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Guigo M, Dauda MS, Lequesne J, Blache A, Pereira R, Le Gall I, Pernin VE, Gaichies L, Clarisse B, Grellard JM, Joly F, Meyer E, Balosso J. Simultaneous integrated boost on pathologic lymph nodes safely improves clinical outcomes compared to sequential boost in locally advanced cervical cancer: a multicenter retrospective study. Front Oncol 2024; 14:1353813. [PMID: 38887236 PMCID: PMC11180790 DOI: 10.3389/fonc.2024.1353813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Background Objective This multicenter study aimed to retrospectively evaluate the impact of high boost simultaneous integrated boost (SIB) to pathologic lymph nodes compared to Sequential boost (Seq) in patients with locally advanced cervical cancer (LACC). Materials and methods 97 patients with pelvic and/or para-aortic (PAo) node-positive LACC treated by definitive chemoradiation were included. Two groups were analyzed: Sequential boost group and simultaneous integrated boost (SIB) group. Endpoints were Distant Recurrence Free Survival (DRFS), Recurrence Free Survival (RFS), Overall Survival (OS), locoregional pelvic and PAo control and toxicities. Results 3-years DRFS in SIB and Seq groups was 65% and 31% respectively (log-rank p < 0.001). 3-years RFS was 58% and 26% respectively (log-rank p = 0.009). DRFS prognostic factors in multivariable analysis were SIB, PAo involvement and maximum pelvic node diameter ≥ 2cm. Adenocarcinoma histology and absence of brachytherapy tended to be prognostic factors. SIB provided the best pelvic control at first imaging with 97%. There was no significant difference in terms of toxicities between groups. Conclusions Nodal SIB seems to be unavoidable in the treatment of node-positive LACC. It provides the best DRFS, RFS and pelvic control without additional toxicity, with a shortened treatment duration.
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Affiliation(s)
- Marin Guigo
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | | | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - Alice Blache
- Department of Radiation Oncology, Centre Hospitalier Universitaire (CHU) Amiens-Picardie, Amiens, France
| | - Renata Pereira
- Department of Radiation Oncology, Centre Guillaume Le Conquérant, Le Havre, France
| | - Ioana Le Gall
- Department of Radiation Oncology, Centre de la Baie, Avranches, France
| | | | | | | | | | - Florence Joly
- Clinical Research Department, Centre François Baclesse, Caen, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM), U1086, ANTICIPE, Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Emmanuel Meyer
- Department of Radiation Oncology, Centre Maurice Tubiana, Caen, France
| | - Jacques Balosso
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
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Olthof EP, Wenzel HHB, van der Velden J, Stalpers LJA, Mom CH, van der Aa MA. Treatment Strategies Guided by [18F]FDG-PET/CT in Patients with Locally Advanced Cervical Cancer and [18F]FDG-Positive Lymph Nodes. Cancers (Basel) 2024; 16:717. [PMID: 38398108 PMCID: PMC10887300 DOI: 10.3390/cancers16040717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Modern treatment guidelines for women with advanced cervical cancer recommend staging using 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography ([18F]FDG-PET/CT). However, the risk of false-positive nodes and therapy-related adverse events requires caution in treatment planning. Using data from the Netherlands Cancer Registry (NCR), we estimated the impact of [18F]FDG-PET/CT on treatment management in women with locally advanced cervical cancer, i.e., on nodal boosting, field extension, and/or debulking in cases of suspected lymph nodes. METHODS Women diagnosed between 2009 and 2017, who received chemoradiotherapy for International Federation of Gynaecology and Obstetrics (2009) stage IB2, IIA2-IVB cervical cancer with an [18F]FDG-positive node, were retrospectively selected from the NCR database. Patients with pathological nodal examination before treatment were excluded. The frequency of nodal boosting, extended-field radiotherapy, and debulking procedures applied to patients with [18F]FDG-positive lymph nodes was evaluated. RESULTS Among the 434 eligible patients with [18F]FDG-positive nodes, 380 (88%) received interventions targeting these lymph nodes: 84% of these 380 patients received nodal boosting, 78% extended-field radiotherapy, and 12% debulking surgery. [18F]FDG-positive nodes in patients receiving these treatments were more likely to be classified as suspicious than inconclusive (p = 0.009), located in the para-aortic region (p < 0.001), and larger (p < 0.001) than in patients who did not receive these treatments. CONCLUSION While existing guidelines advocate [18F]FDG-PET/CT-guided treatment planning for the management of advanced cervical cancer, this study highlights that not all cases of [18F]FDG-positive nodes received an intervention, possibly due to the risk of false-positive results. Improvement of nodal staging may reduce suboptimal treatment planning.
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Affiliation(s)
- Ester P. Olthof
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Hans H. B. Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
| | - Jacobus van der Velden
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Lukas J. A. Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centre, 1055 AZ Amsterdam, The Netherlands;
| | - Constantijne H. Mom
- Centre for Gynaecologic Oncology Amsterdam (CGOA), Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands; (J.v.d.V.); (C.H.M.)
| | - Maaike A. van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 LC Utrecht, The Netherlands; (H.H.B.W.); (M.A.v.d.A.)
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Cheung ESN, Law FCH, Fung NTC, Soong IS, Hung RHM, Tse TKH, Wong KKS, Wu PY. Simultaneous Integrated Boost for Dose Escalation in Node-Positive Cervical Cancer: 5-Year Experience in a Single Institution. Cancers (Basel) 2023; 15:4647. [PMID: 37760614 PMCID: PMC10526141 DOI: 10.3390/cancers15184647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
This study retrospectively evaluates clinical outcomes of dose escalation to involved nodes using volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) for node-positive locally advanced cervical cancer (LACC) at a single institution. Consecutive patients with node-positive LACC (FIGO2018 IIIC1-IVA) who received definitive chemoradiotherapy by VMAT 45 Gy in 25 fractions with SIB to 55-57.5 Gy, followed by magnetic resonance image-guided adaptive brachytherapy (IGABT) between 2018 and 2022 were identified. A standardized strategy regarding nodal boost delivery and elective para-aortic (PAO) irradiation was employed. Primary endpoints were involved nodal control (INC) and regional nodal control (RNC). Secondary endpoints were pelvic control (PC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), failure pattern, and radiotherapy-related toxicities. A total of 234 involved nodes (182 pelvic and 52 PAO) in 54 patients, with a median of 3 involved nodes per patient (range 1-16), were analyzed. After a median follow-up of 19.6 months, excellent INC was achieved, with four (2%) boost-volume failures occurring in three patients. The 2-year actuarial RNC, PC, LRC, DFS, and OS were 93%, 87%, 87%, 78%, and 85%, respectively. Adenocarcinoma histology was associated with worse RNC (p = 0.02) and OS (p = 0.04), whereas the primary tumor maximum standardized uptake value (SUVmax) was associated with worse PC (p = 0.04) and LRC (p = 0.046) on univariate analysis. The incidence of grade ≥3 acute and late radiotherapy-related toxicity were 2% and 4%, respectively. Treatment of node-positive LACC with VMAT with SIB allows safe and effective dose escalation. The 5-year local experience demonstrated excellent treatment outcomes without additional toxicity.
