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Carvalho HDA, Mauro GP. History of radiotherapy in the treatment of uterine cervix cancer: an overview. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S126. [PMID: 37556645 PMCID: PMC10411717 DOI: 10.1590/1806-9282.2023s126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/17/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Heloisa de Andrade Carvalho
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Radiologia e Oncologia, Serviço de Radioterapia – São Paulo (SP), Brazil
| | - Geovanne Pedro Mauro
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Radiologia e Oncologia, Serviço de Radioterapia – São Paulo (SP), Brazil
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Sapienza LG, Thomas JJ, Echeverria AE, Sharma S, Hamstra DA, Hall TR, Ludwig MS. Predictors of follow-up non-compliance after definitive radiotherapy for locally advanced cervical cancer at a community cancer center. Gynecol Oncol Rep 2022; 44:101091. [PMID: 36325116 PMCID: PMC9618769 DOI: 10.1016/j.gore.2022.101091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/15/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Non-compliance to post-treatment cancer surveillance can lead to late detection of recurrence. This study aims to identify patients at high risk for loss of follow-up after radiotherapy for locally advanced cervical cancer. Methods Consecutive patients with locally advanced cervical cancer treated with definitive chemoradiotherapy (2013-2020) at a community cancer center were retrospectively reviewed. The main outcome was overall follow-up compliance rate over time. Additionally, specialist-specific follow-up times, reasons for discontinuation and predictors of loss of follow-up events were evaluated. Results The median age of the 154 patients included was 46.5 years (range: 26-84). The 6-month, 1-, 3-, and 5-year overall loss of follow-up rates were: 5.3%, 15.3%, 33.6%, and 48.2%, respectively. After a median overall follow-up time of 21.0 months, the median specialist-specific surveillance times were 17 months and 6 months with gynecologic and radiation oncologists, respectively (p < 0.01). Overall, the most common reasons for loss of follow-up were financial (21.7%) and relocation to another city (28.3%). By specialty, the most common reasons were relocation of care (56.5%, gynecologic oncologist) and disease progression (31.3%, radiation oncologist). In the multivariable analysis, older age (continuous, OR: 0.96; p < 0.01) and Hispanic ethnicity (OR: 0.39; p < 0.01) were protective against loss of follow-up, while increased number of gestations (continuous, OR: 1.23, p = 0.01) and living farther from the cancer center (continuous, OR: 1.002; p = 0.03) increased the chance of loss of follow-up. Conclusion Younger, non-Hispanic, multiparous women that live far from the community cancer center have an increased chance of follow-up discontinuity, which are attributed to financial reasons in more than 20% of the cases.
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Affiliation(s)
- Lucas G. Sapienza
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA,Corresponding author at: Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
| | - Justin J. Thomas
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA
| | - Alfredo E. Echeverria
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA
| | - Shelly Sharma
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA
| | - Daniel A. Hamstra
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA
| | - Tracilyn R. Hall
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Michelle S. Ludwig
- Department of Radiation Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA,Department of Radiation Oncology, Smith Clinic – J. Evans and Mary P. Attwell Radiation Therapy Center – Harris Health System, Baylor College of Medicine, Houston, TX, USA
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Franco I, Viswanathan AN. Radiation oncology management of stage III and IVA cervical carcinoma. Int J Gynecol Cancer 2022; 32:231-238. [PMID: 35256408 PMCID: PMC9899098 DOI: 10.1136/ijgc-2021-002491] [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: 09/03/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Worldwide, stage III-IVA carcinomas of the uterine cervix comprise a significant proportion of cases at presentation, and have a higher rate of recurrence and worse overall survival. This review will discuss the epidemiology, prevention strategies, clinical presentation, and treatment recommendations for stage III-IVA cervical cancer. The focus will be on the role of radiation therapy, concurrent chemoradiotherapy, and brachytherapy, including the potential benefits and anticipated toxicities. The unique challenges and considerations of fistula formation and approaches to management will be highlighted, and follow-up care and future directions discussed. As low and middle income countries bear the highest burden of advanced stage carcinoma of the uterine cervix, this review will address the unique needs of global communities.
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Affiliation(s)
- Idalid Franco
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kurosu H, Todo Y, Yamada R, Minowa K, Tsuruta T, Minobe S, Nishiyama N, Kato H. Clinical relevance of addition of conventional treatment to concurrent chemoradiotherapy in patients with FIGO stage III-IV cervical cancer: a retrospective analysis of a Japanese cohort. Jpn J Clin Oncol 2021; 52:244-250. [PMID: 34891157 DOI: 10.1093/jjco/hyab191] [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: 06/25/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy has limited therapeutic efficacy for stage III-IV cervical cancer. We aimed to identify a subgroup of patients with stage III-IV cervical cancer who benefit from concurrent chemoradiotherapy with additional treatment. METHODS We retrospectively reviewed 120 patients with stage III-IV cervical cancer who were treated with concurrent chemoradiotherapy from 2002 to 2018. We compared overall survival between patients treated with concurrent chemoradiotherapy alone and those who received concurrent chemoradiotherapy with additional conventional treatments (systemic chemotherapy before and/or after concurrent chemoradiotherapy and/or extended-field radiation). Prognostic factors were statistically analysed. RESULTS Overall, 44 (36.7%) and 21 (17.5%) patients were radiologically diagnosed with pelvic and para-aortic lymph node enlargement, respectively. The median tumour diameter was 5.7 cm. A total of 69 (57.5%) patients received no additional treatment, and 51 (42.5%) received additional treatment. Cox regression analysis identified the following prognostic factors: histological non-squamous cell carcinoma (hazard ratio, 3.9; 95% confidence interval, 1.8-8.2), tumour diameter of ≥6 cm (hazard ratio, 2.1; 95% confidence interval, 1.2-3.7), radiological pelvic lymph node enlargement (hazard ratio, 2.1; 95% confidence interval, 1.1-4.0) and radiological para-aortic lymph node enlargement (hazard ratio, 2.1; 95% confidence interval, 1.1-4.1). Even in the lowest risk group (no risk factors), the 5-year overall survival rate was lower in the additional treatment group than in the concurrent chemoradiotherapy alone group (78.7% vs. 80.9%, respectively; log-rank test, P = 0.79). CONCLUSIONS Addition of conventional treatments to concurrent chemoradiotherapy might not improve survival in patients with advanced cervical cancer. Novel treatment strategies including immune checkpoint inhibitors should be considered for such patients.
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Affiliation(s)
- Hiroyuki Kurosu
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Ryutaro Yamada
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Kaoru Minowa
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Tomohiko Tsuruta
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Shinichiro Minobe
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Noriaki Nishiyama
- Division of Radiation Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
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Grover S, Ning MS, Bale M, Lichter KE, Shah S, Bvochora-Nsingo M, Chiyapo S, Balang D, McGinnis GJ, Ralefala T, Moloi T, Luckett R, Ramogola-Masire D, Robertson ES, Zetola NM. Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus. Int J Gynecol Cancer 2021; 31:1220-1227. [PMID: 34312220 DOI: 10.1136/ijgc-2021-002601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status. METHODS Between February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan-Meier method. Cox proportional hazards modeling was used to analyze associations with survival. RESULTS Among 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01). CONCLUSIONS Addition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.
