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Geeitha S, Ravishankar K, Cho J, Easwaramoorthy SV. Integrating cat boost algorithm with triangulating feature importance to predict survival outcome in recurrent cervical cancer. Sci Rep 2024; 14:19828. [PMID: 39191808 DOI: 10.1038/s41598-024-67562-0] [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: 03/21/2024] [Accepted: 07/12/2024] [Indexed: 08/29/2024] Open
Abstract
Cervical cancer is one of the most dangerous malignancies in women. Prolonged survival times are made possible by breakthroughs in early recognition and efficient treatment of a disease.The existing methods are lagging on finding the important attributes to predict the survival outcome. The main objective of this study is to find individuals with cervical cancer who are at greater risk of death from recurrence by predicting the survival.A novel approach in a proposed technique is Triangulating feature importance to find the important risk factors through which the treatment may vary to improve the survival outcome.Five algorithms Support vector machine, Naive Bayes, supervised logistic regression, decision tree algorithm, Gradient boosting, and random forest are used to build the concept. Conventional attribute selection methods like information gain (IG), FCBF, and ReliefFare employed. The recommended classifier is evaluated for Precision, Recall, F1, Mathews Correlation Coefficient (MCC), Classification Accuracy (CA), and Area under curve (AUC) using various methods. Gradient boosting algorithm (CAT BOOST) attains the highest accuracy value of 0.99 to predict survival outcome of recurrence cervical cancer patients. The proposed outcome of the research is to identify the important risk factors through which the survival outcome of the patients improved.
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Affiliation(s)
- S Geeitha
- Department of Information Technology, M. Kumarasamy College of Engineering, Thalavapalayam, Karur, Tamil Nadu, India
| | - K Ravishankar
- Department of Computer Science and Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Jaehyuk Cho
- Department of Software Engineering and Division of Electronics and Information Engineering, Jeonbuk National University, Jeonju-Si, Republic of Korea.
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Haghighi H, Zahraie N, Haghani M, Heli H, Sattarahmady N. An amplified sonodynamic therapy by a nanohybrid of titanium dioxide-gold-polyethylene glycol-curcumin: HeLa cancer cells treatment in 2D monolayer and 3D spheroid models. ULTRASONICS SONOCHEMISTRY 2024; 102:106747. [PMID: 38154206 PMCID: PMC10765485 DOI: 10.1016/j.ultsonch.2023.106747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
The utilization of ultrasound (US) to activate sonosensitizers for sonodynamic therapy (SDT) has faced challenges such as low activation efficiency and limited therapeutic outcomes, which have hampered its clinical applications. In this study, a nanohybrid of titanium dioxide-gold-polyethylene glycol-curcumin (TiO2-Au-PEG-Cur NH), as a novel US sensitizer, was synthesized, characterized, and applied for SDT of HeLa cancer cells in 2D monolayer model, and also a 3D spheroid model to bridge the gap between 2D cell culture and in vivo future studies. TiO2-Au-PEG-Cur NH contained TiO2 nanoparticles of 36 ± 11 nm in diameter, PEG-curcumin as a filler, and gold nanoparticles of 21 ± 7 nm in diameter with a high purity and a 35:17 of Ti:Au ratio (W/W), and it had a band gap of 2.4 eV, a zeta potential of -23 ± 7 mV, high stability upon US radiation cycles as well as one year storage. SDT of HeLa cells using TiO2-Au-PEG-Cur NH was investigated in the courses of cytotoxicity assessment in vitro, reactive oxygen species (ROS) generation capability, colony formation, cell migration, and the way to form spheroid. IC50 values of 122 and 38 μg mL-1 were obtained for TiO2-Au-PEG-Cur NH without and with US radiation, respectively. TiO2-Au-PEG-Cur NH not only exhibited an inherent capacity to generate ROS, but also represented an excellent therapeutic performance on the cancer cells through ROS generation and enhanced inhibitory effects on cell migration and spheroid formation.
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Affiliation(s)
- H Haghighi
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Zahraie
- Department of Radiology, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Haghani
- Department of Radiology, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Heli
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Sattarahmady
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Krishnamoorthy S, Muruganantham B, Yu JR, Park WY, Muthusami S. Exploring the utility of FTS as a bonafide binding partner for EGFR: A potential drug target for cervical cancer. Comput Biol Med 2023; 167:107592. [PMID: 37976824 DOI: 10.1016/j.compbiomed.2023.107592] [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: 07/28/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
Establishment of human papilloma virus (HPV) infection and its progression to cervical cancer (CC) requires the participation of epidermal growth factor (EGF) receptor (EGFR) and fused toes homolog (FTS). This review is an attempt to understand the structure-function relationship between FTS and EGFR as a tool for the development of newer CC drugs. Motif analysis was performed using national center for biotechnology information (NCBI), kyoto encyclopedia of genes and genomes (KEGG), simple modular architecture research tool (SMART) and multiple expectation maximizations for motif elicitation (MEME) database. The secondary and tertiary structure prediction of FTS was performed using DISOPRED3 and threading assembly, respectively. A positive correlation was found between the transcript levels of FTS and EGFR. Amino acids responsible for interaction between EGFR and FTS were determined. The nine micro-RNAs (miRNAs) that regulates the expression of FTS were predicted using Network Analyst 3.0 database. hsa-miR-629-5p and hsa-miR-615-3p are identified as significant positive and negative regulators of FTS gene expression. This review opens up new avenues for the development of CC drugs which interfere with the interaction between FTS and EGFR.