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Affiliation(s)
- Elki Sze-Nga Cheung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Frederick Chun-Him Law
- Department of Medical Physics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Nelson Tsz-Cheong Fung
- Department of Medical Physics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Inda Sung Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Rico Hing-Ming Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Teddy Ka-Ho Tse
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ken Ka-Shing Wong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Philip Yuguang Wu
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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Kahvecioglu A, Gurlek E, Yedekci FY, Sari SY, Gultekin M, Yildiz F. Simultaneous integrated or sequential boost to clinically involved lymph nodes in patients with locally advanced cervical cancer treated with definitive chemoradiotherapy. Gynecol Oncol 2023; 176:10-15. [PMID: 37413947 DOI: 10.1016/j.ygyno.2023.06.020] [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: 05/12/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The optimal treatment of metastatic lymph nodes (LNs) in locally-advanced cervical cancer (LACC) is controversial. With the widespread use of modern radiotherapy (RT) techniques, it is become possible to perform dose escalation in clinically involved LNs. This study aimed to evaluate the oncologic outcomes of dose escalation to the involved LNs with the simultaneous-integrated (SIB) or sequential boost (SEB) techniques as a part of definitive chemoradiotherapy (CRT) for patients with LACC. METHODS The data of 47 patients treated with definitive CRT with either a SIB or SEB technique to the metastatic LNs between 2015 and 2021 were retrospectively analyzed. All patients received 50.4 Gy/28 fractions of external-beam RT and 28 Gy/4 fractions of brachytherapy. RESULTS The number of boosted LNs was 146. The median size of the LNs was 2 cm (range, 1-5 cm). The median cumulative equivalent dose in 2-Gy fractions for the LNs was 64.2 Gy (range, 57.6-71.2 Gy). During the median 30 months of follow-up (range, 14-91 months), no boosted LNs recurred and the local control (LC) rate was 100%. The 2-year overall, disease-free, local recurrence-free, and distant metastasis-free survival rate was 83.1%, 70.5%, 77.5%, and 74.4%, respectively. In multivariate analysis, the non-squamous cell histology was the only negative independent prognostic factor for DFS and DMFS. Treatment was well tolerated without any serious acute toxicity. Serious late toxicity developed in three (6%) patients as ureteral stenosis, rectal bleeding and pelvic fracture in one patient each. CONCLUSIONS RT dose escalation provides excellent LC for the clinically involved LNs, even for bulky ones, with a low toxicity profile. Routine LN dissection may not be necessary. However, randomized trials are needed to determine the optimal treatment approach.
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Affiliation(s)
- Alper Kahvecioglu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Ezgi Gurlek
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Fazli Yagiz Yedekci
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Sezin Yuce Sari
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Melis Gultekin
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Ferah Yildiz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
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Sari SY, Akdag NNS, Gultekin M, Yildiz F. Adjuvant chemotherapy for locally advanced cervical cancer. Lancet Oncol 2023; 24:e289. [PMID: 37414017 DOI: 10.1016/s1470-2045(23)00270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Sezin Yuce Sari
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Türkiye.
| | - Nur Nimet Saliha Akdag
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Türkiye
| | - Melis Gultekin
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Türkiye
| | - Ferah Yildiz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Türkiye
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Chargari C, Tanderup K, Planchamp F, Chiva L, Humphrey P, Sturdza A, Tan LT, van der Steen-Banasik E, Zapardiel I, Nout RA, Fotopoulou C. ESGO/ESTRO quality indicators for radiation therapy of cervical cancer. Radiother Oncol 2023; 183:109589. [PMID: 37268359 DOI: 10.1016/j.radonc.2023.109589] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/11/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND The European Society of Gynaecological Oncology (ESGO) has previously defined and established a list of quality indicators for the surgical treatment of cervical cancer. As a continuation of this effort to improve overall quality of care for cervical cancer patients across all aspects, ESGO and the European SocieTy for Radiotherapy and Oncology (ESTRO) initiated the development of quality indicators for radiation therapy of cervical cancer. OBJECTIVE To develop a list of quality indicators for radiation therapy of cervical cancer that can be used to audit and improve clinical practice by giving to practitioners and administrators a quantitative basis to improve care and organizational processes, notably for recognition of the increased complexity of modern external radiotherapy and brachytherapy techniques. METHODS Quality indicators were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for identification of potential quality indicators and documentation of scientific evidence, consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians (n = 99). RESULTS Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are detailed to define how the quality indicators will be measured in practice. Targets were also defined for specifying the level which each unit or center should be aiming to achieve. Nineteen structural, process, and outcome indicators were defined. Quality indicators 1-6 are general requirements related to pretreatment workup, time to treatment, upfront radiation therapy, and overall management, including active participation in clinical research and the decision making process within a structured multidisciplinary team. Quality indicators 7-17 are related to treatment indicators. Quality indicators 18 and 19 are related to patient outcomes. DISCUSSION This set of quality indicators is a major instrument to standardize the quality of radiation therapy in cervical cancer. A scoring system combining surgical and radiotherapeutic quality indicators will be developed within an envisaged future ESGO accreditation process for the overall management of cervical cancer, in an effort to support institutional and governmental quality assurance programs.
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Affiliation(s)
| | | | | | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Pauline Humphrey
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Li T Tan
- Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, the Netherlands
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7
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Chargari C, Tanderup K, Planchamp F, Chiva L, Humphrey P, Sturdza A, Tan LT, van der Steen-Banasik E, Zapardiel I, Nout RA, Fotopoulou C. ESGO/ESTRO quality indicators for radiation therapy of cervical cancer. Int J Gynecol Cancer 2023:ijgc-2022-004180. [PMID: 37258414 DOI: 10.1136/ijgc-2022-004180] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The European Society of Gynaecological Oncology (ESGO) has previously defined and established a list of quality indicators for the surgical treatment of cervical cancer. As a continuation of this effort to improve overall quality of care for cervical cancer patients across all aspects, ESGO and the European SocieTy for Radiotherapy and Oncology (ESTRO) initiated the development of quality indicators for radiation therapy of cervical cancer. OBJECTIVE To develop a list of quality indicators for radiation therapy of cervical cancer that can be used to audit and improve clinical practice by giving to practitioners and administrators a quantitative basis to improve care and organizational processes, notably for recognition of the increased complexity of modern external radiotherapy and brachytherapy techniques. METHODS Quality indicators were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for identification of potential quality indicators and documentation of scientific evidence, consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians (n=99). RESULTS Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are detailed to define how the quality indicators will be measured in practice. Targets were also defined for specifying the level which each unit or center should be aiming to achieve. Nineteen structural, process, and outcome indicators were defined. Quality indicators 1-6 are general requirements related to pretreatment workup, time to treatment, upfront radiation therapy, and overall management, including active participation in clinical research and the decision making process within a structured multidisciplinary team. Quality indicators 7-17 are related to treatment indicators. Quality indicators 18 and 19 are related to patient outcomes. DISCUSSION This set of quality indicators is a major instrument to standardize the quality of radiation therapy in cervical cancer. A scoring system combining surgical and radiotherapeutic quality indicators will be developed within an envisaged future ESGO accreditation process for the overall management of cervical cancer, in an effort to support institutional and governmental quality assurance programs.