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Affiliation(s)
- Surbhi Grover
- Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Oncology, University of Botswana, Gaborone, Botswana
| | - Matthew S Ning
- Radiation Oncology, University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, USA
| | - Michelle Bale
- Radiation Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie E Lichter
- Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Sidrah Shah
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sebathu Chiyapo
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Dawn Balang
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Gwendolyn J McGinnis
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Thabo Moloi
- Princess Marina Hospital, Gaborone, Gaborone, Botswana
| | - Rebecca Luckett
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Doreen Ramogola-Masire
- Obstetrics & Gynaecology - Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Erle S Robertson
- Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola M Zetola
- Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA
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Martins J, Vaz AF, Grion RC, Costa-Paiva L, Baccaro LF. Topical estrogen, testosterone, and vaginal dilator in the prevention of vaginal stenosis after radiotherapy in women with cervical cancer: a randomized clinical trial. BMC Cancer 2021; 21:682. [PMID: 34112100 PMCID: PMC8191143 DOI: 10.1186/s12885-021-08274-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to evaluate the effects of different therapeutic options to prevent the evolution of vaginal stenosis after pelvic radiotherapy in women with cervical cancer. METHODS open-label randomized clinical trial of 195 women, stage I-IIIB, aged 18-75 years, using topical estrogen (66), topical testosterone (34), water-based intimate lubricant gel (66), and vaginal dilators (29) to assess the incidence and severity of vaginal stenosis after radiotherapy at UNICAMP-Brazil, from January/2013 to May/2018. The main outcome measure was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE) scale and percental changes in vaginal volume. The women were evaluated at four different times: shortly after the end of radiotherapy, and four, eight, and 12 months after the beginning of the intervention. Statistical analysis was carried out using Symmetry test, Kruskal-Wallis test and multiple regression. RESULTS the mean age of women was 46.78 (±13.01) years, 61,03% were premenopausal and 73,84% had stage IIB-IIIB tumors. The mean reduction in vaginal volume in the total group was 25.47%, with similar worsening in the four treatment groups with no statistical difference throughout the intervention period. There was worsening of vaginal stenosis evaluated by CTCAE scale after 1 year in all groups (p < 0.01), except for the users of vaginal dilator (p = 0.37). CONCLUSIONS there was a reduction in vaginal volume in all treatment groups analyzed, with no significant difference between them. However, women who used vaginal dilators had a lower frequency and severity of vaginal stenosis assessed by the CTCAE scale after one year of treatment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials, RBR-23w5fv . Registered 10 January 2017 - Retrospectively registered.
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Affiliation(s)
- Jumara Martins
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Ana Francisca Vaz
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Regina Celia Grion
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Luiz Francisco Baccaro
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
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Talarico MCR, Nunes RAL, Silva GÁF, da Costa LBE, Cardoso MR, Esteves SCB, Zanatta Sarian LO, Zeferino LC, Termini L. High Expression of SOD2 Protein Is a Strong Prognostic Factor for Stage IIIB Squamous Cell Cervical Carcinoma. Antioxidants (Basel) 2021; 10:antiox10050724. [PMID: 34062984 PMCID: PMC8147985 DOI: 10.3390/antiox10050724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022] Open
Abstract
High superoxide dismutase 2 (SOD2) expression is associated with a poor prognosis at many cancer sites, the presence of metastases, and more advanced cervical cancer. This study aims to determine whether SOD2 protein expression is associated with the prognosis of stage IIIB cervical carcinoma. Methods: sixty-three patients with stage IIIB squamous cell cervical carcinoma were included. The evaluation of SOD2 expression by immunohistochemistry was based on a positive cell ratio score and the staining intensity score. Taking disease recurrence and death as endpoints, receiver operating characteristic curves were used to discriminate between high and low SOD2 expression. Results: high SOD2 expression was associated with recurrence (p = 0.001), distant recurrence (p = 0.002), and death (p = 0.005). A multivariate analysis showed that patients with high SOD2 expression had a threefold increased risk for recurrence (HR = 3.16; 1.33–7.51) and death (HR = 2.98; 1.20–7.40) compared with patients who had low SOD2 expression. Patients with high SOD2 expression had shorter disease-free survival (p = 0.001) and overall survival (p = 0.003) than patients with low SOD2 expression. Conclusion: high SOD2 expression is a strong prognostic factor for stage IIIB squamous cell carcinoma of the cervix and could be used as a prognostic marker in women with cervical carcinoma.
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Affiliation(s)
- Maria Cecília Ramiro Talarico
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, School of Medical Sciences, State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13081970, Brazil; (M.C.R.T.); (M.R.C.); (L.O.Z.S.)
| | - Rafaella Almeida Lima Nunes
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403911, Brazil; (R.A.L.N.); (G.Á.F.S.)
| | - Gabriela Ávila Fernandes Silva
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403911, Brazil; (R.A.L.N.); (G.Á.F.S.)
| | - Larissa Bastos Eloy da Costa
- Department of Pathology, State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13083887, Brazil;
| | - Marcella Regina Cardoso
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, School of Medical Sciences, State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13081970, Brazil; (M.C.R.T.); (M.R.C.); (L.O.Z.S.)
| | - Sérgio Carlos Barros Esteves
- Department of Radiotherapy, Division of Gynecologic and Breast Oncology, Women’s Hospital Professor Doutor José Aristodemo Pinotti—Centro de Atenção Integral à Saúde da Mulher (CAISM), State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13083881, Brazil;
| | - Luis Otávio Zanatta Sarian
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, School of Medical Sciences, State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13081970, Brazil; (M.C.R.T.); (M.R.C.); (L.O.Z.S.)
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, School of Medical Sciences, State University of Campinas (UNICAMP—Universidade Estadual de Campinas), Campinas, São Paulo 13081970, Brazil; (M.C.R.T.); (M.R.C.); (L.O.Z.S.)
- Correspondence: (L.C.Z.); (L.T.); Tel.: +55-19-3521-9516 (L.C.Z.)
| | - Lara Termini
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403911, Brazil; (R.A.L.N.); (G.Á.F.S.)
- Correspondence: (L.C.Z.); (L.T.); Tel.: +55-19-3521-9516 (L.C.Z.)