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Affiliation(s)
- Sneha Krishnamoorthy
- Department of Biochemistry, Karpagam Academy of Higher Education, Coimbatore, 641021, Tamil Nadu, India
| | - Bharathi Muruganantham
- Centre for Cancer Research, Karpagam Academy of Higher Education, Coimbatore, 641021, Tamil Nadu, India
| | - Jae-Ran Yu
- Department of Environmental and Tropical Medicine, Konkuk University College of Medicine, Chungju, South Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea.
| | - Sridhar Muthusami
- Department of Biochemistry, Karpagam Academy of Higher Education, Coimbatore, 641021, Tamil Nadu, India; Centre for Cancer Research, Karpagam Academy of Higher Education, Coimbatore, 641021, Tamil Nadu, India.
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Zheng Z, Hu K, Hou X, Yu L, Yan J, Zhang F. Radiotherapy for postoperative vaginal recurrences of cervical squamous cell carcinoma: analysis of dosing and prognosis. J OBSTET GYNAECOL 2023; 43:2213328. [PMID: 37462369 DOI: 10.1080/01443615.2023.2213328] [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: 07/25/2022] [Accepted: 04/16/2023] [Indexed: 07/21/2023]
Abstract
Squamous cell carcinoma (SCC) is the most common type of vaginal recurrence in cervical cancer patients, and the role of salvage radiotherapy on these patients remains unclear. This study aimed to investigate the efficacy of salvage radiotherapy for vaginal recurrence of SCC in patients who previously underwent surgery and to explore prognostic factors associated with survival. Ninety-seven patients with histologically proven SCC who were treated for vaginal recurrence at Peking Union Medical College Hospital were identified. All patients had previously undergone surgery and received salvage radiotherapy. Factors predictive of overall survival (OS), progression-free survival (PFS), and local control (LC) were investigated. The median follow-up time was 42.5 months. The estimated 5-year OS, PFS, and LC rates were 84%, 79%, and 91%. On multivariate analysis, inguinal lymph node metastasis was significantly associated with poor OS; a tumour size ≤4 cm was associated with longer PFS (p < 0.05); the recurrence pattern was an independent predictor of LC (p < 0.05). In the 45 patients with recurrences that were paravaginal or invasive of surrounding organs, biologically equivalent doses in 2 Gy fractions of ≥72.6 Gy were independently predictive of longer LC (p < 0.05). RT is an effective treatment for postoperative vaginal recurrence in patients with cervical SCC. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.Impact statementWhat is already known on this subject? Radiotherapy plays a critical role in treating recurrent cervical cancer, but the effectiveness of RT for vaginal recurrence in patients who previously underwent surgery remains limited. Few studies have focussed on the effect of RT dose on patient survival.What do the results of this study add? This study investigated the efficacy of RT in patients with cervical squamous cell carcinoma who experienced postoperative recurrence. Lymph node metastasis, tumour size and recurrence pattern were significantly associated with survival. Moreover, an EQD2 ≥ 72.6 Gy was independently predictive of longer LC.What are the implications of these findings for clinical practice and/or further research? RT is an effective treatment for postoperative vaginal recurrence in patients with cervical squamous cell carcinoma. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.
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Affiliation(s)
- Ziye Zheng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lihua Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
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Le CT, Nguyen AQ, Thi Pham HD, Tran LT, Van Truong H, Nguyen DB, Tran HV, Nguyen DD. Recurrent early-stage squamous cell carcinoma cervical cancer presenting with isolated ovary metastasis: a rare case report. Ann Med Surg (Lond) 2023; 85:5662-5665. [PMID: 37915691 PMCID: PMC10617924 DOI: 10.1097/ms9.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/25/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Ovarian metastatic squamous carcinoma of the cervix is rare, accounting for about 0.4%. This study reports a single case of metastatic recurrent cervical cancer in the ovary. Case presentation A 46-year-old patient with a history of cervical cancer T1b2N0M0 underwent a radical hysterectomy, bilateral pelvic lymph node dissection, and ovarian preservation. One year later, the patient was admitted to the hospital because of abdominal pain in the left iliac fossa; the abdominal computed tomography image showed a left ovarian tumour. The patient underwent laparoscopic left oophorectomy. Postoperative histopathology confirmed ovarian squamous cell carcinoma. From this case, we would like to review the literature on epidemiology, diagnosis, treatment, and prognosis. Clinical discussion Ovarian preservation during surgery in patients with cervical cancer offers many benefits, but careful patient selection is required. However, it should be selected carefully and closely monitored. Conclusions Clinicians should be aware of this situation of ovarian metastasis in patients with early cervical cancer undergoing ovarian-conserving surgery.