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Affiliation(s)
| | | | | | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Pauline Humphrey
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Wien, Austria
| | - Li T Tan
- Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Netherlands
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8
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Jiang Y, Wang J, Jiang P, Wang X, Zhang L, Zhang Y. Clinical research of the value of high-risk CTV setting on intensity-modulated radiotherapy for stage IIB-IVA cervical cancer. BMC Cancer 2023; 23:481. [PMID: 37245053 DOI: 10.1186/s12885-023-10931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND This study aims to evaluate the clinical efficacy and side effects of setting up a high-risk clinical target volume (CTV-hr) alongside simultaneous integrated boost intensity-modulated radiotherapy (IMRT-SIB) in patients diagnosed with stage IIB-IVA cervical cancer. METHODS This study retrospectively analysed patients with stage IIB-IVA cervical cancer who received radical radiotherapy at the Affiliated Hospital of Qingdao University between November 2014 and September 2019. The patients were divided into experimental and control groups based on whether CTV-hr was set. All patients received a combined treatment of radiotherapy and chemotherapy. The dosage for paclitaxel was 135 mg/m2, while for cisplatin it was 75 mg/m2 or for carboplatin it was AUC 4-6, given in a cycle of 21 days. Radiotherapy (RT) included external beam radiation therapy (EBRT) and intracavitary brachytherapy (ICBT). In the control group, positive lymph nodes (GTV-n) were treated at a dose of 58-62 Gy/26-28 fractions(f), while clinical target volumes (CTV) were treated with a dose of 46-48 Gy/26-28f. The experimental group received a simultaneous integrated boost (SIB) to CTV-hr at a dose of 54-56 Gy/26-28f, with the same CTV and GTV-n as the control group. Both groups were combined with brachytherapy with a total dose (EQD2, the equivalent dose in 2 Gy/f) of 80-90 Gy. The study measured objective remission rate (ORR), 3-year progression-free survival (PFS) rate, 3-year overall survival (OS) rate, recurrence rate, and side effects as endpoints. RESULTS The study enrolled 217 patients, with 119 in the experimental group and 98 in the control group. Results showed that the experimental group had a higher 3-year OS rate (87.4% vs. 71.4%, p = 0.001) and 3-year PFS rate (72.3% vs. 51.0%, p = 0.000) compared to the control group. Additionally, the experimental group had significantly lower rates of overall recurrence (26.1% vs. 50.0%, p = 0.003), in-field recurrence (15.1% vs. 36.7%, p = 0.000), and out-field recurrence(13.4% vs. 35.7%, p = 0.000) compared to the control group. All observed differences were found to be statistically significant. However, the experimental and control groups had no statistically significant difference in ORR and radiological side effects, such as radiation cystitis and enteritis (p > 0.05). CONCLUSIONS Setting CTV-hr and performing IMRT-SIB on patients with stage IIB-IVA cervical cancer effectively increased the 3-year OS rate, 3-year PFS rate and reduced recurrence rate, with no significant differences in side effects.
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Affiliation(s)
- Yuqi Jiang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Jing Wang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Peng Jiang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Xiang Wang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Lei Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yongchun Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
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9
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Meng Q, Liu X, Hu K, Hou X, Zhang F, Wang W, Yan J, Yang B, Li W. Image-guided intensity-modulated radiotherapy in patients with FIGO IIIC1 cervical cancer: efficacy, toxicity and prognosis. J Cancer 2023; 14:1001-1010. [PMID: 37151392 PMCID: PMC10158505 DOI: 10.7150/jca.81953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/26/2023] [Indexed: 05/09/2023] Open
Abstract
Background: To investigate the efficacy, toxicity and prognosis of image-guided intensity-modulated radiotherapy (IG-IMRT) in patients with FIGO IIIC1 cervical cancer. Methods: We retrospectively reviewed clinical records of patients with FIGO IIIC1 cervical cancer treated with definitive IG-IMRT in our institute from January 2008 to December 2017. A dose of 50.4Gy in 28 fractions was prescribed to at least 95% of PCTV, the positive pelvic lymph nodes received a dose of 56-61.6Gy in 28 fractions with simultaneous integrated boost (SIB). Weekly cone beam compute tomography (CBCT) and daily megavoltage CT (MVCT) was performed before treatment. Both 2D brachytherapy and 3D brachytherapy were allowed in our study. Weekly Cisplatin (30-40mg/m2) was the first line regimen for concurrent chemotherapy. Overall survival (OS), disease free survival (DFS), local control (LC) and local regional control (LRC) was calculated with Kaplan-Meier method. Cox proportional hazard model was used to perform univariate and multivariate analyses. Results: A total of 502 patients were enrolled in this study. The median follow-up duration was 42.1 months (range: 2.3-137.3 months). The 3-year and 5-year estimated OS, DFS, LC, LRC were 81.7% and 75.5%, 71.4% and 68.6%, 89.9% and 89.9%, 86.1% and 84.3%, respectively. The incidences of chronic grade 3 or greater gastrointestinal and genitourinary toxicities were 2.7 % and 0.8%, respectively. Pelvic lymph nodes recurrence occurred in 21 patients (4.2%). Advanced T stage was identified as adverse factor for OS and LC. More positive lymph nodes (≥2) were associated with worse OS, DFS and LRC. The cycles of concurrent chemotherapy significantly affected OS, DFS and LRC. Conclusion: For patients with FIGO IIIC1 cervical cancer, IG-IMRT was well tolerated with excellent survivals. T stage and number of positive lymph nodes significantly influenced the survivals indicating the heterogeneity of stage IIIC1 cervical cancer patients. Adequate cycles of chemotherapy (≥4 cycles) was of great value for this group of patients.