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Fachini AMD, Zuliani AC, Sarian LO, Teixeira JC, Esteves SCB, da Costa Machado H, Zeferino LC. Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: A randomized controlled trial. Gynecol Oncol 2020; 160:379-383. [PMID: 33341239 DOI: 10.1016/j.ygyno.2020.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/26/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The present analysis determined the disease free survival (DFS) and overall survival (OS) at up to 14 years of follow-up in women who participated in our previous phase 3 randomized controlled clinical trial, in which women with stage IIIB squamous cervical cancer received either cisplatin plus RT or RT alone for treatment. The first study showed that the addition of cisplatin to RT offered a significant benefit in DFS, but not in OS. METHODS The present analysis examined DFS and OS in 146 women from the original cohort (72 patients in the CRT arm and 74 patients in the RT-only arm) with follow-up of up to 14 years. RESULTS Longer term follow-up showed that treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only. Patients who received RT alone had significantly worse OS (HR, 1.88; 95% CI, 1.09-3.24) and DFS (HR, 1.82; 95% CI, 1.07-3.08) compared with patients who received CRT. The multivariate analyses also showed that the patients with baseline Karnofsky performance status (KPS) <90% showed significantly worse OS (HR, 3.11; 95% CI, 1.78-5.43), as did those with hemoglobin <10 mg/dL (HR, 4.32; 95% CI, 2.23-8.36). Patients with baseline KPS < 90% showed significantly worse DFS (HR, 2.83; 95% CI, 1.60-5.01), as did those with hemoglobin <10 mg/dL (HR, 4.16; 95% CI, 2.17-7.95). CONCLUSIONS For stage IIIB cervical cancer, treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only.
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Affiliation(s)
- Ana Maria Dias Fachini
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Antonio Carlos Zuliani
- Department of Radiotherapy, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Júlio César Teixeira
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sérgio Carlos Barros Esteves
- Department of Radiotherapy, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Helymar da Costa Machado
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
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Yang SL, Chen L, He Y, Zhao H, Wu YM. Effect of neoadjuvant chemotherapy followed by surgery for FIGO stage I-II cervical cancer: a meta-analysis. J Int Med Res 2020; 48:300060520945507. [PMID: 32867558 PMCID: PMC7469733 DOI: 10.1177/0300060520945507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In this meta-analysis, we aimed to evaluate the oncological outcomes of preoperative neoadjuvant chemotherapy followed by radical surgery compared with radical surgery alone for treatment of International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer. METHOD We searched for studies comparing the safety and efficacy of neoadjuvant chemotherapy plus surgery versus surgery alone in treatment outcomes of locally advanced cervical cancer. Meta-analysis was used to calculate the pooled odds ratios with corresponding 95% confidence intervals (CI). RESULTS Sixteen studies were included in our analysis. Pooled analysis of overall survival rate [odds ratio (OR) = 1.09, 95% CI: 0.83-1.43] and progression-free survival rate (OR = 1.10, 95% CI: 0.77-1.57) showed that preoperative neoadjuvant chemotherapy did not have a benefit compared with surgery alone in terms of survival rates. The pooled results for postoperative parameters indicated that preoperative neoadjuvant chemotherapy followed by radical surgery was associated with a high rate of vascular space involvement (OR = 0.25, 95% CI: 0.17-0.35) and parametrial infiltration (OR = 0.60, 95% CI: 0.45-0.79). CONCLUSIONS This meta-analysis indicated that surgery following neoadjuvant chemotherapy for FIGO stage I-II cervical cancer and surgery alone had similar oncological outcomes.
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Affiliation(s)
- Shu-Li Yang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ling Chen
- Guangzhou Red Cross Hospital, Guangzhou, China
| | - Yue He
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hui Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yu-Mei Wu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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10
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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:220-234. [DOI: 10.1016/j.prro.2020.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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Kinsella T, Safran H, Wiersma S, DiPetrillo T, Schumacher A, Rosati K, Vatkevich J, Anderson LW, Hill KD, Kunos C, Collins JM. Phase I and Pharmacology Study of Ropidoxuridine (IPdR) as Prodrug for Iododeoxyuridine-Mediated Tumor Radiosensitization in Advanced GI Cancer Undergoing Radiation. Clin Cancer Res 2019; 25:6035-6043. [PMID: 31337643 PMCID: PMC6801071 DOI: 10.1158/1078-0432.ccr-19-0862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/21/2019] [Accepted: 07/17/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Iododeoxyuridine (IUdR) is a potent radiosensitizer; however, its clinical utility is limited by dose-limiting systemic toxicities and the need for prolonged continuous infusion. 5-Iodo-2-pyrimidinone-2'-deoxyribose (IPdR) is an oral prodrug of IUdR that, compared with IUdR, is easier to administer and less toxic, with a more favorable therapeutic index in preclinical studies. Here, we report the clinical and pharmacologic results of a first-in-human phase I dose escalation study of IPdR + concurrent radiation therapy (RT) in patients with advanced metastatic gastrointestinal (GI) cancers. PATIENTS AND METHODS Adult patients with metastatic GI cancers referred for palliative RT to the chest, abdomen, or pelvis were eligible for study. Patients received IPdR orally once every day × 28 days beginning 7 days before the initiation of RT (37.5 Gy in 2.5 Gy × 15 fractions). A 2-part dose escalation scheme was used, pharmacokinetic studies were performed at multiple time points, and all patients were assessed for toxicity and response to Day 56. RESULTS Nineteen patients were entered on study. Dose-limiting toxicity was encountered at 1,800 mg every day, and the recommended phase II dose is 1,200 mg every day. Pharmacokinetic analyses demonstrated achievable and sustainable levels of plasma IUdR ≥1 μmol/L (levels previously shown to mediate radiosensitization). Two complete, 3 partial, and 9 stable responses were achieved in target lesions. CONCLUSIONS Administration of IPdR orally every day × 28 days with RT is feasible and tolerable at doses that produce plasma IUdR levels ≥1 μmol/L. These results support the investigation of IPdR + RT in phase II studies.
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Affiliation(s)
- Timothy Kinsella
- Brown University Oncology Group (BrUOG), Providence, Rhode Island.