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Affiliation(s)
| | | | | | | | - Hop Van Truong
- Vietnam National Cancer Hospital
- Hanoi Medical University, Hanoi, Vietnam
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Li J, Zhou H, Lu X, Wang Y, Pang H, Cesar D, Liu A, Zhou P. Preoperative prediction of cervical cancer survival using a high-resolution MRI-based radiomics nomogram. BMC Med Imaging 2023; 23:153. [PMID: 37821840 PMCID: PMC10568765 DOI: 10.1186/s12880-023-01111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Cervical cancer patients receiving radiotherapy and chemotherapy require accurate survival prediction methods. The objective of this study was to develop a prognostic analysis model based on a radiomics score to predict overall survival (OS) in cervical cancer patients. METHODS Predictive models were developed using data from 62 cervical cancer patients who underwent radical hysterectomy between June 2020 and June 2021. Radiological features were extracted from T2-weighted (T2W), T1-weighted (T1W), and diffusion-weighted (DW) magnetic resonance images prior to treatment. We obtained the radiomics score (rad-score) using least absolute shrinkage and selection operator (LASSO) regression and Cox's proportional hazard model. We divided the patients into low- and high-risk groups according to the critical rad-score value, and generated a nomogram incorporating radiological features. We evaluated the model's prediction performance using area under the receiver operating characteristic (ROC) curve (AUC) and classified the participants into high- and low-risk groups based on radiological characteristics. RESULTS The 62 patients were divided into high-risk (n = 43) and low-risk (n = 19) groups based on the rad-score. Four feature parameters were selected via dimensionality reduction, and the scores were calculated after modeling. The AUC values of ROC curves for prediction of 3- and 5-year OS using the model were 0.84 and 0.93, respectively. CONCLUSION Our nomogram incorporating a combination of radiological features demonstrated good performance in predicting cervical cancer OS. This study highlights the potential of radiomics analysis in improving survival prediction for cervical cancer patients. However, further studies on a larger scale and external validation cohorts are necessary to validate its potential clinical utility.
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Affiliation(s)
- Jia Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhou
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaofei Lu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yiren Wang
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daniel Cesar
- Department of Gynecology Oncology, National Cancer Institute, Rio de Janeiro, Brazil
| | - Aiai Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Ping Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Liu H, Sun L, Lian J, Wang L, Xi Y, Zhao G, Wang J, Lan X, Du H, Yan W, Bu P, Wang P, Moore A, Zhao H. Comparison of PD-L1 expression and MMR status between primary and matched metastatic lesions in patients with cervical cancer. J Cancer Res Clin Oncol 2023; 149:11397-11410. [PMID: 37378674 DOI: 10.1007/s00432-023-05020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Programmed death-ligand 1 (PD-L1) and DNA mismatch repair (MMR) are considered predictive biomarkers for immunotherapy in cervical cancer. However, their expression in primary tumors and metastases does not always match affecting the course of treatment. We investigated the consistency of their expression in primary and matched recurrent/metastatic lesions from patients with cervical cancer. METHODS Primary and matched recurrent/metastatic specimens from patients with recurrent cervical cancer (n = 194) were stained for PD-L1 and MMR (MLHI, MSH6, MSH2, and PMS2) using immunohistochemistry. The degree of consistency of PD-L1 and MMR expression in these lesions was analyzed. RESULTS The inconsistency rate of PD-L1 expression in primary and recurrent/metastatic lesions was 33.0%, and it varied between the recurrence sites. Positive PD-L1 rate in primary lesions was lower (15.4%) than that in recurrent/metastatic lesions (30.4%). The discordance rate of MMR expression between primary and recurrent/metastatic lesions was 4.1%. CONCLUSION We conclude that to use PD-L1 as a predictive biomarker for immunotherapy, analysis of both metastatic and primary lesions may be required. High consistency rate of MMR expression between primary and metastatic lesions suggests that testing primary lesions alone can be sufficient for guiding the course of therapy, thereby solving the difficulty of obtaining recurrent/metastatic specimens in clinic.
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Affiliation(s)
- Huizhen Liu
- Department of Gynecologic Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Lixin Sun
- Department of Gynecologic Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Jing Lian
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Lixia Wang
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Yanfeng Xi
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Guohai Zhao
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Jiahong Wang
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Xiaoyu Lan
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Haiyan Du
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Wenxia Yan
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Peng Bu
- Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Ping Wang
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, Rm. 2022, East Lansing, MI, 48824, USA
| | - Anna Moore
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA.
- Department of Radiology, College of Human Medicine, Michigan State University, 766 Service Road, Rm. 2022, East Lansing, MI, 48824, USA.
| | - Hongwei Zhao
- Department of Gynecologic Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China.