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Affiliation(s)
| | | | - Ke Hu
- ✉ Corresponding authors: Ke Hu, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5487; Fax: 86-10-6512-4875; . Or Xiaorong Hou, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5483; Fax: 86-10-6512-4875; . Or Fuquan Zhang, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5485; Fax: 86-10-6512-4875;
| | - Xiaorong Hou
- ✉ Corresponding authors: Ke Hu, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5487; Fax: 86-10-6512-4875; . Or Xiaorong Hou, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5483; Fax: 86-10-6512-4875; . Or Fuquan Zhang, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5485; Fax: 86-10-6512-4875;
| | - Fuquan Zhang
- ✉ Corresponding authors: Ke Hu, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5487; Fax: 86-10-6512-4875; . Or Xiaorong Hou, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5483; Fax: 86-10-6512-4875; . Or Fuquan Zhang, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China, 100730. Tel: 86-10-6915-5485; Fax: 86-10-6512-4875;
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10
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Brower JV, Bradley KA, Russo AL. Management of Radiographically Positive Pelvic and/or Para-aortic Lymph Nodes During Primary Chemoradiation Therapy for Cervix Cancer. Pract Radiat Oncol 2022; 13:246-250. [PMID: 36529239 DOI: 10.1016/j.prro.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Jeffrey V Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Radiation Oncology Associates-New England, Manchester, New Hampshire.
| | - Kristin A Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrea L Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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11
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Chen J, Li C, Cao Y, Zhu L, Zhang B, You J, Hou H, Wang J, Yuan Z. Toripalimab combined with concurrent platinum-based Chemoradiotherapy in patients with locally advanced cervical Cancer: an open-label, single-arm, phase II trial. BMC Cancer 2022; 22:793. [PMID: 35854236 PMCID: PMC9295395 DOI: 10.1186/s12885-022-09866-w] [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: 12/03/2021] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Concurrent chemoradiotherapy is currently the standard of care for patients with locally advanced cervical cancer. However, even with the application of modern radiotherapy techniques, a considerable number of patients still develop distant metastases. PD-L1 inhibitors show good efficacy in cervical cancer. This single-arm phase II study aims to explore the efficacy and tolerability of combining PD-L1 inhibitor with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer. Methods/design The primary endpoint of the study was the objective response rate assessed according to RECIST v1.1 criteria. The inclusion criteria were previously untreated patients aged 18–75 years with stage III-IVA (FIGO 2018 staging system) locally advanced cervical cancer. During concurrent chemoradiotherapy and consolidation chemotherapy, the enrolled patients will receive toripalimab (240 mg) every 3 weeks. After consolidation chemotherapy, the enrolled patients will be treated with toripalimab (240 mg) once every 6 weeks until the whole treatment cycle reaches 1 year. Intensity modulated radiotherapy was used for external beam radiation, and high-dose rate brachytherapy was delivered under image-guidance. Weekly DDP (40 mg/m2) was given concurrently with radiotherapy while 6 cycles of consolidated chemotherapy (paclitaxel plus DDP) were given after radiotherapy every three weeks. Secondary objectives included safety and tolerability, toxicity profile, progression-free survival, and overall survival. Discussion PD-L1 inhibitor has shown good efficacy in recurrent/metastatic cervical cancer. However, there is still a lack of evidence about its combination with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer. The purpose of this study is to explore the efficacy and tolerance of this combination therapy, so as to lay the foundation for the future phase III randomized study. Trial registration clinicaltrials.govNCT05084677. Retrospectively registered on Octorber 07, 2021.
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Affiliation(s)
- Jie Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Chen Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Yuanjie Cao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Li Zhu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bailin Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Jinqiang You
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Hailing Hou
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Jing Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
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12
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Olthof EP, Wenzel H, van der Velden J, Spijkerboer AM, Bekkers R, Beltman JJ, Nijman HW, Slangen B, Smolders R, van Trommel N, Zusterzeel PLM, Zweemer R, Stalpers LJA, van der Aa M, Mom C. Treatment of bulky lymph nodes in locally advanced cervical cancer: boosting versus debulking. Int J Gynecol Cancer 2022; 32:861-868. [PMID: 35483738 PMCID: PMC9279830 DOI: 10.1136/ijgc-2022-003357] [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] [Indexed: 11/25/2022] Open
Abstract
Objective Treatment strategies for bulky lymph nodes in patients with locally advanced cervical cancer scheduled for definitive chemoradiation include nodal boosting with radiotherapy, surgical debulking, or both. The aim of this retrospective cohort study was to compare survival and toxicity in patients receiving these treatments and to compare them with a group that received neither form of treatment. Methods Women diagnosed between January 2009 and January 2017 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2, IIA2–IVA cervical cancer with lymph nodes ≥1.5 cm without upper limit on pretreatment imaging and treated with definitive chemoradiation were selected from the Netherlands Cancer Registry. Patients were categorized by intention-to-treat strategy: boosting, debulking, or neither treatment, with subgroup analysis for patients receiving both treatments, that is, debulking with boosting. Overall and relapse-free survival outcomes were compared by Kaplan-Meier and Cox regression analyses and toxicity by logistic regression analysis. Results Of 190 patients, 101 (53%) received only nodal boosting, 31 (16%) debulking alone, 29 (15%) debulking combined with boosting, and 29 (15%) received neither treatment. The 5 year overall and relapse-free survival for the treatment groups were 58%, 45% and 45% (p=0.19), and 47%, 44% and 46% (p=0.87), respectively. Multivariable Cox regression analyses demonstrated no differences in overall and relapse-free survival. Combination of debulking with boosting was associated with decreased overall and relapse-free survival compared with debulking alone (HR 2.47, 95% CI 1.22 to 5.00; and HR 2.37, 95% CI 1.14 to 4.93). Nodal boosting was independently associated with a decreased toxicity risk compared with debulking strategy (OR 0.37, 95% CI 0.16 to 0.83). Conclusions This study showed no survival benefit from either nodal boosting or debulking strategy in patients with suspicious bulky nodes. Nodal boosting might, however, be associated with less toxicity. Dual treatment with debulking and boosting showed a worse survival outcome because this group probably represents patients with poor prognostic factors.