- EMEK, Inc., Warwick, Rhode Island
| | - Howard Safran
- Brown University Oncology Group (BrUOG), Providence, Rhode Island
| | | | | | | | - Kayla Rosati
- Brown University Oncology Group (BrUOG), Providence, Rhode Island
| | | | | | - Kimberly D Hill
- Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Charles Kunos
- Cancer Therapy Evaluation Program (CTEP), NCI, Bethesda, Maryland
| | - Jerry M Collins
- Developmental Therapeutics Program (DTP), NCI, Bethesda, Maryland
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Shrivastava S, Mahantshetty U, Engineer R, Chopra S, Hawaldar R, Hande V, Kerkar RA, Maheshwari A, Shylasree TS, Ghosh J, Bajpai J, Gurram L, Gulia S, Gupta S. Cisplatin Chemoradiotherapy vs Radiotherapy in FIGO Stage IIIB Squamous Cell Carcinoma of the Uterine Cervix: A Randomized Clinical Trial. JAMA Oncol 2019; 4:506-513. [PMID: 29423520 DOI: 10.1001/jamaoncol.2017.5179] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The evidence for concurrent chemoradiotherapy (CT-RT) in International Federation of Gynecology and Obstetrics (FIGO) stage IIIB squamous cell carcinoma of the uterine cervix is not robust. This study reports the final results of a randomized clinical trial of concurrent cisplatin-based CT-RT and radiotherapy alone (RT) in women with FIGO stage IIIB squamous cell carcinoma of the uterine cervix. Objective To investigate the benefit of concurrent CT-RT in FIGO stage IIIB squamous cell carcinoma of the uterine cervix. Design, Setting, and Participants This phase 3 open-label randomized clinical trial accrued 850 women in Mumbai, India, between July 7, 2003, and September 22, 2011. Of 2121 screened, 850 women with FIGO stage IIIB squamous cell carcinoma of the uterine cervix suitable for concurrent cisplatin chemotherapy were randomly assigned to CT-RT and RT using block randomization (1:1). The data were updated for a minimum follow-up period of 5 years until December 2016. The final analyses were performed in February and March 2017. This single-institution study was conducted at a tertiary cancer center setting. Interventions Randomization to receive RT (RT arm), comprising a combination of external beam RT (50 Gy in 25 fractions over 5 weeks) and brachytherapy, or to receive in addition to the same RT concurrent weekly cisplatin chemotherapy (40 mg/m2 per week) (CT-RT arm). Main Outcomes and Measures The primary end point was 5-year disease-free survival (DFS), defined as the time between the date of randomization and the date of any recurrence or death (whichever occurred first) in the intent-to-treat population. Results This trial included 424 women assigned to CT-RT (mean [SD] age, 49.4 [7.9] years) and 426 women assigned to RT (mean [SD] age, 49.3 [7.9] years). At a median follow-up of 88 months (interquartile range, 61.3-113.1 months), there were 222 recurrences and 213 deaths in the CT-RT arm and 252 recurrences and 243 deaths in the RT arm. The 5-year DFS was significantly higher in the CT-RT arm (52.3%; 95% CI, 52.2%-52.4%) compared with the RT arm (43.8%; 95% CI, 43.7%-43.9%), with a hazard ratio for relapse or death of 0.81 (95% CI, 0.68-0.98) (P = .03). Similarly, the 5-year overall survival (OS) was significantly higher in the CT-RT arm (54.0%; 95% CI, 53.9%-54.1%) compared with the RT arm (46.0%; 95% CI, 45.9%-46.1%), with a hazard ratio for death of 0.82 (95% CI, 0.68-0.98; P = .04). After adjusting for prognostic factors, CT-RT continued to be significantly superior to RT for DFS and OS. There was a higher incidence of acute hematological adverse effects in the CT-RT arm. Conclusions and Relevance Chemoradiotherapy using weekly cisplatin results in significantly better DFS and OS compared with RT in women with stage IIIB squamous cell carcinoma of the uterine cervix. This study provides level 1 evidence in the largest clinical trial reported so far in favor of concurrent weekly cisplatin chemotherapy in this setting. Trial Registration clinicaltrials.gov Identifier: NCT00193791.
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Affiliation(s)
- Shyamkishore Shrivastava
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rohini Hawaldar
- Department of Clinical Research Secretariat, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vinod Hande
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Kerkar
- Department of Gynecology Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amita Maheshwari
- Department of Gynecology Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - T S Shylasree
- Department of Gynecology Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Fabri VA, Queiroz ACM, Mantoan H, Sanches SM, Guimarães APG, Ribeiro ARG, Souza RP, Maya JML, Santos ES, Castro FS, Lima JPNS, Chen MJ, Baiocchi G, da Costa AABA. The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse. JOURNAL OF ONCOLOGY 2019; 2019:1217838. [PMID: 30984261 PMCID: PMC6432701 DOI: 10.1155/2019/1217838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aimed to evaluate the benefit of consolidation CT compared to no additional treatment in patients treated with RTCT. METHODS This is a retrospective study including 186 patients with FIGO stage IB2, IIA2, or IIB to IVB (paraaortic lymph nodes only) uterine cervical cancer who were treated with standard RTCT alone or RTCT followed by consolidation CT. Overall survival (OS), progression free survival (PFS), and the risk of distant and local relapses were compared between the two treatment groups. RESULTS At 3 years OS was 91% versus 82.3% (p=0.027), PFS 84.3% versus 54.4% (p=0.047), and distant metastasis free survival (DMFS) 80.4% versus 62.5% (p=0.027) in favor of the consolidation CT group. Multivariate analysis confirmed the benefit of consolidation CT. There was no difference in locoregional free survival (LRFS). Positive lymph node was related to a higher risk of distant relapse. In the lymph node positive subgroup consolidation CT resulted in longer OS (p=0.050), PFS (p=0.014), and DMFS (p=0.022); in the lymph node negative subgroup there was no benefit from consolidation CT. CONCLUSIONS Use of consolidation CT resulted in longer OS and PFS, mostly due to control of distant relapses. Patients at higher risk of distant relapse showed the greatest benefit. This data generates a hypothesis that could help to better select patients to consolidation CT.
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Affiliation(s)
- Vanessa A. Fabri
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Ana C. M. Queiroz
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Henrique Mantoan
- Gynecology Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Solange M. Sanches
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Andrea P. G. Guimarães
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Adriana R. G. Ribeiro
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Ronaldo P. Souza
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Joyce M. L. Maya
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Elizabeth S. Santos
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Fabrício S. Castro
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - João P. N. S. Lima
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Michael J. Chen
- Radiotherapy Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Glauco Baiocchi
- Gynecology Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
| | - Alexandre A. B. A. da Costa
- Medical Oncology Department, A.C.Camargo Cancer Center, Sao Paulo, 211 Professor Antonio Prudente Street, 01509-900 Liberdade, Brazil
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Queiroz ACM, Fabri V, Mantoan H, Sanches SM, Guimarães APG, Ribeiro ARG, da Nogueira Silveira Lima JP, Chen MJ, Baiocchi G, da Costa AABA. Risk factors for pelvic and distant recurrence in locally advanced cervical cancer. Eur J Obstet Gynecol Reprod Biol 2019; 235:6-12. [PMID: 30771718 DOI: 10.1016/j.ejogrb.2019.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results. STUDY DESIGN A retrospective review of data from 127 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics Stages IIB-IVA), treated at a single institution from 2005 to 2014. Risk factors for loco-regional and systemic recurrence, and prognostic factors for overall survival (OS) were analysed using Cox regression. Survival of patients treated with consolidation chemotherapy was compared with survival of patients not treated with consolidation chemotherapy in the role cohort and in a propensity-score-matched cohort. RESULTS With a median follow-up time of 48.7 months, loco-regional-recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and OS at 5 years were 76.6%, 54.0% and 63.0%, respectively. On multivariate analysis, tumour size ≥6 cm was associated with shorter LRFS [hazard ratio (HR) 5.18; 95% confidence interval (CI) 1.45-18.45; p = 0.011], and adenocarcinoma (HR 2.48; 95% CI 1.10-5.57; p = 0.028) and positive lymph nodes (HR 2.21; 95% CI 1.303-4.72; p = 0.041) were associated with shorter DMFS. Tumour size ≥6 cm was associated with shorter OS (HR 2.64; 95% CI 1.09-6.35; p = 0.031). Twenty-two patients were treated with consolidation chemotherapy; on univariate analysis, these patients had longer OS compared with patients who were not treated with consolidation chemotherapy (p = 0.043). In a propensity-score-matched cohort, patients treated with consolidation chemotherapy had longer DMFS and OS compared with patients who were not treated with consolidation chemotherapy, although the difference was not significant. CONCLUSIONS Different risk factors are associated with loco-regional and distant metastases in patients with locally advanced cervical cancer, and could potentially lead to particular therapeutic strategies. Although the number of patients treated with consolidation chemotherapy in the study cohort was small, they seemed to live longer and to have better control of distant relapse then patients who were not treated with consolidation chemotherapy.
