consortium (AMC)-081, a multicenter study of cisplatin and radiation therapy for women with locally advanced cervical cancer living with HIV, conducted by the AIDS Malignancy Consortium at 2 sites in South Africa and Zimbabwe. METHODS AND MATERIALS Women living with HIV with newly diagnosed stage IB2, IIA (>4 cm), IIB-IVA cervical carcinoma (per the 2009 International Federation of Gynecology and Obstetrics [FIGO] staging classifications) were enrolled in AMC-081. They received 3-dimensional conformal external beam radiation therapy (EBRT) to the pelvis (41.4-45 Gy) using a linear accelerator, high-dose-rate brachytherapy (6-9 Gy to point A with each fraction and up to 4 fractions), and concurrent weekly cisplatin (40 mg/m2). IROC reviewed EBRT and brachytherapy quality assurance records after treatment. RESULTS All of the 38 women enrolled in AMC-081 received ±5% of the protocol-specified prescribed dose of EBRT. Geometry of brachytherapy applicator placement was scored as per protocol in all implants. Doses to points A and B, International Commission on Radiation Units and Measurements (ICRU) bladder, or ICRU rectum required correction by IROC in >50% of the implants. In the final evaluation, 58% of participants (n = 22) were treated per protocol, 40% (n = 15) had minor protocol deviations, and 3% (n = 1) had major protocol deviations. No records were received within 60 days of treatment completion as requested in the protocol. CONCLUSIONS Major radiation therapy deviations were low, but timely submission of radiation therapy data did not occur. Future studies, especially those that include specialized radiation therapy techniques such as stereotactic or intensity-modulated radiation therapy, will require pathways to ensure timely and adequate quality assurance.
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Affiliation(s)
- Lilie L Lin
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | - Ntokozo Ndlovu
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jessica Lowenstein
- Department of Radiation Physics and the Imaging and Radiation Oncology Core, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | | | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, New York, New York
| | - Jeffrey Kotzen
- Department of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Webster Kadzatsa
- Department of Radiotherapy and Oncology, College of Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Joel Palefsky
- Department of Medicine, University of California, San Francisco, California
| | - Susan E Krown
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Women's Health, Rutgers New Jersey Medical School, Newark, New Jersey
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Mileshkin LR, Moore KN, Barnes EH, Gebski V, Narayan K, King MT, Bradshaw N, Lee YC, Diamante K, Fyles AW, Small W, Gaffney DK, Khaw P, Brooks S, Thompson JS, Huh WK, Mathews CA, Buck M, Suder A, Lad TE, Barani IJ, Holschneider CH, Van Dyk S, Quinn M, Rischin D, Monk BJ, Stockler MR. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:468-482. [PMID: 37080223 PMCID: PMC11075114 DOI: 10.1016/s1470-2045(23)00147-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is chemoradiotherapy, but many patients relapse and die of metastatic disease. We aimed to determine the effects on survival of adjuvant chemotherapy after chemoradiotherapy. METHODS The OUTBACK trial was a multicentre, open-label, randomised, phase 3 trial done in 157 hospitals in Australia, China, Canada, New Zealand, Saudi Arabia, Singapore, and the USA. Eligible participants were aged 18 year or older with histologically confirmed squamous cell carcinoma, adenosquamous cell carcinoma, or adenocarcinoma of the cervix (FIGO 2008 stage IB1 disease with nodal involvement, or stage IB2, II, IIIB, or IVA disease), Eastern Cooperative Oncology Group performance status 0-2, and adequate bone marrow and organ function. Participants were randomly assigned centrally (1:1) using a minimisation approach and stratified by pelvic or common iliac nodal involvement, requirement for extended-field radiotherapy, FIGO 2008 stage, age, and site to receive standard cisplatin-based chemoradiotherapy (40 mg/m2 cisplatin intravenously once-a-week for 5 weeks, during radiotherapy with 45·0-50·4 Gy external beam radiotherapy delivered in fractions of 1·8 Gy to the whole pelvis plus brachytherapy; chemoradiotherapy only group) or standard cisplatin-based chemoradiotherapy followed by adjuvant chemotherapy with four cycles of carboplatin (area under the receiver operator curve 5) and paclitaxel (155 mg/m2) given intravenously on day 1 of a 21 day cycle (adjuvant chemotherapy group). The primary endpoint was overall survival at 5 years, analysed in the intention-to-treat population (ie, all eligible patients who were randomly assigned). Safety was assessed