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Bartl T, Grimm C, Mader RM, Zielinski C, Prager G, Unseld M, Herac-Kornauth M. Interactions of EGFR/PTEN/mTOR-Pathway Activation and Estrogen Receptor Expression in Cervical Cancer. J Pers Med 2023; 13:1186. [PMID: 37623437 PMCID: PMC10455725 DOI: 10.3390/jpm13081186] [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: 07/03/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Objective: Late-line chemotherapy rechallenge in recurrent cervical cancer is associated with modest therapy response but significant side effects. As mTOR pathways modulate cellular growth via estrogen receptor (ER) signaling and combined mTOR and ER inhibition previously demonstrated survival benefits in breast cancer, this exploratory study evaluates mTOR pathway and ER expression interactions in a preclinical cervical cancer model. (2) Methods: Immunostaining of a 126-tumor core tissue microarray was performed to assess phosphorylated-mTOR and ER expression. To identify tumor subsets with different clinical behavior, expression results were matched with clinicopathologic patient characteristics, and both univariate and multivariable survival statistics were performed. (3) Results: phosphorylated-mTOR correlates with ER (r = 0.309, p < 0.001) and loss of PTEN expression (r = -2.09, p = 0.022) in tumor samples across stages but not in matched negative controls. Positive ER expression is observed significantly more often in phosphorylated-mTOR positive samples (30.0% vs. 6.3%, p = 0.001). In the subgroup of phosphorylated-mTOR positive tumors (n = 60), ER expression is associated with improved survival (p = 0.040). (4) Conclusion: ER expression appears closely intertwined with EGFR/PTEN/mTOR-pathway activation and seems to define a subgroup with clinically distinct behavior. Considering limited therapeutic options in recurrent cervical cancer, further validation of combined mTOR and ER inhibition in selected patients could appear promising.
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Affiliation(s)
- Thomas Bartl
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Christoph Grimm
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Robert M. Mader
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, 1160 Wien, Austria
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Barmon D, Tak A, Baruah U, Begum D, Gupta S, Khanikar D, Nath J, Yadav G. Pattern of Care of Recurrent Cervical Cancer in Low-resource Settings: Challenges and Patient-initiated Follow-up as a Novel Opportunity. J Midlife Health 2023; 14:205-211. [PMID: 38312765 PMCID: PMC10836429 DOI: 10.4103/jmh.jmh_103_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/29/2023] [Accepted: 07/29/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The availability of optimum diagnostic strategies remains a major problem in resource-constraint countries. This technique of patient-initiated follow-up (PIFU) has been recently adopted in the UK for gynecological cancers and has proven cost benefits. However, no study from the Indian subcontinent has ever been reported. Aims and Objectives The primary objective was to study the pattern of care of recurrent cervical cancer in low-resource settings. The secondary objective was to compare the reliability of symptomatology/clinical evaluation and imaging methods on follow-up to detect recurrence and thus explore the feasibility of symptom-based PIFU. Materials and Methods This was a single-institutional retrospective analysis of recurrent cervical cancer cases for a period of 3 years from January 2019 to January 2022. Patients who followed up for minimum of 6 months were included in the study. Results In 57 of the total 69 patients, symptoms alone were the index diagnostic method. Interestingly, neither of the methods of recurrence detection had impact on overall survival (OS). Cox regression analysis revealed adverse impact of erratic/lost to follow-up (hazard ratio [HR] = 3.8) and pelvic side wall disease (HR = 1.33) on survival. Patients with positive para-aortic nodes had significantly shorter disease-free interval of 11 months, so adding systemic therapy to adjuvant treatment in this cohort needs to be further investigated. Conclusion Our analysis showed that patients with recurrence who were diagnosed with clinical manifestations alone vis-à-vis the ones who were diagnosed primarily on routine follow-up visit by some imaging or diagnostic test had comparable oncologic outcomes. PIFU can be a "practice changing modality" in patient management system, especially in low-resource settings. It will prove to be a simple cost-effective method to detect recurrence and prevent fallouts. Our study points to the feasibility of PIFU in Indian scenario.
