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Cho WK, Park W, Kim SW, Lee KK, Ahn KJ, Choi JH. Postoperative Hypofractionated Intensity-Modulated Radiotherapy With Concurrent Chemotherapy in Cervical Cancer: The POHIM-CCRT Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:737-743. [PMID: 38662364 PMCID: PMC11046415 DOI: 10.1001/jamaoncol.2024.0565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 04/26/2024]
Abstract
Importance Prospective data assessing the safety of hypofractionated (40 Gy in 16 fractions) radiotherapy (RT) among patients who receive postoperative concurrent chemoradiotherapy for cervical cancer are lacking. Objective To evaluate the acute toxic effects of hypofractionated pelvic intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy among women with cervical cancer who underwent radical hysterectomy. Design, Setting, and Participants The POHIM-CCRT (Postoperative Hypofractionated Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy in Cervical Cancer) study was designed as a multicenter, phase 2 nonrandomized controlled trial that accrued and followed up patients from June 1, 2017, to February 28, 2023. In total, 84 patients were enrolled from 5 institutions affiliated with the Korean Radiation Oncology Group. Eligible patients experienced lymph node metastasis, parametrial invasion, or positive resection margins after radical hysterectomy for treatment of confirmed cervical cancer. Intervention Postoperative pelvic radiation using hypofractionated IMRT with 40 Gy in 16 fractions to the whole pelvis combined with concurrent chemotherapy. Main Outcomes and Measures The primary end point was incidence of acute grade 3 or higher gastrointestinal tract, genitourinary, and hematologic toxic effects (based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0) in the evaluable population during RT or within 3 months after RT completion. Results Of 84 patients enrolled, 5 dropped out prior to RT, and data from 79 patients were analyzed. The patients' median (IQR) age was 48 (42-58) years, and the median (IQR) tumor size was 3.7 (2.7-4.5) cm. Of these patients, 31 (39.7%) had lymph node metastasis, 4 (5.1%) had positive resection margins, and 43 (54.4%) had parametrial invasion. Grade 3 or higher acute toxic effects occurred in 2 patients (2.5% [90% CI, 0%-4.8%]). After a median (IQR) follow-up of 43.0 (21.1-59.0) months, the 3-year disease-free survival rate was 79.3%, and the overall survival rate was 98.0%. Conclusions Findings from this nonrandomized control trial indicated that postoperative pelvic irradiation combined with concurrent chemotherapy using hypofractionated IMRT with 40 Gy in 16 fractions was safe and well-tolerated in women with cervical cancer. Studies assessing long-term toxic effects and oncological outcomes with longer follow-up periods are needed. Trial Registration ClinicalTrials.gov Identifier: NCT03239613.
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Affiliation(s)
- Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Kim
- Department of Radiation Oncology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Kang Kyu Lee
- Department of Radiation Oncology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
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Wickenheisser NE, Dillon M, Broadwater G, Zacherl K, Bixel K, Levine M, Newton M, Thel H, Tucker K, Gehrig P, Khetan VU, Brunette-Masi LL, Matsuo K, Khouri OR, Duhon A, Gowthaman D, Cowan M, Mojdehbakhsh R, Rose S, Olawaiye A, Davidson BA, Moss HA, Havrilesky LJ. Radical hysterectomy case volume and cervical cancer treatment in the era of COVID-19: A multi-site analysis of National Cancer Institute-designated Comprehensive Cancer Centers. Gynecol Oncol 2023; 179:70-78. [PMID: 37944328 DOI: 10.1016/j.ygyno.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic. METHODS In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018-2/28/2020; (2) Pandemic & Recovery: 4/1/2020-12/31/2021. The primary outcome was total monthly radical hysterectomy case volume. Secondary outcomes were stage at diagnosis and diagnosis-to-treatment time. Statistical analyses used chi-squared and two sample t-tests. RESULTS Between 3/1/2018-12/31/2021, 561 patients were diagnosed with cervical cancer. The Pre-Pandemic and Pandemic & Recovery cohorts had similar age, race, ethnicity, smoking status, and Body Mass Index (BMI). During Pandemic & Recovery, the mean monthly radical hysterectomy case volume decreased from 7[SD 2.8] to 5[SD 2.0] (p = 0.001), the proportion of patients diagnosed with Stage I disease dropped from 278/561 (49.5%) to 155/381 (40.7%), and diagnosis of stage II-IV disease increased from 281/561 (50.1%) to 224/381 (58.8%). Primary surgical management was less frequent (38.3% Pandemic & Recovery versus 46.7% Pre-Pandemic, p = 0.013) and fewer surgically-treated patients received surgery within 6 weeks of diagnosis (27.4% versus 38.9%; p = 0.025). CONCLUSIONS Lower radical hysterectomy case volume, a shift to higher cervical cancer stage, and delay in surgical therapy were observed across the United States following the COVID-19 outbreak. Decreased surgical volume may result from lower detection of early-stage disease or other factors.