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Affiliation(s)
| | - Vanessa Fabri
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Henrique Mantoan
- Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | | | - Glauco Baiocchi
- Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Basta T, Knapp P, Blecharz P, Bodnar L, Gawron I, Babczyk D, Piróg M, Kluz T, Markowska A, Horbaczewska A, Jach R. Current management of cervical cancer in Poland-Analysis of the questionnaire trial for the years 2002-2014 in relation to ASCO 2016 recommendations. PLoS One 2019; 14:e0209901. [PMID: 30703105 PMCID: PMC6354992 DOI: 10.1371/journal.pone.0209901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/13/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives To assess the survival of patients with cervical cancer (CC). Since the recommendations concerning cervical cancer management adopted by Polish medical societies do not differ significantly from the ESGO or non-European guidelines, and the fact that evaluation of the system for CC treatment in Poland, as well as the mortality rate of Polish women with CC, which is 70% higher than the average for European Union (EU) countries, justifies the hypothesis that treatment of CC in Poland deviates from the Polish and international recommendations. This article puts forward the current management of cervical cancer in Poland and discusses it in the context of ASCO guidelines. Material and methods A survey retrospective multicenter analysis of the medical records of 1247 patients with cervical cancer who underwent treatment for disease and who had completed at least two years of follow-up. Results Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. Conclusion Within the IA to II A cervical cancer patients studied group, the methods of treatment remained in line with ASCO guidelines for countries with the highest standard of care. Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. Our findings, together with the inconsistencies within the cervical cancer screening program, may be one of the explanations of poorer survival rate of women with cervical cancer in Poland.
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Affiliation(s)
- Tomasz Basta
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Knapp
- Department of Gynecology and Gynecological Oncology, Faculty of Medicine, Medical University in Bialystok, Bialystok, Poland
| | - Paweł Blecharz
- Gynecologic Oncology Department, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Krakow Branch, Krakow, Poland
| | - Lubomir Bodnar
- Department of Clinical Oncology, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Iwona Gawron
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Babczyk
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Piróg
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Fryderyk Chopin University Hospital No 1, Faculty of Medicine, Rzeszow University, Rzeszow, Poland, Poland
| | - Anna Markowska
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Horbaczewska
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Robert Jach
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
- * E-mail:
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Horeweg N, Creutzberg CL, Rijkmans EC, Laman MS, Velema LA, Coen VLMA, Stam TC, Kerkhof EM, Kroep JR, de Kroon CD, Nout RA. Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer. Int J Gynecol Cancer 2019; 29:257-265. [PMID: 30630883 DOI: 10.1136/ijgc-2018-000057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and toxicity of primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer and to identify predictors of treatment failure and toxicity. METHODS Retrospective analysis of 155 stage IB-IVA cervical cancer patients treated from 2008 to 2016 with chemoradiation and image-guided adaptive brachytherapy. Treatment consisted of external beam radiotherapy (45 - 48.6 Gy in 1.8 - 2 Gy fractions) with concurrent weekly cisplatin (40 mg/m2, 5 - 6 cycles) and image-guided adaptive brachytherapy (3-4 × 7 Gy high dose rate) using intracavitary or combined intracavitary-interstitial techniques according to GEC-ESTRO (Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology) recommendations. Incidences of all outcomes were calculated using Kaplan-Meier's methodology. Risk factors for treatment failure and toxicity were identified using Cox's proportional hazards model and the Kruskal-Wallis H-test respectively. RESULTS Median follow-up was 57 months. Five-year local control was 90.4 %. Five-year para-aortic lymph node metastasis-free and distant metastasis-free survival were 85.3 % and 70.2 % respectively. Tumor size and lymph node metastasis were independent risk factors for treatment failure. Cumulative incidences of severe late bladder, rectal, bowel, and vaginal toxicity were 0.8%, 3.3%, 3.6%, and 1.4% respectively at 5 years of follow-up. Combined intracavitary-interstitial brachytherapy techniques were associated with less vaginal morbidity. CONCLUSIONS Primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer is a highly effective local and loco-regional treatment. However, survival is compromised by the occurrence of distant metastasis. Patients with large tumors and nodal involvement at diagnosis are at increased risk and may benefit from intensified treatment. Severe late gastrointestinal and urogenital toxicity is limited and may be further reduced by increasing conformity, using combined intracavitary-interstitial techniques and lowering doses to organs at risk.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eva C Rijkmans
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam S Laman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laura A Velema
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Tanja C Stam
- Department of Radiation Oncology, Haaglanden Medical Center Antoniushove, Leidschendam, The Netherlands
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cor D de Kroon
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Datta NR, Stutz E, Gomez S, Bodis S. Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2018; 103:411-437. [PMID: 30391522 DOI: 10.1016/j.ijrobp.2018.09.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Abstract
Treatment options in locally advanced cervix cancer (LACC) have evolved around radiation therapy (RT) and/or chemotherapy (CT), hypoxic cell sensitizers, immunomodulators (Imm), and locoregional moderate hyperthermia (HT). A systematic review and network meta-analysis was conducted to synthesize the evidence for efficacy and safety in terms of long-term locoregional control (LRC), overall survival (OS), and grade ≥3 acute morbidity (AM) and late morbidity (LM). Five databases were searched, and 6285 articles (1974-2018) were screened per the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Fifty-nine randomized trials in untreated LACC without surgical intervention were shortlisted. These used 13 different interventions: RT alone and/or neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent chemoradiation therapy (CTRT) (weekly cisplatin [CDDP]/3-weekly CDDP/combination CT with CDDP/non-CDDP-based CT), hypoxic cell sensitizers, Imm, or HT. Odds ratios (ORs) using random effects network meta-analysis were estimated. Interventions for each endpoint were ranked according to their corresponding surface under cumulative ranking curve values. Of the 9894 patients evaluated, the total events reported for LRC, OS, AM, and LM were 5431 of 8197, 4482 of 7958, 1710 of 7183, and 441 of 6333, respectively. ORs and 95% credible intervals (CrIs) for the 2 best strategies were HT + RT versus CTRT + ACT (OR, 1.23; 95% CrI, 0.49-3.19) for LRC, CTRT (3-weekly CDDP) versus HTCTRT (OR, 1.14; 95% CrI, 0.35-3.65) for OS, RT + ACT versus RT (OR, 0.01; 95% CrI, 0.00-1.04) for AM, and NACT + RT + ACT versus RT + Imm (OR, 0.42; 95% CrI, 0.02-7.39) for LM. The 3 interventions with the highest cumulative surface under cumulative ranking curve values for all 4 endpoints were HTRT, HTCTRT, and CTRT (3-weekly CDDP). Articles with low risk of bias and those published during 2004 to 2018 also retained these interventions as the best. Two-step cluster analysis grouped these 3 modalities in a single distinctive cluster. HTRT, HTCTRT, and CTRT with 3-weekly CDDP were identified as therapeutic modalities with the best comprehensive impact on key clinical endpoints in LACC. This warrants a phase 3 randomized trial among these strategies for a head-to-head comparison and additional validation.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland.