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Affiliation(s)
- Debabrata Barmon
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Apoorva Tak
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Upasana Baruah
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dimpy Begum
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sakshi Gupta
- Department of Oncopathology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Duncan Khanikar
- Department of Medical Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Garima Yadav
- Department of Obstetrics and Gynaecology, AIIMS, Jodhpur, Rajasthan, India
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Yoder AK, Dong E, Yu X, Echeverria A, Sharma S, Montealegre J, Ludwig MS. Effect of Quality of Life on Radiation Adherence for Patients With Cervical Cancer in an Urban Safety Net Health System. Int J Radiat Oncol Biol Phys 2023; 116:182-190. [PMID: 36228745 PMCID: PMC10083186 DOI: 10.1016/j.ijrobp.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Outcomes for patients undergoing chemoradiation for cervical cancer are dependent on adherence to radiation therapy (RT). In other diseases, quality of life (QoL) is associated with treatment adherence, but the association between QoL and RT adherence for patients with cervical cancer remains unclear. METHODS AND MATERIALS This prospective study included patients undergoing RT for cervical cancer from 2017 to 2021 at an urban safety net hospital. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 was used to assess QoL based on 5 subscales (physical, functional, social and emotional, and cervical-cancer specific). The survey was administered at radiation consult, then weekly during RT and at follow-up. Patient information was abstracted from the medical record. Radiation nonadherence was defined as missing ≥2 days of external beam RT. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 total and subscale scores were compared between adherent and nonadherent patients. Multivariable logistic regression was performed to control for confounding variables. RESULTS Ninety-three patients were enrolled, completing 522 surveys. Median age at diagnosis was 46 years (interquartile range, 40-51); 76% of patients were Hispanic, and 12% were Black. Only 30% of patients were nonadherent with RT. A psychiatric comorbidity (P = .012) and symptomatic presentation (P = .027) were associated with decreased adherence. Baseline total QoL was higher in treatment-adherent than in nonadherent patients (median, 124.86; range, 48-160; 108.9, 46-150; P = .01). Higher baseline functional and physical subscale scores were associated with adherence (P < .05). Change from baseline to lowest score during treatment in the emotional subscale was also associated with patient adherence (P < .05). In multivariable analysis, higher baseline physical score, baseline total score, and change in emotional subscale score were associated with adherence (P < .05). CONCLUSIONS Poor QoL during chemoradiation for cervical cancer is associated with missed treatments. Physician assessment of a patient's well-being while they are undergoing RT is of utmost importance to improve adherence to treatment.
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Affiliation(s)
- Alison K Yoder
- The University of Texas MD Anderson Cancer Center Department of Radiation Oncology, Houston, Texas
| | | | - Xiaoman Yu
- Baylor College of Medicine, Houston, Texas
| | - Alfredo Echeverria
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Shelly Sharma
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Jane Montealegre
- Department of Pediatrics-Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Michelle S Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas.
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Razlog R, Kruger CA, Abrahamse H. Cytotoxic Effects of Combinative ZnPcS 4 Photosensitizer Photodynamic Therapy (PDT) and Cannabidiol (CBD) on a Cervical Cancer Cell Line. Int J Mol Sci 2023; 24:ijms24076151. [PMID: 37047123 PMCID: PMC10094677 DOI: 10.3390/ijms24076151] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The most prevalent type of gynecological malignancy globally is cervical cancer (CC). Complicated by tumor resistance and metastasis, it remains the leading cause of cancer deaths in women in South Africa. Early CC is managed by hysterectomy, chemotherapy, radiation, and more recently, immunotherapy. Although these treatments provide clinical benefits, many patients experience adverse effects and secondary CC spread. To minimize this, novel and innovative treatment methods need to be investigated. Photodynamic therapy (PDT) is an advantageous treatment modality that is non-invasive, with limited side effects. The Cannabis sativa L. plant isolate, cannabidiol (CBD), has anti-cancer effects, which inhibit tumor growth and spread. This study investigated the cytotoxic combinative effect of PDT and CBD on CC HeLa cells. The effects were assessed by exposing in vitro HeLa CC-cultured cells to varying doses of ZnPcS4 photosensitizer (PS) PDT and CBD, with a fluency of 10 J/cm2 and 673 nm irradiation. HeLa CC cells, which received the predetermined lowest dose concentrations (ICD50) of 0.125 µM ZnPcS4 PS plus 0.5 µM CBD to yield 50% cytotoxicity post-laser irradiation, reported highly significant and advantageous forms of cell death. Flow cytometry cell death pathway quantitative analysis showed that only 13% of HeLa cells were found to be viable, 7% were in early apoptosis and 64% were in late favorable forms of apoptotic cell death, with a minor 16% of necrosis post-PDT. Findings suggest that this combined treatment approach can possibly induce primary cellular destruction, as well as limit CC metastatic spread, and so warrants further investigation.
