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Akyildiz A, Gultekin M, Yigit E, Demir E, Ismayilov R, Ahmed M, Buyukkor M, Yildirim HC, Yildirim N, Ucar G, Algin E, Ozturk AE, Akbas S, Selcukbiricik F, Orman S, Turan N, Yilmaz M, Colak R, Engin EO, Majidova N, Bayoglu IV, Beyaz H, Ates O, Ibıs K, Ergen SA, Yuce Sari S, Tezcan Y, Yildiz F, Arik Z. Efficacy of cumulative cisplatin dose on survival in patients with locally advanced cervical cancer treated with definitive chemoradiotherapy: multicenter study by Turkish Oncology Group. Int J Gynecol Cancer 2024:ijgc-2024-005419. [PMID: 38950923 DOI: 10.1136/ijgc-2024-005419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE To investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy. METHODS A retrospective analysis was conducted on 654 patients with stage IB3-IVA disease treated with definitive chemoradiotherapy. Radiotherapy was applied as external beam pelvic with or without para-aortic radiotherapy and brachytherapy. Concomitant chemotherapy was in the form of weekly or 3 weekly cisplatin. Data on demographics, treatment protocols, cumulative cisplatin dose, adverse effects, and survival outcomes were collected. Statistical analyses, including univariate and multivariate Cox regression models, were used to assess factors influencing progression free survival and overall survival. RESULTS The median cumulative cisplatin dose was 210 mg (range 40-320), and ≥200 mg in 503 (76.9%) patients. Median follow-up was 35 months (range 1-150). The 5 year progression free survival and overall survival rates were 66.9% and 77.1%, respectively. Multivariate analysis identified poor performance status, non-squamous cell histology, presence of lymph node metastases, and hemoglobin <10 g/dL before chemoradiotherapy as poor prognostic factors for both progression free survival and overall survival in the whole group. When stage III cases were evaluated separately, the cumulative cisplatin dose <200 mg was found to be a significant poor prognostic factor in overall survival (hazard ratio 1.79, 95% confidence interval 1.1 to 3.0, p=0.031). CONCLUSION Our study showed that a cumulative cisplatin dose >200 mg, particularly in patients with lymph node metastases, significantly improved overall survival. Factors such as anemia, toxicity related challenges, and comorbidities were identified as critical considerations in treatment planning. These findings emphasize the balance between maximizing therapeutic efficacy and managing toxicity, guiding personalized treatment approaches for locally advanced cervical cancer.
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Affiliation(s)
- Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ecem Yigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ecem Demir
- Department of Radiation Oncology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melin Ahmed
- Department of Medical Oncology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Buyukkor
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Yildirim
- Department of Medical Oncology, Fırat University Faculty of Medicine, Elazig, Turkey
| | - Gokhan Ucar
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Efnan Algin
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ahmet Emin Ozturk
- Department of Medical Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Sinem Akbas
- Department of Medical Oncology, Koc University Hospital, Istanbul, Turkey
| | | | - Seval Orman
- Department of Medical Oncology, Kartal Dr. Lufti Kirdar City Hospital, Istanbul, Turkey
| | - Nedim Turan
- Department of Medical Oncology, Kartal Dr. Lufti Kirdar City Hospital, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Rumeysa Colak
- Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Esra Ozen Engin
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Nargiz Majidova
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Vedat Bayoglu
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Havva Beyaz
- Department of Radiation Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ozturk Ates
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Kamuran Ibıs
- Department of Radiation Oncology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Sefika Arzu Ergen
- Department of Radiation Oncology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yilmaz Tezcan
- Department of Radiation Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Nandakumar A, Kishor Rath G, Chandra Kataki A, Poonamalle Bapsy P, Gupta PC, Gangadharan P, Mahajan RC, Nath Bandyopadhyay M, Kumaraswamy, Vallikad E, Visweswara RN, Selvaraj Roselind F, Sathishkumar K, Daniel Vijaykumar D, Jain A, Lakshminarayana Sudarshan K. Concurrent Chemoradiation for Cancer of the Cervix: Results of a Multi-Institutional Study From the Setting of a Developing Country (India). J Glob Oncol 2015; 1:11-22. [PMID: 28804767 PMCID: PMC5551651 DOI: 10.1200/jgo.2015.000877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose The primary output of hospital-based cancer registries is data on cancer stage and treatment-based survival that can be used to evaluate patient care, but because there are many challenges in obtaining follow-up details, a separate study on patterns of care and patterns of survival for patients at selected