| | - Emanuel Stutz
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Silvia Gomez
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland
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Comparison of Nedaplatin- and Cisplatin-Based Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer Patients: A Propensity Score Analysis. Int J Gynecol Cancer 2018; 28:1029-1037. [DOI: 10.1097/igc.0000000000001265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
PurposeThe aim of this study was to evaluate the efficacy of using nedaplatin to replace cisplatin for concurrent chemoradiotherapy (CCRT) in patients with newly diagnosed locally advanced cervical cancer.MethodsThe medical records of 155 patients with cervical cancer who had undergone CCRT with cisplatin (n = 85) or nedaplatin (n = 70) between January 2012 and January 2017 were retrospectively reviewed. Propensity score analysis with 1:1 matching with the nearest neighbor matching method was performed to assess response rates, progression-free survival, overall survival, and toxicity between 2 groups.ResultsPropensity score matching identified 63 patients in each group. After matching, compared with patients treated with cisplatin-based concurrent chemoradiotherapy (CisRT), we found that patients treated with nedaplatin-based concurrent chemoradiotherapy (NedaRT) had a significant higher recurrence rate (25.4% vs 42.9%; P = 0.04). In addition, the 3-year progression-free survival rate for NedaRT group was also worse than that for the CisRT group (52.2% vs 63.4%, P = 0.03). There was no difference in the overall response rates between the CisRT and NedaRT groups (87.3% and 90.5%, respectively; P = 0.57). The rates of 3-year overall survival and grades 3 to 4 toxicities were similar between the 2 groups.ConclusionsThe clinical outcome of this cohort of patients with locally advanced cervical cancer treated with CCRT did in no way provide support for the use of nedaplatin in place of cisplatin in chemoradiation and demonstrated no equivalence of the 2 drugs. Cautions should be taken for the replacement among platinum complexes in cancer treatment.
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Abstract
Two major treatment modalities in cervical cancer are radiation therapy (RT) and surgery. Chemotherapy continues to be the main form of systemic therapy adjunctive to definitive local therapies, and is used for palliation. Platinum-based regimens, administered concurrently with both definitive and postoperative RT, were demonstrated to provide significant survival benefits, whereas the beneficial effect of concurrent chemoradiotherapy in later-stage disease was smaller. The role of chemotherapy in addition to RT in IB1/IIA1 cervical cancer patients not undergoing surgery remains undefined. Likewise, the role of chemotherapy in combination with postoperative RT for patients with intermediate-risk factors for recurrence has not yet been verified. The recent standard for chemoradiotherapy is cisplatin alone administered weekly. Other cisplatin-based or non-cisplatin-based regimens have not been subjected to large clinical studies. The benefits of consolidation chemotherapy after chemoradiation for locally advanced cervical cancer are still undetermined. Neoadjuvant cisplatin-based chemotherapy followed by surgery has shown survival benefits, however its role in the era of chemoradiotherapy remains unclear. The combination of cisplatin and paclitaxel is considered a standard regimen in the palliative setting. There is no standard of care for second-line systemic therapy in advanced cervical cancer. Bevacizumab combined with palliative chemotherapy (cisplatin/paclitaxel or topotecan/paclitaxel) in the first-line treatment for recurrent/metastatic cervical cancer significantly improves overall survival when compared to chemotherapy alone. The role of immunotherapy in cervical cancer remains to be established. The optimal combined modality treatment including systemic therapy for cervical tumors of non-squamous histology remains a matter of debate. Ongoing accumulation of data on genomic and proteomic characteristics provides insight into the molecular heterogeneity of cervical cancer and paves the way for developing molecularly targeted therapies.
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Affiliation(s)
- Krystyna Serkies
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
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21
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Li H, Li M, Pang Y, Liu F, Sheng D, Cheng X. Fructose‑1,6‑bisphosphatase‑1 decrease may promote carcinogenesis and chemoresistance in cervical cancer. Mol Med Rep 2017; 16:8563-8571. [PMID: 28990097 DOI: 10.3892/mmr.2017.7665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022] Open
Abstract
Fructose-1,6-bisphosphatase-1 (FBP1), a gluconeogenesis rate-limiting enzyme expressed in various tissues, is important in the carcinogenesis of various cancers. To evaluate the association of FBP1 expression and carcinogenesis and chemoresistance in cervical cancer, the present study analyzed 140 patients of squamous cell carcinoma of cervical cancer (CSCC) who had adjuvant concurrent chemoradiation therapy following radical surgery. By detecting FBP1 protein expression in paraffin‑embedded tumor tissues through immunohistochemistry, it was observed that 50% of the cases had a low expression of FBP1, which was associated with a shorter overall survival time (P=0.011). In addition, FBP1 mRNA level was downregulated in tumor tissues, compared with cervical normal tissues. Among the tumor‑associated prognostic factors, loss of FBP1 expression (χ2‑test, P=0.025) was significantly associated with the tumor recurrence and greater tumor stage of cervical cancer patients (2‑test, P<0.0001). In 3‑(4,5)‑dimethylthiahiazo(‑z‑y1)-3,5-diphenytetrazoliumromide (MTT) assay of primary tumor cells, the median in vitro inhibition rate of cisplatin, carboplatin, nedaplatin, and oxaliplatin was 62, 47, 58 and 52%, respectively. Although there was no significant association between FBP1 expression and in vitro tumor inhibition rates of primary tumor cells, overexpression of FBP1 markedly suppressed carcinogenesis and restored the chemosensitivity to cisplatin in cervical cancer cell lines of HeLa and CaSki. Overall, decreased levels of FBP1 may be used as a predictor for poor prognosis of cervical cancer patients, however the mechanism requires further investigation.