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Affiliation(s)
- Ester Paulien Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands .,Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Hans Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ruud Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Brigitte Slangen
- Department of Gynecologic Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ramon Smolders
- Department of Gynecological Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecological Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Centre for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald Zweemer
- Department of Gynecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maaike van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Constantijne Mom
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
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13
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Song T, Xu H, Shi L, Yan S. Prognostic Analysis and Comparison of the 2014 and 2018 International Federation of Gynecology and Obstetrics Staging System on Overall Survival in Patients with Stage IIB-IVA Cervix Carcinoma. Int J Womens Health 2022; 14:333-344. [PMID: 35283649 PMCID: PMC8909488 DOI: 10.2147/ijwh.s348074] [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: 11/12/2021] [Accepted: 02/25/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aimed to assess the prognostic factors of overall survival (OS) in patients with stage IIB–IVA cervix carcinoma (CC) who underwent external beam radiation therapy (EBRT) and brachytherapy (BRT) and to compare the prognostic accuracy of the 2014 and 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with a histopathological diagnosis of CC between 2004 and 2016 were included. The primary endpoint was OS. The prognostic significance for OS was analyzed by the Cox regression model. Prognostic accuracy in evaluating 3- and 5-year OS in different staging systems was evaluated using time-dependent receiver operating characteristic (tdROC) curves. Results A total of 2585 patients with stage IIB–IVA CC, staged according to the 2014 FIGO staging system, were included in the study. The 3- and 5-year OS rates were 63.9% and 56.6%, respectively, with a median OS of 98 months. Independent variables, such as older age at diagnosis, histological grades apart from well or moderately differentiated, large tumor size, advanced tumor stages classified according to the 2014 and 2018 FIGO staging systems and treatment without chemotherapy or unknown were associated with a worse OS. A tdROC analysis conducted using DeLong’s tests revealed no significant difference in the prediction of 3- and 5-year OS between the 2014 and 2018 FIGO staging systems (P = 0.912 and 0.863, respectively). Conclusion Both 2014 and 2018 FIGO staging systems were strong prognostic factors for OS. No significant risk classification was observed for stage IIIC1 disease in the revised 2018 FIGO staging system for patients who underwent EBRT and BRT.
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Affiliation(s)
- Tao Song
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China.,Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Hong'en Xu
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Lei Shi
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
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14
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Scharl S, Weidenbaecher CB, Hugo C, Brambs CE, Knorr K, Combs SE, Schüttrumpf L. First experiences with PET-MRI/CT in radiotherapy planning for cervical cancer. Arch Gynecol Obstet 2022; 306:1821-1828. [PMID: 35262779 PMCID: PMC9519516 DOI: 10.1007/s00404-022-06395-6] [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: 03/09/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Purpose PET-CT has recently been included in the NCCN staging recommendations for cervical cancer stages II–IV and is already routinely applied to radiotherapy planning for other malignancies, as it is expected to provide higher accuracy for the detection of areas with tumor cell spread. In this study, we report on our first experiences of PET-based radiotherapy planning for cervical cancer. Methods 19 patients with cervical cancer that underwent pre-therapeutic PET imaging treated at our institution between January 2016 and April 2019 were included in the study. Information on the primary tumor, lymph node involvement, metastatic spread and changes in the radiotherapy procedure based on the PET findings are described. Results A previously unknown primary tumor extension that was detected by PET imaging in one patient. In patients who underwent a PET before the systematic pelvic and paraaortic lymphonodectomy (n = 2), PET was false negative for pelvic lymph node metastases in 50%. In patients who underwent a PET after the systematic LNE (n = 13), additional lymph node metastases were detected in seven patients (53.80%). Distant metastases were suspected in three patients (15.7%) based on PET imaging. The suspicion was confirmed in one patient (peritoneal spread) and excluded in two patients (supra-diaphragmatic lymph nodes). In 13 patients (68.4%), RT procedures were altered due to findings in PET imaging. Conclusion PET-based radiochemotherapy planning may improve control rates by identifying areas of tumor cell spread eligible for dose escalation. False positivity, however, should be excluded in patients with findings that lead to major modifications of the therapeutic strategy.
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Affiliation(s)
- Sophia Scharl
- Department of Radiation Oncology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany.,Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Clara-Bianca Weidenbaecher
- Department of Radiation Oncology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christine Hugo
- Department of Radiation Oncology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christine E Brambs
- Department of Obstetrics and Gynecology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany
| | - Karina Knorr
- Department of Nuclear Medicine, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Lars Schüttrumpf
- Department of Radiation Oncology, Technische Universität München (TUM), Ismaninger Straße 22, Munich, Germany.
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15
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Jamora KE, Patricia A. Cañal J. Factors predictive of parametrial boost in patients with cervical cancer treated with definitive chemoradiation. Gynecol Oncol Rep 2022; 39:100919. [PMID: 35036508 PMCID: PMC8753115 DOI: 10.1016/j.gore.2021.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study is to identify demographic, clinical, and treatment-related characteristics associated with the prescription of parametrial boost (PMB) in cervical cancer patients undergoing definitive chemoradiation. MATERIALS/METHODS A retrospective chart review of 132 non-metastatic cervical cancer patients treated with definitive chemoradiation from May 2017 to December 2019 was performed. Demographic, clinical, and treatment characteristics were obtained and compared between those who received PMB and those who did not. Clinical outcomes (pelvic recurrence, tumor persistence, distant metastases, and median survival time) were also gathered and compared. Statistical software was used for analysis, with a p < 0.05 considered statistically significant. RESULTS Of the 132 patients included in the analysis, 74 (56%) received PMB of 10 Gy in five daily fractions and 58 (44%) did not. Patients who received PMB were more likely to have pelvic sidewall invasion at the time of diagnosis (OR 4.053, 95% CI 1.163-14.13, p < 0.05) and received more cycles of concurrent chemotherapy during whole pelvis irradiation (OR 2.149, 95% CI 1.370-3.371, p < 0.05). At a median follow-up of 24 months, there was no statistically significant difference in the crude rates of pelvic recurrence, tumor persistence, distant metastasis, and median survival between the two groups. CONCLUSION Presence of pelvic sidewall invasion at diagnosis and increased number of chemotherapy cycles were predictive of administering PMB after whole pelvis irradiation. There was no significant difference in treatment outcomes for those with and without PMB.
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Affiliation(s)
- Kurl E. Jamora
- Division of Radiation Oncology, Department of Radiology, University of the Philippines – Philippine General Hospital, Manila, Philippines
| | - Johanna Patricia A. Cañal
- Division of Radiation Oncology, Department of Radiology, University of the Philippines – Philippine General Hospital, Manila, Philippines
- Department of Radiology, University of the Philippines – College of Medicine, Manila, Philippines
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Qin F, Pang H, Yu T, Luo Y, Dong Y. Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review. Technol Cancer Res Treat 2022; 21:15330338221086403. [PMID: 35341413 PMCID: PMC8966198 DOI: 10.1177/15330338221086403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the fourth most common malignant tumor globally in terms of morbidity and mortality. The presence of lymph node metastasis (LNM) is an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in cervical cancer patients. The International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2018. An important revision designates patients with regional LNM as stage IIIC, pelvic LNM only as stage IIIC1, and para-aortic LNM as stage IIIC2. However, the current staging system is only based on the anatomical location of metastatic lymph nodes (LNs). It does not consider other LN status parameters, which may limit its prognostic significance to a certain extent and needs further exploration and confirmation in the future. The purpose of this review is to summarize the choice of treatment for stage IIIC cervical cancer and the effect of different LN status parameters on prognosis.