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Affiliation(s)
- Radmila Razlog
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Doornfontein, P.O. Box 17011, Johannesburg 2028, South Africa
| | - Cherie Ann Kruger
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Doornfontein, P.O. Box 17011, Johannesburg 2028, South Africa
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Doornfontein, P.O. Box 17011, Johannesburg 2028, South Africa
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12
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Zhong Q, Tang F, Ni T, Chen Y, Liu Y, Wu J, Zhou W, Feng Z, Lu X, Tan S, Zhang Y. Salvage high intensity focused ultrasound for residual or recurrent cervical cancer after definitive chemoradiotherapy. Front Immunol 2022; 13:995930. [PMID: 36325337 PMCID: PMC9618866 DOI: 10.3389/fimmu.2022.995930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The treatment of residual/recurrent cervical cancer within a previously irradiated area is challenging and generally associated with a poor outcome. Local treatments such as salvage surgery and re-irradiation are usually traumatic and have limited efficacy. High intensity focused ultrasound (HIFU) treatment can directly ablate solid tumors without damaging neighboring healthy tissue. However, the HIFU studies for these patients are limited. Experience gained over the course of 10 years with the use of HIFU for the management of residual/recurrent cervical cancer after chemoradiotherapy is reported herein. Methods 153 patients with residual/recurrent cervical cancer in a previously irradiated field who received HIFU treatment between 2010 and 2021 were retrospectively analyzed. Adverse effects, survival benefit and factors affecting prognosis were given particular attention. Results A total of 36 patients (23.5%) achieved a partial response following HIFU treatment and 107 patients (69.9%) had stable disease. The objective response and disease control rates were 23.5% and 93.5%, respectively. The median progression-free survival (mPFS) and median overall survival (mOS) were 17.0 months and 24.5 months, respectively. Moreover, patients with lesions ≥1.40 cm before HIFU treatment and a shrinkage rate ≥ 30% after treatment had a higher mPFS and mOS, and patients with lesions ≤1.00 cm after HIFU treatment had a higher mPFS (P=<0.05). All the treatment-related adverse events were limited to minor complications, which included skin burns, abdominal pain and vaginal discharge. Conclusions HIFU treatment is likely a preferred option for cervical cancer patients with residual disease or recurrence following CRT that can safely improve the local control rate and extend survival.
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Affiliation(s)
- Qin Zhong
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Fei Tang
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Tingting Ni
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Yanping Chen
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Yuncong Liu
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Jing Wu
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Wen Zhou
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Zhiyu Feng
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Xiaokai Lu
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
| | - Shisheng Tan
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
- *Correspondence: Yu Zhang, ; Shisheng Tan,
| | - Yu Zhang
- Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China
- National Health Commission Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Province People's Hospital, Guiyang, Guizhou, China
- *Correspondence: Yu Zhang, ; Shisheng Tan,
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13
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Meng S, Liu Y, Wang X, Wu X, Xie W, Kang X, Liu X, Guo L, Wang C. The prognostic value and biological significance of gap junction beta protein 2 (GJB2 or Cx26) in cervical cancer. Front Oncol 2022; 12:907960. [PMID: 35936685 PMCID: PMC9355537 DOI: 10.3389/fonc.2022.907960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the prognostic value and explore the biological significance of gap junction protein beta 2 (GJB2 or Cx26) in cervical cancer (CC).MethodsWe first compared GJB2 expression between CC and normal tissues using public databases and immunohistochemistry (IHC). Based on The Cancer Genome Atlas data (TCGA cohort, n = 304) and tissue microarray samples (OBC cohort, n = 111), we explored the prognostic value of GJB2 for CC patients using bioinformatics analysis and IHC scoring. To explore the biological significance of GJB2, Gene set enrichment analysis (GSEA) and Gene Ontology (GO) were performed. The impact of GJB2 on the immune microenvironment was analyzed by CIBERSORTx and ESTIMATE algorithms. We finally investigated the relationship between GJB2 and drug sensitivity based on the Genomics of Drug Sensitivity in Cancer (GDSC).ResultsThe expression of GJB2 was significantly increased in CC over normal tissues. Both the TCGA and OBC cohort found that patients with high GJB2 expression had shorter overall survival (OS) time, and high GJB2 expression was the independent risk factor for prognosis (TCGA: HR, 2.566; 95% CI, 1.066–6.180; p = 0.036; OBC: HR, 2.198; 95% CI, 1.019–4.741; p = 0.045). GJB2 was correlated with patient clinical factors such as tumor size and differentiation grade. The p53 signaling pathway and toll-like receptor pathway may be regulated by GJB2. The abundance of various immune cells was significantly different between the low and high GJB2 expression groups. The ImmuneScore was significantly increased in the high GJB2 expression group. In addition, the expression level of GJB2 was positively correlated with the natural log of the half-maximal inhibitory concentration (LN_IC50) value of cisplatin/paclitaxel (Spearman r = 0.238/0.153, p < 0.001).ConclusionGJB2 can serve as a potential prognostic marker of poor survival and a therapeutic target in CC. Moreover, GJB2 may affect the immune microenvironment and is correlated with chemoresistance.