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Affiliation(s)
- Haoran Li
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Mengjiao Li
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Yangyang Pang
- Institute of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Fei Liu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Dong Sheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xi Cheng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
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22
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Mayadev J, Viswanathan A, Liu Y, Li CS, Albuquerque K, Damato AL, Beriwal S, Erickson B. American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer. Brachytherapy 2017; 16:22-43. [PMID: 28109631 DOI: 10.1016/j.brachy.2016.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFS-RT: 55%, SD: 10; CRT: 65%, SD: 7; OS-RT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1-6% and for chemoRT 2-20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4-11% and for chemoRT, 1-11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1-2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.
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Affiliation(s)
- Jyoti Mayadev
- Department of Radiation Oncology, Davis Medical Center, University of California, Sacramento, CA.
| | - Akila Viswanathan
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Yu Liu
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Chin-Shang Li
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Antonio L Damato
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburg Medical Center, Pittsburgh, PA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin Medical Center, Milwaukee, WI
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23
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Zhou S, Xiao Y, Zhuang Y, Liu Y, Zhao H, Yang H, Xie C, Zhou F, Zhou Y. Knockdown of homeobox containing 1 increases the radiosensitivity of cervical cancer cells through telomere shortening. Oncol Rep 2017. [PMID: 28628186 DOI: 10.3892/or.2017.5707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Homeobox containing 1 (HMBOX1) modulates telomere length in various types of tumor cells by binding to double‑stranded telomeric DNA. There is a negative correlation between telomere length and radiosensitivity in tumor cells. In the present study, we aimed to investigate the relationship among HMBOX1, telomere and radiosensitivity in cervical cancer cells. Lentivirus-based shRNAs were used to establish stable transfected cell lines in which protein and mRNA levels of HMBOX1 were notably decreased. Knockdown of HMBOX1 increased the radiosensitivity of HeLa and C33A cells. TERT protein was also decreased while HMBOX1 was downregulated. Knockdown of HMBOX1 shortened telomere length in the HeLa cells, while TERT overexpression rescued telomere shortening in the HeLa-HMBOX1 cells. Knockdown of HMBOX1 increased the apoptosis rate, decreased radiation-induced DNA damage foci, and inhibited the expression of ATM, ATR, p-ATM, p-ATR and BRCA1 in the homologous recombination repair pathway. Our data suggest a possible role of HMBOX1 in regulating radiosensitivity in cervical cancer cells. Moreover, HMBOX1 may be a potential factor in the radiotherapy of cervical cancer.
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Affiliation(s)
- Shuliang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Youde Xiao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yafei Zhuang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yinyin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Hong Zhao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Hui Yang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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24
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Datta NR, Stutz E, Liu M, Rogers S, Klingbiel D, Siebenhüner A, Singh S, Bodis S. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis. Gynecol Oncol 2017; 145:374-385. [PMID: 28188016 DOI: 10.1016/j.ygyno.2017.01.033] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
The efficacy of concurrent chemoradiotherapy (CTRT) in locally advanced cervix cancer (LACC, stages IIB-IVA) is contentious. This is due to the variable extent of therapeutic benefit reported in different randomized clinical trials and meta-analyses that usually include all stages of cervix cancer. A systematic review and meta-analysis was therefore conducted to evaluate the efficacy of concurrent CTRT over radiotherapy (RT) alone, predominantly in LACC for the key endpoints; complete response (CR), long-term loco-regional control (LRC), overall survival (OS), grade III/IV acute and late toxicities. Six databases namely - PubMed, EMBASE, SCOPUS, Web of Science, Google Scholar and Cochrane library were explored and supplemented by hand-searching. Only prospective randomized trials conducted in LACC between concurrent CTRT and RT alone with no surgical interventions were included. Fourteen English language articles from 1788 citations were shortlisted for the final analysis. Of the 2445 patients evaluated (CTRT: n=1217; RT: n=1228), 95.7% had LACC and 96% had a squamous cell histology. Eight studies used cisplatin alone, 4 had cisplatin-based combination chemotherapy (CT) while 2 used mitomycin-C, either alone or in combination. CTRT improved the CR (+10.2%, p=0.027), LRC (+8.4%, p<0.001) and OS (+7.5%, p<0.001) over RT alone. However a 10.4% higher incidence of grade III/IV acute toxicities (p<0.001) was also evident with CTRT. Late toxicities in both groups were equivalent. Subgroup analysis and meta-regression did not reveal any significant advantage in outcomes between the 3 CTRT regimens. Thus, although concurrent CTRT provides conclusive therapeutic benefit over RT alone in LACC, the choice of CT agents should be based on their cost-effectiveness and the anticipated expenses for the management of any associated acute toxicities. This assumes importance particularly in resource-constrained low-middle-income countries with the highest burden of LACC, where majority of the patients meet the treatment costs as out-of-pocket expenses.
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Affiliation(s)
- Niloy Ranjan Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - Emanuel Stutz
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Liu
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Susanne Rogers
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Dirk Klingbiel
- Swiss Group for Clinical Cancer Research (SAKK), Coordinating Centre, Bern, Switzerland
| | | | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland
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25
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Fu ZZ, Li K, Peng Y, Zheng Y, Cao LY, Zhang YJ, Sun YM. Efficacy and toxicity of different concurrent chemoradiotherapy regimens in the treatment of advanced cervical cancer: A network meta-analysis. Medicine (Baltimore) 2017; 96:e5853. [PMID: 28079819 PMCID: PMC5266181 DOI: 10.1097/md.0000000000005853] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy and toxicity of different concurrent chemoradiotherapy (CCRT) regimens in the treatment of advanced cervical cancer (CC) by adopting a network meta-analysis. METHODS We searched PubMed and Cochrane Library from the inception of these databases to September 2016, and all cohort studies (CSs) related to different CCRT regimens in the treatment of CC were included. A network analysis was adopted to compare the combination of direct and indirect evidence, to analyze the odds ratio (OR), and to draw a surface under the cumulative ranking curve of the efficacy and toxicity of different CCRT regimens for CC. Cluster analyses were used to group each category based on similar treatment regimens. RESULTS Nineteen CSs were enrolled in this network meta-analysis, including 12 CCRT regimens (radiotherapy [RT], CCRT [cisplatin], CCRT [vinorelbine], CCRT [paclitaxel], CCRT [hydroxyurea], CCRT [cisplatin + FU], CCRT [cisplatin + gemcitabine], CCRT [cisplatin + docetaxel], CCRT [cisplatin + paclitaxel], CCRT [cisplatin + amifostine], CCRT [cisplatin + FU + hydroxyurea], and CCRT [cisplatin + vincristine + bleomycin]). The results of the network meta-analysis showed that regarding efficacy, the overall response rate of CCRT (cisplatin + docetaxel) was higher than RT, and the 5-year overall survival (OS) rate of CCRT (cisplatin + FU + hydroxyurea) was relatively higher than CCRT (hydroxyurea). As for toxicity, CCRT (cisplatin) had a lower incidence of leukopenia than CCRT (hydroxyurea), CCRT (cisplatin + FU) and CCRT (cisplatin + paclitaxel), and the incidences of diarrhea and vomiting in CCRT (cisplatin) were lower than those in CCRT (cisplatin + gemcitabine). Additionally, the cluster analysis showed that CCRT (cisplatin) had relatively lower incidences of both hematotoxicity and gastrointestinal toxicity, and CCRT (paclitaxel) had lower gastrointestinal toxicity than other regimens. CONCLUSION Our study demonstrated that CCRT (cisplatin + docetaxel) might be the best choice of CCRT regimens in the treatment of CC, and the 5-year OS rate of CCRT (cisplatin + FU + hydroxyurea) might be the highest among these different regimens. CCRT (cisplatin) might have the lowest toxicity among all the CCRT regimens.