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Affiliation(s)
- Fengying Qin
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Huiting Pang
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Yu
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yahong Luo
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yue Dong
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
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17
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Jensen GL, Mezera MA, Hasan S, Hammonds KP, Swanson GP, El-Ghamry MN. Dose escalated simultaneous integrated boost of gross nodal disease in gynecologic cancers: a multi-institutional retrospective analysis and review of the literature. Radiat Oncol J 2021; 39:219-230. [PMID: 34610661 PMCID: PMC8497864 DOI: 10.3857/roj.2020.00948] [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: 11/07/2020] [Accepted: 03/16/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Typical doses of 45-50.4 Gy used to treat regional nodes have demonstrated inadequate control of gross nodal disease (GND) in gynecologic cancer, and accelerated repopulation may limit the efficacy of a sequential boost. We reviewed outcomes of patients treated with a simultaneous integrated boost (SIB) at 2.25 Gy per fraction to positron emission tomography (PET) avid GND to evaluate toxicity and tumor control using this dose-escalated regimen. MATERIALS AND METHODS A total of 83 patients with gynecologic cancer and PET avid inguinal, pelvic, or para-aortic lymphadenopathy were treated using intensity-modulated radiation therapy (IMRT) with SIB. Primary cancers were mostly cervical (51%) and endometrial (34%), and included patients who received concurrent chemotherapy (59%) and/or brachytherapy boost (78%). RESULTS Median follow-up from radiation completion was 12.6 months (range, 2.7 to 92.9 months). Median dose to elective lymphatics was 50.4 Gy (range, 45 to 50.4 Gy) at 1.8 Gy/fraction. Median SIB dose and volume were 63 Gy (range, 56.3 to 63 Gy) and 72.8 mL (range, 6.8 to 1,134 mL) at 2-2.25 Gy/fraction. Nodal control was 97.6% in the SIB area while 90.4% in the low dose area (p = 0.013). SIB radiotherapy (RT) field failure-free, non-SIB RT field failure-free, and out of RT field failure-free survival at 4 years were 98%, 86%, and 51%, respectively. Acute and late grade ≥3 genitourinary toxicity rates were 0%. Acute and late grade ≥3 gastrointestinal toxicity rates were 7.2% and 12.0%, respectively. CONCLUSION Dose escalated SIB to PET avid adenopathy results in excellent local control with acceptable toxicity.
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Affiliation(s)
- Garrett Lee Jensen
- Department of Radiation Oncology, Baylor Scott & White Health, Temple, TX, USA
| | - Megan Ann Mezera
- Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Salman Hasan
- Department of Radiation Oncology, Ascension Via Christi Cancer Center, Wichita, KS, USA
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Tiwari R, Narayanan GS, Reddy VP, Vishwanathan B, Narayanan S, Venugopal R. Impact of nodal boost irradiation and MR-based brachytherapy on oncologic outcomes in node-positive cervical cancer. Gynecol Oncol 2021; 163:110-116. [PMID: 34304907 DOI: 10.1016/j.ygyno.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 12/09/2022]
Abstract
This study aimed to prospectively evaluate the impact of dose-escalated irradiation of nodal metastases on clinical outcomes compared to no boost in patients with node-positive, bulky, locally advanced cervical cancer (LACC) undergoing standard chemoradiation and MRI-based brachytherapy. METHODS This comparative study included 161 patients with node-positive LACC treated with definitive chemoradiation and MRI-based brachytherapy. The prospective Boost arm accrued 71 patients to receive nodal boost either sequentially or simultaneously to an equivalent dose of 60 Gy. The control arm comprised 90 patients treated before this protocol period with no additional nodal boost. RESULT Baseline patient and tumor characteristics were similar in both groups. All patients had at least one tumor dimension >5 cm at presentation, and 31% had para-aortic node involvement. With a median follow-up of 36 months (IQR:19-50.5), the overall 3-year Local control rate was 88.8%. The 3-year Regional control (93% vs. 80%, p = 0.035) was statistically better in the Boost arm. No nodal failure was observed in nodes <3 cc and < 2 cm, even in the No-boost arm. There was no significant difference in Disease-free survival (67.6% vs. 58.9%,p = 0.454) and Overall Survival (78.9% vs. 74.4%,p = 0.87) between the two arms. Incidence of acute or late toxicities did not differ significantly with nodal boost or the boost delivery technique. CONCLUSION The addition of external radiation nodal boost to standard treatment of high-volume cervical cancer has improved pelvic control with an acceptable rate of toxicities. However, high systemic failures continue to pose a challenge in improving survival outcomes.
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Affiliation(s)
- Richa Tiwari
- Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India.
| | - Geeta S Narayanan
- Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India
| | - Vaishnavi Perumal Reddy
- Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India
| | - Bhaskar Vishwanathan
- Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India
| | - Sowmya Narayanan
- Department of Radiation Physics, Vydehi institute of medical sciences and research centre, Bengaluru, India
| | - Ramya Venugopal
- Department of Radiation Physics, Vydehi institute of medical sciences and research centre, Bengaluru, India
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Díaz-Feijoo B, Acosta Ú, Torné A, Gil-Ibáñez B, Hernández A, Domingo S, Gil-Moreno A. Laparoscopic Debulking of Enlarged Pelvic Nodes during Surgical Para-aortic Staging in Locally Advanced Cervical Cancer: A Retrospective Comparative Cohort Study. J Minim Invasive Gynecol 2021; 29:103-113. [PMID: 34217852 DOI: 10.1016/j.jmig.2021.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE To evaluate laparoscopic pelvic lymph node debulking during extraperitoneal aortic lymphadenectomy in diagnosis, therapeutic planning, and prognosis of patients with locally advanced cervical cancer and enlarged lymph nodes on imaging before chemoradiotherapy. DESIGN Retrospective, multicenter, comparative cohort study. SETTING The study was carried out at 11 hospitals with specialized gynecologic oncology units in Spain. PATIENTS Total of 381 women with locally advanced cervical cancer and International Federation of Gynecology and Obstetrics 2018 stage IIIC 1r (radiologic) and higher who received primary treatment with chemoradiotherapy. INTERVENTIONS Patients underwent pelvic lymph node debulking and para-aortic lymphadenectomy (group 1), only para-aortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). On the basis of pelvic node histology, group 1 was subdivided as negative (group 1A) or positive (group 1B). MEASUREMENTS AND MAIN RESULTS False positives and negatives of imaging tests, disease-free survival, overall survival, and postoperative complications were evaluated. In group 1, pelvic lymph node involvement was 43.3% (71 of 164), and aortic involvement was 24.4% (40 of 164). In group 2, aortic nodes were positive in 29.7% (33 of 111). Disease-free survival and overall survival were similar in the 3 groups (p = .95) and in groups 1A and 1B (p = .25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs 2.7%, p = .744), early postoperative (8.0% vs 6.3%, p = .776), or late postoperative complications (6.1% vs 2.7%, p = .252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p = .022). CONCLUSION Laparoscopic pelvic lymph node debulking during para-aortic staging surgery in patients with locally advanced cervical cancer with suspicious nodes allows for the confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves the selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.