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Affiliation(s)
- Natalie E Wickenheisser
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Mairead Dillon
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Gloria Broadwater
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Kathleen Zacherl
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Monica Levine
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Meredith Newton
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Hannah Thel
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Katherine Tucker
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Paola Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Varun U Khetan
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Laurie L Brunette-Masi
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Koji Matsuo
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Olivia R Khouri
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Ashley Duhon
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Divya Gowthaman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Matthew Cowan
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Rachel Mojdehbakhsh
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Stephen Rose
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Alexander Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America.
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Singh N, Mishra N, Jayraj AS, Ghatage P. Management of Gynecologic Cancer During COVID-19 Pandemic: South Asian Perspective. Cancer Control 2022; 29:10732748221119349. [PMID: 36036360 PMCID: PMC9420651 DOI: 10.1177/10732748221119349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Management of gynecological cancers has suffered during the pandemic, partly due to lockdown and partly due to directing resources to manage COVID-19 patients. Modification of gynecological cancer management during this pandemic is recommended. Cervical cancer patients who present with stage IA1 disease can have a delay of up to 8 weeks for surgical treatment, considering the slow tumor growth rate. Women with stages IA2, IB1, IB2, IIA1 must undergo radical hysterectomy and lymphadenectomy within 6 to 8 weeks. In areas where surgical treatment is not available, patients should be referred for radiation therapy/areas with adequate surgical expertise. The surgical option is attractive for early cancers during the COVID era, as it involves a single visit compared to the multiple visits required for chemoradiation. The value of lymph node staging needs to be reconsidered. Neoadjuvant chemotherapy should be given preference over primary cytoreductive surgery for advanced ovarian cancers. Surgeries, which demand extended surgical time such as Hyperthermic Intraperitoneal Chemotherapy and pelvic exenterations, should be avoided during this pandemic. For patients scheduled for interval surgery after two or three neoadjuvant cycles, six cycles of chemotherapy should be considered before surgery is performed. For early-stage, low-grade endometrial cancer, consideration should be given to medical management until surgery is possible. The above recommendations have been made keeping in mind the geography, patient load, and availability of resources available to health care providers from southeast Asia. They might not be applicable globally and every practitioner should take call regarding patient's management as per availability of resources and loco-regional circumstances. The implementation of recommended international guidelines for the management of gynecologic cancers should take precedence. Each modification to the standard approach should be approved by a multidisciplinary team depending on the condition of the patients and the locoregional circumstances.