in all patients in the chemoradiotherapy only group who started chemoradiotherapy and all patients in the adjuvant chemotherapy group who received at least one dose of adjuvant chemotherapy. The OUTBACK trial is registered with ClinicalTrials.gov, NCT01414608, and the Australia New Zealand Clinical Trial Registry, ACTRN12610000732088. FINDINGS Between April 15, 2011, and June 26, 2017, 926 patients were enrolled and randomly assigned to the chemoradiotherapy only group (n=461) or the adjuvant chemotherapy group (n=465), of whom 919 were eligible (456 in the chemoradiotherapy only group and 463 in the adjuvant chemotherapy group; median age 46 years [IQR 37 to 55]; 663 [72%] were White, 121 [13%] were Black or African American, 53 [6%] were Asian, 24 [3%] were Aboriginal or Pacific islander, and 57 [6%] were other races) and included in the analysis. As of data cutoff (April 12, 2021), median follow-up was 60 months (IQR 45 to 65). 5-year overall survival was 72% (95% CI 67 to 76) in the adjuvant chemotherapy group (105 deaths) and 71% (66 to 75) in the chemoradiotherapy only group (116 deaths; difference 1% [95% CI -6 to 7]; hazard ratio 0·90 [95% CI 0·70 to 1·17]; p=0·81). In the safety population, the most common clinically significant grade 3-4 adverse events were decreased neutrophils (71 [20%] in the adjuvant chemotherapy group vs 34 [8%] in the chemoradiotherapy only group), and anaemia (66 [18%] vs 34 [8%]). Serious adverse events occurred in 107 (30%) in the adjuvant chemotherapy group versus 98 (22%) in the chemoradiotherapy only group, most commonly due to infectious complications. There were no treatment-related deaths. INTERPRETATION Adjuvant carboplatin and paclitaxel chemotherapy given after standard cisplatin-based chemoradiotherapy for unselected locally advanced cervical cancer increased short-term toxicity and did not improve overall survival; therefore, it should not be given in this setting. FUNDING National Health and Medical Research Council and National Cancer Institute.
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Affiliation(s)
- Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Elizabeth H Barnes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kailash Narayan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Nathan Bradshaw
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Yeh Chen Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrina Diamante
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony W Fyles
- National Cancer Institute of Canada Clinical Trial Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Pearly Khaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Susan Brooks
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
| | - J Spencer Thompson
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cara A Mathews
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Martin Buck
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Aneta Suder
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Thomas E Lad
- Division of Hematology-Oncology, Cook County Hospital, Chicago, IL, USA
| | - Igor J Barani
- Department of Radiation Oncology, St Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | | | - Sylvia Van Dyk
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Michael Quinn
- Oncology Unit, Royal Women's Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Bradley J Monk
- Division of Gynecologic Oncology, HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Ma X, Fang J, Zhang L, Huang Y, Shen H, Ma X, Zhang S, Zhang B. Efficacy and safety of adjuvant chemotherapy for locally advanced cervical cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2023; 184:103953. [PMID: 36889613 DOI: 10.1016/j.critrevonc.2023.103953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Locally advanced cervical cancer (LACC) is generally treated using concurrent chemo-radiotherapy (CCRT); yet, the effectiveness of adjuvant chemotherapy (ACT) following CCRT remains controversial. METHODS The databases Embase, Web of Science, and PubMed were analyzed for relevant research. Primary endpoints included overall survival (OS) and progression-free survival (PFS). RESULTS Fifteen trials with 4041 patients were included. Pooled HRs for PFS and OS were 0.81 (95 % CI: 0.67-0.96) and 0.69 (95 % CI: 0.51-0.93), respectively. However, subgroup analyses indicated that in randomized trials and trials with larger sample sizes (n > 100) as well as ACT cycles ≤ 3, ACT was not linked with improved PFS and OS. Moreover, ACT induced a greater rate of hematologic toxicities (P < 0.05). CONCLUSION Higher quality of evidence suggests that ACT could not yield additional survival benefits for LACC; however, identifying high-risk patients who may benefit from ACT is required to design further clinical trials and better inform treatment decisions.