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Affiliation(s)
- Berta Díaz-Feijoo
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine - University of Barcelona (Drs. Díaz-Feijoo and Torné).
| | - Úrsula Acosta
- Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (Drs. Acosta and Gil-Moreno), Barcelona
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine - University of Barcelona (Drs. Díaz-Feijoo and Torné)
| | - Blanca Gil-Ibáñez
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre (Dr. Gil-Ibáñez), Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz (Dr. Hernández)
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia (Dr. Domingo), Spain
| | - Antonio Gil-Moreno
- Service of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (Drs. Acosta and Gil-Moreno), Barcelona; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC (Dr. Gil-Moreno), Madrid
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20
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Jayatilakebanda I, Tsang YM, Hoskin P. High dose simultaneous integrated boost for node positive cervical cancer. Radiat Oncol 2021; 16:92. [PMID: 34001158 PMCID: PMC8130443 DOI: 10.1186/s13014-021-01818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/10/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Lymph node metastases presenting with locally advanced cervical cancer are poor prognostic features. Modern radiotherapy approaches enable dose escalation to radiologically abnormal nodes. This study reports the results of a policy of a simultaneous integrated boost (SIB) in terms of treatment outcomes. MATERIALS AND METHODS Patients treated with radical chemoradiation with weekly cisplatin for locally advanced cervical cancer including an SIB to radiologically abnormal lymph nodes were analysed. All patients received a dose of 45 Gy in 25 fractions and a SIB dose of 60 Gy in 25 fractions using intensity modulated radiotherapy/volumetric modulated arc therapy, followed by high dose rate brachytherapy of 28 Gy in 4 fractions. A control cohort with radiologically negative lymph nodes was used to compare impact of the SIB in node positive patients. Treatment outcomes were measured by overall survival (OS), post treatment tumour response and toxicities. The tumour response was based on cross sectional imaging at 3 and 12 months and recorded as local recurrence free survival (LRFS), regional recurrence free survival (RRFS) and distant recurrence free survival (DRFS). RESULTS In between January 2015 and June 2017, a total of 69 patients with a median follow up of 30.9 months (23 SIB patients and 46 control patients) were identified. The complete response rate at 3 months was 100% in the primary tumour and 83% in the nodal volume receiving SIB. The OS, LRFS, RRFS and DRFS at 3 years of the SIB cohort were 69%, 91%, 79% and 77% respectively. High doses can be delivered to regional pelvic lymph nodes using SIB without excessive toxicity. CONCLUSION Using a SIB, a total dose of 60 Gy in 25 fractions chemoradiation can be delivered to radiologically abnormal pelvic nodes with no increase in toxicity compared to node negative patients. The adverse impact of positive nodal status may be negated by high dose deposition using SIB, but larger prospective studies are required to confirm this observation.
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Affiliation(s)
| | - Yat Man Tsang
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK.
- University of Manchester, Manchester, UK.
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21
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Kunogi H, Hsu IC, Yamaguchi N, Kusunoki S, Nakagawa K, Sugimori Y, Fujino K, Terao Y, Ogishima D, Yoshimura R, Sasai K. CT-Guided Pelvic Lymph Nodal Brachytherapy. Front Oncol 2021; 10:532555. [PMID: 33680907 PMCID: PMC7933543 DOI: 10.3389/fonc.2020.532555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose This is a report of our initial experience using computed tomography (CT)-guided interstitial high dose rate (HDR) brachytherapy to treat bulky pelvic nodal metastases as a part of definitive radiotherapy. Material and methods Between February 2015 and April 2019, 14 cervical/endometrial cancer patients presenting with bulky pelvic node(s) underwent nodal interstitial brachytherapy boost in our institution. In total, 17 nodes were treated. The median maximum diameters of the positive nodes at the time of diagnosis and at the first nodal implant were 25 mm (range: 10-65 mm) and 16 mm (range: 9-51 mm), respectively. Dosimetry data of the lymph nodal target volume and small bowel were collected and compared using the paired-sample t-test. Treatment-related toxicities were classified using the Common Terminology Criteria for Adverse Events version 4.0. Results The median follow-up time for all patients was 26 months. Local recurrence in pelvic nodes occurred in one patient (7%) after 16 months. One patient experienced grade 3 bladder bleeding, and one patient experienced grade 2 pubic bone fracture. No patient had grade 2 or greater gastrointestinal toxicity. In the dosimetric analysis, the mean nodal brachytherapy D90% in terms of the total equivalent dose of 2 Gy (EQD2) was 65.6 Gyαβ10. The mean small bowel dose (SBD)0.1cc and SBD1cc in terms of the total EQD2 were 60.4 and 56.5 Gyαβ3, respectively. Nodal D90% was significantly higher in terms of the total EQD2 than the SBD0.1cc (p = 0.003) and SBD1cc (p < 0.001). The Kaplan-Meier 2-year pelvic control estimate was 90%. Conclusions CT-guided interstitial HDR pelvic nodal brachytherapy appears to be well tolerated with excellent local control in cervical or endometrial cancer patients with bulky pelvic nodes. This approach may offer a useful therapeutic option for unresected bulky pelvic nodes.
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Affiliation(s)
- Hiroaki Kunogi
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Nanae Yamaguchi
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Soshi Kusunoki
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Keiko Nakagawa
- Department of Radiation Oncology, Tokyo Medical Dental University, Tokyo, Japan
| | - Yayoi Sugimori
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | | | - Yasuhisa Terao
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Daiki Ogishima
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Oncology, Tokyo Medical Dental University, Tokyo, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
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22
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Zhang K, Wang H, Wang Z, LI F, Cui Y, Ma S, Chen R, Wang Y, Guo S, Wei Y. Intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar in patients with pelvic locoregional recurrence of cervical cancer: Results from a hospital in the Qinghai-Tibet Plateau. Medicine (Baltimore) 2020; 99:e21966. [PMID: 33285664 PMCID: PMC7717818 DOI: 10.1097/md.0000000000021966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The treatment of recurrent cervical cancer, especially pelvic locoregional recurrence, is very challenging for gynecologic oncologists. This study investigated the efficacy and safety of intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar, a novel modified recombinant human endostatin, in patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.This phase 2 study was conducted between May 2018 and May 2019 at a single center in the Qinghai-Tibet Plateau and enrolled 31 patients with pelvic locoregional recurrence of cervical cancer following surgical treatment. All patients were treated with IMRT-based CCRT for 6 weeks and intravenous infusions of Endostar (15 mg/m), which were administered on days 1 to 7 of CCRT, followed by rest for 4 weeks. After resting, chemotherapy with cisplatin (70 mg/m) plus paclitaxel (135-175 mg/m) was given every 3 weeks for a total of 4 treatments.Thirty-one patients were evaluable for the primary endpoint. The mean age was 50.03 years (SD 7.72). The objective response rate was 67.74% and the disease control rate was 83.87% (48.39% achieved a complete response, 19.35% a partial response, 16.13% had disease stabilization, and 16.13% had progressive disease). The most common adverse events were nausea, vomiting, alopecia, neutropenia, and leukopenia; most events were grade 1 or 2 in intensity. Grade 3 toxicities included thrombocytopenia and neutropenia in 2 patients each, and leukopenia in 4 patients. No cases of grade 4 acute toxicity were observed.IMRT-based CCRT with Endostar infusions is effective and safe. Our results support the use of this treatment for patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.