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Affiliation(s)
- Silu Meng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuhuan Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Wang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan Xie
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Kang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lili Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changyu Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Changyu Wang,
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14
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Wang Z, Ren X, Liu Z, Li Y, Wang T. Multimodality treatment for multiple recurrences of cervical cancer after radiotherapy: a case report. Transl Cancer Res 2022; 11:943-951. [PMID: 35571661 PMCID: PMC9091019 DOI: 10.21037/tcr-21-2250] [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] [Received: 10/14/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022]
Abstract
Background Despite the availability of multiple treatments, the prognosis of recurrent cervical cancer (RCC) remains poor. There are no reports of the entire treatment of cases with multiple recurrences, and clinicians have no guidelines in such cases. We share our experience and consider this complex case of multiple recurrences of cervical cancer. Case Description We report our encounter with a challenging case of locally advanced cervical cancer with multiple recurrences after primary chemoradiotherapy. The first recurrence was a bulky lesion invading the posterior bladder wall and pelvic wall accompanied by severe haematuria and moderate anaemia. The patient was treated with various treatments during the course of the disease, including pelvic exenteration (PE), external beam radiotherapy (EBRT), radioactive seed implantation, and targeted therapy. These salvage treatments led to an overall survival (OS) of 47 months, a progression-free survival (PFS) after the last chemotherapy of 34 months, and a post-relapse survival of 13.5 months. However, the patient died from severe infection due to an intestinal fistula. Conclusions This study reports on the experience of treatment after multiple relapses to provide a reference for clinicians. It suggests that PE should be considered for cervical cancer patients with central recurrence within the primary irradiated field when positive margins can be guaranteed, but it can be palliative even if the pelvic wall is invaded when no other treatments are available. Appropriate extension of resection or additional treatments such as intraoperative radiotherapy (IORT) and neoadjuvant chemotherapy can be considered for patients at high risk of re-recurrence.
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Affiliation(s)
| | - Xiaojun Ren
- Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Zhongshan Liu
- Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun, China
| | - Yunfeng Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun, China
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15
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Ren K, Wang W, Sun S, Wang D, Liu X, Hou X, Hu K, Zhang F. Recurrence Features and Factors influencing Post-relapse Survival in Early-stage Endometrial Cancer after Adjuvant Radiotherapy. J Cancer 2022; 13:202-211. [PMID: 34976183 PMCID: PMC8692693 DOI: 10.7150/jca.65246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose: To evaluate the recurrent patterns and effect of clinicopathological factors on survival after recurrence (R-OS) in early stage endometrial cancer (EC). Methods: Patients with FIGO stage I-II EC, who underwent post-surgery radiotherapy (RT) at our institution between 2000 and 2017, were enrolled. First recurrent patterns, overall survival (OS), and R-OS were evaluated. Univariate and multivariate analyses (MVA) were used to evaluate factors associated with R-OS. Results: 756 patients were analyzed including 510 patients who received vaginal brachytherapy (VBT) and 246 patients who received external beam radiotherapy (EBRT) ± VBT, of whom 66 patients experienced recurrence, including 21 locoregional relapses and 45 distant metastases. Outside RT field recurrence predominated intra-RT field recurrence (106 versus 10 lesions). The 5-year OS rates for patients with and without recurrence were 62.2% and 98.2%, respectively (p<0.001). Among patients who underwent previous VBT, the 5-year OS rates were 61.1%, 92.3%, and 99.1% for distant metastasis, locoregional relapse, and non-recurrence, respectively (p<0.001); among patients who received EBRT ± VBT, the 5-year OS rates were 51.4%, 50.0%, and 98.3%, respectively (p<0.001).On Cox MVA of R-OS for locoregional recurrence patients, para-aortic lymph node metastasis was associated with poorer R-OS (hazard ratio [HR] 10.047, p=0.039), and salvage RT was superior to other therapies (HR 0.06, p=0.026). On Cox MVA of R-OS for distant metastasis, patients with brain metastasis (p=0.041) had the worst R-OS and patients benefited most from combined therapy (HR 0.02, p=0.001). Conclusion: Recurrent patterns were dominated by outside RT field and distant metastasis for early-stage ECs after adjuvant RT. The modality of prior RT had an impact on the choice of salvage therapy. RT could still be an effective salvage treatment for patients who develop locoregional recurrence. Patients with distant metastasis may benefit from combined therapies.
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Affiliation(s)
- Kang Ren
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Wenhui Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Dunhuang Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Xiaorong Hou, Ke Hu and Fuquan Zhang contributed equally to this work
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16
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Razlog R, Kruger CA, Abrahamse H. Enhancement of Conventional and Photodynamic Therapy for Treatment of Cervical Cancer with Cannabidiol. Integr Cancer Ther 2022; 21:15347354221092706. [PMID: 35481367 PMCID: PMC9087227 DOI: 10.1177/15347354221092706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2021] [Accepted: 03/22/2022] [Indexed: 01/10/2023] Open
Abstract
Cervical cancer (CC) is the fourth most diagnosed cancer in women worldwide. Conventional treatments include surgery, chemo- and radiotherapy, however these are invasive and may cause severe side effects. Furthermore, approximately 70% of late-stage CC patients experience metastasis, due to treatment resistance and limitations. Thus, there is a dire need to investigate alternative therapeutic combination therapies. Photodynamic therapy (PDT) is an alternative CC treatment modality that has been clinically proven to treat primary CC, as well as to limit secondary metastasis. Since PDT is a non-invasive localized treatment, with fewer side effects and lessened resistance to dose repeats, it is considered far more advantageous. However, more clinical trials are required to refine its delivery and dosing, as well as improve its ability to activate specific immune responses to eradicate secondary CC spread. Cannabidiol (CBD) isolates have been shown to exert in vitro CC anticancer effects, causing apoptosis post treatment, as well as inducing specific immune responses, which obstruct tumor invasion and angiogenesis, and so hinder CC metastatic spread. This review paper discusses the current conventional and alternative PDT treatment modalities for CC, as well as their limitations over the last 10 years. It has a particular focus on the combinative administration of CBD with these treatments in order to prevent CC secondary migration and so possibly encourage future research studies to focus on this synergistic effect to eradicate CC.