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Affiliation(s)
- Xiao Ma
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jin Fang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yao Huang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hui Shen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaohua Ma
- Department of Medical Ultrasonics, Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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Gultekin M, Beduk Esen CS, Ates Ozdemir D, Yildirim S, Yuce D, Usubutun A, Yildiz F. Stromal or intraepithelial tumor-infiltrating lymphocytes: which one has more prognostic significance in cervical cancer? Arch Gynecol Obstet 2023; 307:969-980. [PMID: 35840843 DOI: 10.1007/s00404-022-06687-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the effect of tumor-infiltrating lymphocytes (TILs) and tumor associated macrophages (TAMs) on treatment results in patients with cervical squamous cell carcinoma who underwent definitive or adjuvant radiotherapy (RT) or chemoradiotherapy (CRT). METHODS Pathological specimens were evaluated from 96 cervical cancer patients who were treated with definitive or adjuvant RT/CRT between April 2001 and January 2020. The percentage of intraepithelial TILs (iTILs) and stromal TILs (sTILs) were calculated, and immunohistochemistry was used for identifying lymphocyte lineage with CD4, CD8, and CD20 antibodies and macrophages with CD68 antibody. Prognostic values of TILs/TAMs on oncological outcomes were evaluated. RESULTS Thirty patients had early-stage disease and 66 patients had advanced-stage disease. Sixty-three and 33 patients received adjuvant RT and definitive CRT, respectively. Low number of sCD20 positive cells was associated with large tumor size and parametrial invasion. In multivariate analysis, low percentage of sTILs and advanced-stage disease were independent poor prognostic factors for overall survival, disease-free survival (DFS), and distant metastasis-free survival; low number of sCD4 positive cells was also an independent poor prognostic factor for DFS. Low percentage of sTILs and low number of sCD8 positive cells was correlated with high rates of distant metastasis (p = 0.038 and p = 0.025, respectively). CONCLUSION sTILs have superior predictive value than iTILs in terms of prognosis. Stromal compartment should be investigated as a routine practice in TIL studies in cervical cancer. Intensifying the treatment in cervical cancer patients with low number of sTILs should be studied in further investigations.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Deniz Ates Ozdemir
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selma Yildirim
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Yuce
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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48
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Someya M, Hasegawa T, Tsuchiya T, Kitagawa M, Fukushima Y, Gocho T, Mafune S, Ikeuchi Y, Kozuka Y, Idogawa M, Hirohashi Y, Torigoe T, Iwasaki M, Matsuura M, Saito T, Sakata KI. Predictive value of an exosomal microRNA-based signature for tumor immunity in cervical cancer patients treated with chemoradiotherapy. Med Mol Morphol 2023; 56:38-45. [PMID: 36367588 DOI: 10.1007/s00795-022-00338-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
Resistance of cervical cancer to radiotherapy with concurrent chemotherapy (CCRT) results in a poor prognosis. To identify new biomarkers for predicting the treatment response and prognosis, we explored exosomal microRNA (miRNA) expression signatures associated with the outcome of cervical cancer patients treated with CCRT. Exosomes were isolated from the plasma of 45 patients prior to CCRT during 2014-2020, and miRNA analysis was performed by next-generation sequencing. At a median follow-up of 38 months, 26 patients were recurrence free, 15 patients had died of the disease, and 4 patients received salvage chemotherapy due to distant metastasis. Of the 2522 miRNAs detected, 9 (miR-148a-5p, 1915-3p, 3960, 183-5p, 196b-5p, 200c-3p, 182-5p, 374a-5p, and 431-5p) showed differential expression between the recurrence-free and recurrence groups. Patients were divided into high- and low-risk groups according to the cutoff of the miRNAs-based risk score calculated from respective expression levels. The high-risk group had significantly worse disease-specific survival than the low-risk group (p < 0.001). In addition, miR-374a-5p and miR-431-5p expression showed a weak inverse correlation with tumor-infiltrating CD8+ and FOXP3+ T cells, suggesting a potential inhibitory effect on CCRT by suppressing tumor immunity. This miRNA signature could improve non-invasive monitoring and personalized treatment for cervical cancer.
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Affiliation(s)
- Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan.