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Affiliation(s)
- Kuan Zhang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Huiping Wang
- Ultrasonic Medicine, Xining Maternal and Child Health Planning Branch Family Planning Service Centre, Qinghai, China
| | - Zhenqing Wang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Fuqing LI
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Ying Cui
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Shengchun Ma
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Rui Chen
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Yuhui Wang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Shul Guo
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Ying Wei
- Department of Radiation Oncology, Qinghai Red Cross Hospital
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23
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Sukhikh ES, Sukhikh LG, Lushnikova PA, Tatarchenko MA, Abdelrahman AR. Dosimetric and radiobiological comparison of simultaneous integrated boost and sequential boost of locally advanced cervical cancer. Phys Med 2020; 73:83-88. [PMID: 32334401 DOI: 10.1016/j.ejmp.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/02/2020] [Accepted: 04/12/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction Some patients with locally advanced cervical cancer (LACC) cannot undergo brachytherapy (BT). Possible treatment includes two-stage external beam radiotherapy (sequential boost - SEQ) or single-stage external beam radiotherapy (simultaneous integrated boost - SIB). The goal of this paper was to carry out dosimetric and radiobiological comparison of these techniques with respect to tumour and organs-at-risk (OARs) irradiation. Methods The anatomic data of six patients with LACC were used for this study. The single-stage SIB-VMAT (25, 27 or 30 fractions) and double-stage SEQ-VMAT (25 + 6 fractions) plans were developed to deliver EQD2=50 Gy to the pelvic region and EQD2=90 Gy to the tumour. The developed plans were compared with respect to an EQD2 dose delivered to a tumour and to the OARs, expected tumour control probability and normal tissue complications probability. Results The developed SIB-VMAT and SEQ-VMAT plans had physical coverage of the CTV tumours with more than 95% of the prescribed dose delivered to more than 95% of the volume. The irradiation of the tumour for both SIB-VMAT and SEQ-VMAT has comparable EQD2 values close to 87-88 Gy. SIB-VMAT treatment plans provided lower levels of irradiation of OARs than SEQ-VMAT plans. The optimal number of fractions for SIB-VMAT was 27. Conclusion SIB-VMAT is a better treatment option for patients with LACC that are not eligible for BT. Results show that both SIB-VMAT and SEQ-VMAT allowed good coverage of the tumour and high-quality dose delivery. SIB-VMAT allowed minimising irradiation of OARs and shortening the overall treatment time by a week.
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Affiliation(s)
- E S Sukhikh
- Tomsk Regional Oncology Centre, 115, Lenin avenue, Tomsk 634050, Russia; Tomsk Polytechnic University, 30, Lenin avenue, Tomsk 634050, Russia.
| | - L G Sukhikh
- Tomsk Polytechnic University, 30, Lenin avenue, Tomsk 634050, Russia
| | - P A Lushnikova
- Tomsk Regional Oncology Centre, 115, Lenin avenue, Tomsk 634050, Russia
| | - M A Tatarchenko
- Tomsk Regional Oncology Centre, 115, Lenin avenue, Tomsk 634050, Russia; Tomsk Polytechnic University, 30, Lenin avenue, Tomsk 634050, Russia
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24
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Boldrini L, Piras A, Chiloiro G, Autorino R, Cellini F, Cusumano D, Fionda B, D'Aviero A, Campitelli M, Marazzi F, Balducci M, Valentini V, Gambacorta MA. Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience. TUMORI JOURNAL 2020; 106:497-505. [PMID: 32066345 DOI: 10.1177/0300891620901752] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Magnetic resonance-guided radiotherapy (MRgRT) represents an innovative approach for personalized radiotherapy treatments and its applications are being explored in various anatomical sites to fully understand its potential advantages. This study describes the first clinical experience of MRgRT application in patients with locally advanced cervical cancer (LACC) undergoing neoadjuvant chemoradiotherapy. The feasibility of the technique is evaluated and its toxicity profile and clinical outcomes are reported. METHODS Patients with LACC (International Federation of Gynecology and Obstetrics stage IIA-IVA) undergoing neoadjuvant chemoradiotherapy (CRT) on a 0.35T Tri-60-Co hybrid unit (ViewRay) were retrospectively compared with randomly selected patients treated with a standard linear accelerator. Total prescribed dose was 50.6 Gy (2.3 Gy/fraction) to planning target volume 1 (PTV1) and 39.6 Gy (1.8 Gy/fraction) to PTV2, delivered using a simultaneous integrated boost. Surgery was performed 8 weeks after the end of CRT. The effect of magnetic resonance guidance on replanning approaches, treatment-related toxicities, and pathologic response were assessed for each patient. Patient outcomes were noted and dosimetric comparisons performed between the 2 arms. RESULTS Nine patients with LACC treated from May 2018 to November 2018 were retrospectively enrolled and their records compared with the records of an equivalent cohort of randomly selected patients. Five replanning cases were performed in the MRgRT group and 0 in the linear accelerator group. Acute G1-G2 gastrointestinal toxicities were observed in 33.3% of MRgRT patients and in 55.5% of linear accelerator patients; acute G1-G2 genitourinary toxicities in 22.2% and 33.3%, respectively. No G3 toxicity was found except for neutropenia in 2 patients. No differences were observed in pathologic response between the 2 groups. CONCLUSIONS Despite the retrospective nature of the observations and the low number of enrolled patients, the application of MRgRT in LACC appears to be safe and feasible with a favorable toxicity profile and response rates comparable to gold standard, supporting the setup of larger prospective studies to investigate the potentialities of this new technology.
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Affiliation(s)
- Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Antonio Piras
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Rosa Autorino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Andrea D'Aviero
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maura Campitelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - Mario Balducci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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