sites was initiated under the National Cancer Registry Programme of India. This article presents the results for cervical cancer. Patients and Methods A standardized patient information form was used to record patient information, and data were entered into a central repository—the National Centre for Disease Informatics and Research. The study patients were from 12 institutions and were diagnosed between January 1, 2006, and December 31, 2008. Patterns of treatment were assessed for 7,336 patients, and patterns of survival were determined for 2,669 patients from six institutions, at least 70% of whom had data regarding follow-up as of December 31, 2012. Results Of 7,336 patients, 55.5% received optimal radiotherapy (RT). In all, 80.9% of patients had locally advanced cancers (stage IIB to IVA), 51.1% received RT alone, and 44.4% received concurrent chemoradiation (RTCT). In 1,753 patients with locally advanced cancers, significantly better survival was observed with RTCT than with RT alone (5-year cumulative survival, 70.2% v 47.3%; hazard ratio, 0.48; 95% CI, 0.41 to 0.56). Conclusion A conservative estimate indicates that, on an annual basis, 38,771 patients with cervical cancers in India alone do not get the benefit of RTCT and thus they have poorer survival. There is a need to reiterate the National Cancer Institute's alert that advised supplementing chemotherapy to radiation for locally advanced cancer of the cervix in the context of the developing world, where 84.3% of cancers of the cervix occur.
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Affiliation(s)
- Ambakumar Nandakumar
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Goura Kishor Rath
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Amal Chandra Kataki
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - P Poonamalle Bapsy
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Prakash C Gupta
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Paleth Gangadharan
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Ramesh C Mahajan
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Manas Nath Bandyopadhyay
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Kumaraswamy
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Elizabeth Vallikad
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Rudrapatna N Visweswara
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Francis Selvaraj Roselind
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Krishnan Sathishkumar
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Dampilla Daniel Vijaykumar
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Ankush Jain
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Kondalli Lakshminarayana Sudarshan
- , and , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St. John's Medical College; , International Medical School-M.S. Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr. B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Post Graduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
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Fujiwara M, Isohashi F, Mabuchi S, Yoshioka Y, Seo Y, Suzuki O, Sumida I, Hayashi K, Kimura T, Ogawa K. Efficacy and safety of nedaplatin-based concurrent chemoradiotherapy for FIGO Stage IB2-IVA cervical cancer and its clinical prognostic factors. JOURNAL OF RADIATION RESEARCH 2015; 56:305-314. [PMID: 25428244 PMCID: PMC4380049 DOI: 10.1093/jrr/rru101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/23/2014] [Accepted: 10/05/2014] [Indexed: 06/04/2023]
Abstract
Cisplatin-based concurrent chemoradiotherapy (CCRT) is a standard treatment for cervical cancer, but nedaplatin-based CCRT is not routinely administered. We evaluated the efficacy and safety of nedaplatin-based CCRT (35 mg/m(2) weekly) and analyzed prognostic factors for survival among 52 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB2-IVA cervical cancer treated from 1999 to 2009. Patients were treated with a combination of external beam radiotherapy of 40-56 Gy (in 20-28 fractions) and 13.6-28.8 Gy (in 2-4 fractions) of high-dose-rate (HDR) intracavitary brachytherapy or 18 Gy (in 3 fractions) of HDR interstitial brachytherapy. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. Acute and late toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period was 52 months. The median patient age was 63 years. The 5-year OS, PFS and LC rates were 78%, 57% and 73%, respectively. Multivariate analysis showed that histologic type, maximum tumor diameter, and pretreatment hemoglobin level were independent risk factors for PFS. Regarding adverse effects, 24 patients (46%) had acute Grade 3-4 leukopenia and 5 (10%) had late Grade 3 gastrointestinal toxicities. No patient experienced renal toxicity. Nedaplatin-based CCRT for FIGO Stage IB2-IVA cervical cancer was efficacious and safe, with no renal toxicity. Histologic type, maximum tumor diameter, and pretreatment hemoglobin level were statistically significant prognostic factors for PFS.
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Affiliation(s)
- Masateru Fujiwara
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Kazuhiko Hayashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 5650871, Japan
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