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Affiliation(s)
- Radmila Razlog
- Department of Complementary Medicine,
Faculty of Health Sciences, University of Johannesburg, Doornfontein, Johannesburg,
South Africa
| | - Cherie Ann Kruger
- Laser Research Centre, Faculty of
Health Sciences, University of Johannesburg, Doornfontein, Johannesburg, South
Africa
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of
Health Sciences, University of Johannesburg, Doornfontein, Johannesburg, South
Africa
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17
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Yuan D, Wang J, Yan M, Xu Y. SOX2 as a prognostic marker and a potential molecular target in cervical cancer: A meta-analysis. Int J Biol Markers 2021; 36:45-53. [PMID: 34719977 DOI: 10.1177/17246008211042899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sex determining region Y-box 2 (SOX2) has been reported as a potential therapeutic target for cancer. However, the role of SOX2 in cervical cancer remains largely undetermined. This study was performed to evaluate the correlation of SOX2 with clinical characteristics and prognosis in cervical cancer. METHODS Multiple databases were systematically searched for eligible publications. The combined odds ratios (ORs) or hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were used to assess the effect sizes. RESULTS A total of 17 studies with 1906 participants were identified. SOX2 expression was higher in cervical cancer than in the normal control group (OR = 10.83, 95% CI = 6.64-17.67, P < 0.001), while no significant difference was observed between cervical cancer and cervical intraepithelial neoplasia. SOX2 expression was not associated with age, tumor stage, and lymph node metastasis, but was correlated with tumor grade (grade 2-3 vs. grade 1: OR = 4.59, 95% CI = 2.76-7.62, P < 0.001) and tumor size (≥4 cm vs. ≤4 cm: OR = 1.66, 95% CI = 1.05-2.60, P = 0.028). Based on multivariate Cox analysis, SOX2 expression was not correlated with overall survival, but was closely associated with poor recurrence-free survival (HR = 5.83, 95% CI = 1.35-25.16, P = 0.018) and progress-free survival HR = 2.29, 95% CI = 1.01-5.19, P = 0.046). CONCLUSION SOX2 may serve as a novel prognostic factor and a promising molecular target for cervical cancer.
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Affiliation(s)
- Dandan Yuan
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, PR China
| | - Jian Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, PR China
| | - Mingyu Yan
- Inner Mongolia Medical College Third Affiliated Hospital, Baotou, PR China
| | - Yaohui Xu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, PR China
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Yan J, Zheng Z, Zhu J, Hu K, Hou X, Shen J, Lian X, Sun S, Miao Z, Shen J, Guan H, Meng Q, Zhang F. Radiotherapy for Vaginal Recurrences of Cervical Cancer in Patients After Prior Surgery: Analysis of Effect and Prognostic Factors. Front Oncol 2021; 11:744871. [PMID: 34589438 PMCID: PMC8475272 DOI: 10.3389/fonc.2021.744871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The role of salvage radiotherapy (RT) in the treatment for vaginal recurrence of cervical cancer in patients after prior surgery remains controversial. The aim of this study was to evaluate the efficacy and toxicity of salvage RT and explore prognostic factors associated with the survival after recurrence. Methods Patients with cervical cancer, treated for vaginal recurrences at Peking Union Medical College Hospital between July 2011 and November 2019, were identified. All the patients underwent prior surgery for primary tumor and received salvage RT including external beam radiotherapy (EBRT), brachytherapy (BT), or both. The irradiation field and dose depended on the conditions of patients. Recurrence patterns were classified into four categories according to the site of recurrence. Prognostic factors on the overall survival (OS), progression-free survival (PFS), and local control (LC) were analyzed, and late toxicity was evaluated. Results A total of 141 patients were included in the analysis, with a median follow-up time of 40.8 months. The estimated 5-year OS, PFS, and LC rates were 81%, 75%, and 87%, respectively. In multivariate analysis, endovaginal recurrence and no irradiation history were favorable prognostic factors associated with OS (all p < 0.05), PFS (all p < 0.05), and LC (all p < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of the recurrence pattern is larger than the stage of primary tumor (0.734 vs. 0.670). Conclusions RT was an effective treatment with tolerable toxicity for vaginal recurrences of cervical cancer in patients with prior surgery. Recurrence pattern and irradiation history were important prognostic factors.
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Affiliation(s)
- Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ziye Zheng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiawei Zhu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zheng Miao
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Guan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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