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yuki Fukushima
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Shoh Mafune
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yutaro Ikeuchi
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoh Kozuka
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Masashi Idogawa
- Department of Medical Genome Sciences, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
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49
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Markus M, Sartor H, Bjurberg M, Trägårdh E. Metabolic parameters of [ 18F]FDG PET-CT before and after radiotherapy may predict survival and recurrence in cervical cancer. Acta Oncol 2023; 62:180-188. [PMID: 36815676 DOI: 10.1080/0284186x.2023.2181100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common female malignancy. [18F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is routinely performed in patients with locally advanced cervical cancer for staging and treatment response evaluation. With this retrospective, observational cohort study, we wanted to investigate the prognostic value of the maximum standardised uptake value (SUVmax) and the volumetric parameters of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) before and after treatment in women with cervical cancer, with overall survival (OS) and recurrence as outcome measures. METHODS Women with cervical cancer referred for curative radiotherapy and who underwent two PET-CT scans (before treatment and approximately 7 months post-treatment) were included. SUVmax, MTV and TLG were measured at baseline and post-treatment on the primary tumour, pelvic and distant lymph node metastases, distant organ metastases, and on total tumour burden. The PET parameters were associated with OS by Cox regression and recurrence by multivariable logistic regression. Kaplan-Meier curves and C-index were used to visualise the prognostic potential of the different measures. RESULTS A total of 133 patients were included. At the primary tumour level and on total tumour burden, age- and clinical-stage adjusted analyses showed a significant association between PET parameters and OS and recurrence when measured post-treatment. At baseline (pre-treatment), MTV and TLG were associated with OS and recurrence, whereas SUVmax was not. C-index from adjusted Cox models on total tumour burden showed higher values for the post-treatment PET compared to baseline. Kaplan-Meier curves demonstrated a greater prognostic potential for MTV and TLG compared to SUVmax, both at baseline and post-treatment. CONCLUSIONS The FDG PET-CT-derived parameters SUVmax, MTV, and TLG measured post-treatment can predict OS and recurrence in cervical cancer. Parameters measured before treatment had overall lower prognostic potential, and only MTV and TLG showed significant association to OS and recurrence.
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Affiliation(s)
- Maria Markus
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Hanna Sartor
- Diagnostic Radiology, Department of Translational Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology and radiation Physics, Skåne University Hospital.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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50
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Popat PB, Maheshwari A, Manchanda S, Renganathan R, Sen S, Dhamija E, Thakur M, Deodhar K, Chopra S, Kanteti APK, Ghosh J, Shah S, Sable N, Baheti A, Chauhan S, Gala K, Kulkarni S. Imaging Recommendations for Diagnosis, Staging, and Management of Cervical Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractCervical cancer is the fourth most common cancer in women globally and the second most common cancer in Indian women, more common in lower socioeconomic strata. Improvement in survival and decrease in morbidity reflect the earlier detection with screening and imaging, as well as multifactorial multimodality therapy integrating surgery, and concurrent chemoradiation therapy providing superior therapeutic benefits. Imaging plays a vital role in assessing the extent of disease and staging of cervical cancer. The appropriateness criteria of a modality are different from its availability based on infrastructure, medical facilities, and resource status. Although in an ideal situation, magnetic resonance imaging (MRI) would be of greatest value in locoregional assessment of extent of disease and fluorodeoxyglucose positron emission tomography-computed tomography for distant staging; often, an ultrasonography, chest radiograph, and bone scans are utilized, with contrast-enhanced computed tomography representing a fair superior diagnostic accuracy, and can be reported as per the RECIST 1.1 criteria. MRI is also of good utility in the assessment of residual disease, predicting response and detecting small volume recurrence. MRI offers the highest diagnostic accuracy in determining parametrial invasion and hence surgical planning; so also, MRI-guided radiation planning helps in more accurate graded radiation dose planning in radiation therapy. Stage and therapy-based surveillance imaging should be encouraged and recommended.
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Affiliation(s)
- Palak Bhavesh Popat
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Division of Gynaecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rupa Renganathan
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Centre, Kolkata, West Bengal, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, IRCH, AIIMS, New Delhi, India
| | - Meenakshi Thakur
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aditya Pavan Kumar Kanteti
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay Baheti
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Radiology, H. N. Reliance Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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