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Affiliation(s)
- Zhan-Zhao Fu
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | | | - Yong Peng
- Department of Biomedical Engineering, Yanshan University
| | | | - Li-Yan Cao
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | - Yun-Jie Zhang
- Department of Radiotherapy, the First Hospital of Qinhuangdao
| | - Yong-Mei Sun
- Department of Gynaecology, the First Hospital of Qinhuangdao, Qinhuangdao, P.R. China.
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26
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Di Donato V, Schiavi MC, Ruscito I, Visentin VS, Palaia I, Marchetti C, Fischetti M, Monti M, Muzii L, Benedetti Panici P. Effects of Neoadjuvant Chemotherapy Plus Radical Surgery as Front Line Treatment Strategy in Patients Affected by FIGO Stage III Cervical Cancer. Ann Surg Oncol 2016; 23:841-849. [DOI: 10.1245/s10434-016-5597-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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27
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Chuang LT, Temin S, Camacho R, Dueñas-Gonzalez A, Feldman S, Gultekin M, Gupta V, Horton S, Jacob G, Kidd EA, Lishimpi K, Nakisige C, Nam JH, Ngan HYS, Small W, Thomas G, Berek JS. Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline. J Glob Oncol 2016; 2:311-340. [PMID: 28717717 PMCID: PMC5493265 DOI: 10.1200/jgo.2016.003954] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer. Methods ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines. Results Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater. Recommendations Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
- Linus T Chuang
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Sarah Temin
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Rolando Camacho
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Alfonso Dueñas-Gonzalez
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Sarah Feldman
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Murat Gultekin
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Vandana Gupta
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Susan Horton
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Graciela Jacob
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Elizabeth A Kidd
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Kennedy Lishimpi
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Carolyn Nakisige
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Joo-Hyun Nam
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Hextan Yuen Sheung Ngan
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - William Small
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Gillian Thomas
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Jonathan S Berek
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
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Meng XY, Liao Y, Liu XP, Li S, Shi MJ, Zeng XT. Concurrent cisplatin-based chemoradiotherapy versus exclusive radiotherapy in high-risk cervical cancer: a meta-analysis. Onco Targets Ther 2016; 9:1875-88. [PMID: 27099519 PMCID: PMC4821385 DOI: 10.2147/ott.s97436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the efficacy and safety of cisplatin-based concurrent chemoradiotherapy (DDP-CCRT) in patients with high-risk cervical carcinoma (CC) compared with exclusive radiotherapy (RT). Materials and methods Databases were searched for randomized controlled trials (RCTs) and cohort studies comparing DDP-CCRT with RT alone. Risk of bias assessment for RCTs was performed using the Cochrane Collaboration’s tool, and the Newcastle–Ottawa quality scale was used to perform quality assessment for cohort studies. Meta-analysis was conducted using Review Manager 5 and Stata 12.0 software. Results Finally, eight RCTs and three cohort studies containing 2,130 subjects were included. Analysis on total failures revealed a statistically significant difference in favor of DDP-CCRT (risk ratio =0.77, 95% confidence intervals [CIs]: 0.67–0.89). No significant heterogeneity was detected for pooled analysis concerning overall survival; the result of which demonstrated the superiority of DDP-CCRT over RT alone (hazard ratio =0.68, 95% CI: 0.57–0.80), and stable and established accumulative effects were observed in cumulative meta-analysis. Similar results were observed for progression-free survival (hazard ratio =0.63, 95% CI: 0.50–0.76). In terms of treatment-related Grade 3 and 4 adverse events, our pooled analysis with a fixed-effects model showed significantly enhanced toxicity in the DDP-CCRT group compared with that in the RT group (odds ratio =3.13, 95% CI: 2.37–4.13). Conclusion Solid and stable beneficial effects are associated with DDP-CCRT, and its superiority over comparative RT in patients with high-risk CC is confirmed. DDP-CCRT should be considered one of the frontline treatment options for high-risk CC patients without contraindications. However, enhanced toxicity associated with DDP-CCRT should never be ignored.
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Affiliation(s)
- Xiang-Yu Meng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Yi Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, GuangZhou Province, People's Republic of China
| | - Xiao-Ping Liu
- Department of Hematology and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Sheng Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Ming-Jun Shi
- Institut Curie, Paris Sciences et Lettres Research University, Le Centre National de la Recherche Scientifique, Les Unités Mixtes de Recherche 144, F-75005, Paris, France
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
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Peng YH, Wang XX, Zhu JS, Gao L. Neo-adjuvant chemotherapy plus surgery versus surgery alone for cervical cancer: Meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2016; 42:128-35. [PMID: 26807961 DOI: 10.1111/jog.12896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Yun-Hua Peng
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Xin-Xiu Wang
- General Hospital of Lanzhou Petrochemical Company; Lanzhou City Gansu Province China
| | - Jing-Song Zhu
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Li Gao
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
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Cervix cancer brachytherapy: high dose rate. Cancer Radiother 2014; 18:452-7. [PMID: 25151650 DOI: 10.1016/j.canrad.2014.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 12/12/2022]
Abstract
Cervical cancer, although less common in industrialized countries, is the fourth most common cancer affecting women worldwide and the fourth leading cause of cancer death. In developing countries, these cancers are often discovered at a later stage in the form of locally advanced tumour with a poor prognosis. Depending on the stage of the disease, treatment is mainly based on a chemoradiotherapy followed by uterovaginal brachytherapy ending by a potential remaining tumour surgery or in principle for some teams. The role of irradiation is crucial to ensure a better local control. It has been shown that the more the delivered dose is important, the better the local results are. In order to preserve the maximum of organs at risk and to allow this dose escalation, brachytherapy (intracavitary and/or interstitial) has been progressively introduced. Its evolution and its progressive improvement have led to the development of high dose rate brachytherapy, the advantages of which are especially based on the possibility of outpatient treatment while maintaining the effectiveness of other brachytherapy forms (i.e., low dose rate or pulsed dose rate). Numerous innovations have also been completed in the field of imaging, leading to a progress in treatment planning systems by switching from two-dimensional form to a three-dimensional one. Image-guided brachytherapy allows more precise target volume delineation as well as an optimized dosimetry permitting a better coverage of target volumes.
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