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Affiliation(s)
- Nilanchali Singh
- Department of Obstetrics and Gynaecology, 28730AIIMS, New Delhi, India.,Department of Gynaecologic Oncology, Tom Baker Cancer Centre, 2125University of Calgary, Calgary, AB, Canada
| | - Neha Mishra
- Department of Obstetrics and Gynaecology, 28730AIIMS, New Delhi, India.,Department of Obstetrics and Gynaecology, 517234GIMS, Uttar Pradesh, India
| | | | - Prafull Ghatage
- Department of Gynaecologic Oncology, Tom Baker Cancer Centre, 2125University of Calgary, Calgary, AB, Canada
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Rohilla KK, Kalyani CV, Gupta S, Gupta A, Gupta M. Quality of Life of People with Cancer in the Era of the COVID-19 Pandemic in India: A Systematic Review. Clin Pract Epidemiol Ment Health 2021; 17:280-286. [PMID: 35444705 PMCID: PMC8985464 DOI: 10.2174/1745017902117010280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 12/24/2022]
Abstract
Background:
The recent pandemic of COVID-19 caused havoc on the health system globally and raised a lot of questions and issues. Treatment for cancer is an emergency that cannot be taken back, particularly in an era of global pandemics. Cancer treatment mainly includes chemotherapy, surgery, radiotherapy, and palliative care, and because of the pandemic, all of these treatments are affected. The COVID-19 pandemic also had a potential effect on the quality of life and mental health of patients as well as health workers.
Objective:
This systematic review was intended to discuss the quality of life of people with cancer in the era of the COVID-19 pandemic in India in the light of the best available facts.
Methods:
An extensive literature search was done on PubMed, Medline, Embase, Clinical Key and Google Scholar databases till 3rd Feb 2021. Out of 1455 research articles, 06 research articles were included in this systematic review.
Results:
The results showed that cancer treatment delivery was as per standard safety protocol and the best treatment decisions were made by scheduling and setting priority. Till data, no direct research was conducted on the Indian continent to assess the quality of life of cancer patients in the COVID-19 era. The effect on the quality of life of cancer patients is very large and needs to be explored more by further research. Issues to be discussed with health care administrators and policy makers further. The tele-oncology method of cancer care delivery to patients is another rational option which is applicable as well.
Conclusion:
This systematic review demonstrated up-to-date evidence regarding the quality of life of cancer patients in the COVID-19 era in India. No research has been done to assess the quality of life of cancer patients. Still, the area is unrevealed, but evidence from other global studies indicates an altered quality of life for cancer patients. To maintain quality of life, cancer physicians should make evidence-based decisions and incorporate multidisciplinary management into decision making.
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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Amere Subbarao S. Cancer vs. SARS-CoV-2 induced inflammation, overlapping functions, and pharmacological targeting. Inflammopharmacology 2021; 29:343-366. [PMID: 33723711 PMCID: PMC7959277 DOI: 10.1007/s10787-021-00796-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/27/2021] [Indexed: 12/15/2022]
Abstract
Inflammation is an intrinsic defence mechanism triggered by the immune system against infection or injury. Chronic inflammation allows the host to recover or adapt through cellular and humoral responses, whereas acute inflammation leads to cytokine storms resulting in tissue damage. In this review, we present the overlapping outcomes of cancer inflammation with virus-induced inflammation. The study emphasises how anti-inflammatory drugs that work against cancer inflammation may work against the inflammation caused by the viral infection. It is established that the cytokine storm induced in response to SARS-CoV-2 infection contributes to disease-associated mortality. While cancer remains the second among the diseases associated with mortality worldwide, cancer patients' mortality rates are often observed upon extended periods after illness, usually ranging from months to years. However, the mortality rates associated with COVID-19 disease are robust. The cytokine storm induced by SARS-CoV-2 infection appeared to be responsible for the multi-organ failure and increased mortality rates. Since both cancer and COVID-19 disease share overlapping inflammatory mechanisms, repurposing some anticancer and anti-inflammatory drugs for COVID-19 may lower mortality rates. Here, we review some of these inflammatory mechanisms and propose some potential chemotherapeutic agents to intervene in them. We also discuss the repercussions of anti-inflammatory drugs such as glucocorticoids and hydroxychloroquine with zinc or antiviral drugs such as ivermectin and remdesivir against SARS-CoV-2 induced cytokine storm. In this review, we emphasise on various possibilities to reduce SARS-CoV-2 induced cytokine storm.
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