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Carvalho JP, Freitas D, Hanna S, Velho IA, Carvalho FM. Gemcitabine-Induced Radiation Recall Phenomenon in Cervical Cancer: A Case Report. Cureus 2023; 15:e39228. [PMID: 37337501 PMCID: PMC10277157 DOI: 10.7759/cureus.39228] [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] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
The radiation recall phenomenon is a rare, massive inflammatory reaction induced by some chemotherapeutic agents in previously irradiated areas. When it occurs in the pelvis it looks like a recurrence. Recognizing this phenomenon is paramount to avoiding unnecessary surgical intervention and complications. Symptoms manifest as dermatitis, mucositis, myositis, esophagitis, colitis, proctitis, and pneumonitis in areas within the irradiation field. Most patients respond to clinical treatment with corticosteroids. Here, we describe a 47-year-old patient with cervical carcinoma, FIGO stage IIB, submitted to external beam radiotherapy and concomitant chemotherapy with cisplatin (40 mg/m2 weekly), followed by intracavitary brachytherapy. One month after the end of radiotherapy and chemotherapy, the patient underwent laparoscopic completion hysterectomy plus bilateral salpingo-oophorectomy, followed by three cycles of cisplatin 50 mg/m2 D1 and gemcitabine 1,000 mg/m2 D1 and D8. Four months after the surgery, she presented with a suspicious mass in the vaginal dome that proved to be an exuberant inflammatory reaction that regressed after treatment with corticosteroids.
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Affiliation(s)
- Jesus Paula Carvalho
- Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo (ICESP/HC/FMUSP) Faculdade de Medicina. Universidade de Sao Paulo, Sao Paulo, BRA
| | | | - Samir Hanna
- Radiation Oncology, Hospital Sirio Libanes, Sao Paulo, BRA
| | - Isabela A Velho
- Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo (ICESP/HC/FMUSP) Faculdade de Medicina. Universidade de Sao Paulo, Sao Paulo, BRA
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Krishna A, Hasib AG, Fernandes D, Athiyamaan MS, Rao S, Shankar S, Ali M, Priyadarshini H, Sophia M, Shridhar CH, George S, Babu A, Banerjee S, Sunny J, Srinivas C, Lobo D. Comparison of two high dose rate intracavitary brachytherapy regimens in treatment of cervical cancer: a preliminary report. Discov Oncol 2023; 14:33. [PMID: 36988721 PMCID: PMC10060448 DOI: 10.1007/s12672-023-00646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND To assess and compare the local control and toxicities between HDR Intracavitary Brachytherapy with 7.5 Gy and 9 Gy per fraction after EBRT in treatment of carcinoma cervix. METHODOLOGY A total of 180 patients were randomly assigned to 2 arms. Arm A received HDR intracavitary brachytherapy with a dose of 7.5 Gy per fraction, 1 fraction per week for 3 fractions and Arm B received 9 Gy per fraction, 1 fraction per week for 2 fractions. Patients were evaluated on follow up for assessment of local control and toxicities. RESULTS The median follow up was 12 months (6-18 months). In arm A 89% of the patient had complete response and 11% had recurrence or metastasis. In arm B 93% of the patient had complete response and 7% had recurrence or metastasis. Grade 2/3 diarrhoea was seen in 4.4% of patients in Arm A and in 7.7% in Arm B. Grade 2/3 proctitis was seen in 3.3% of patients in 7.5 Gy arm and in 6.6% in 9 Gy arm. One patient in each arm had grade 1 haematuria. The overall duration of treatment was significant lower in Arm B compared to Arm A (59 days vs 68 days, p = 0.01). CONCLUSION The result of this clinical study shows that Intracavitary brachytherapy with a dose of 9 Gy per fraction is non inferior to other schedules in term of local control and does not result in increased toxicity.
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Affiliation(s)
- Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India.
| | - A G Hasib
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - Donald Fernandes
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - M S Athiyamaan
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India
| | - Sandesh Rao
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | | | | | | | - Maria Sophia
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - C H Shridhar
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - Seby George
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - Amrutha Babu
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - Sourjya Banerjee
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India
- Department of Radiation Oncology, Father Muller Medical College, Mangalore, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India
| | - Challapalli Srinivas
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India
| | - Dilson Lobo
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, India
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The effects of bismuth oxide nanoparticles and cisplatin on MCF-7 breast cancer cells irradiated with Ir-192 High Dose Rate brachytherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Talik Sisin NN, Abdul Razak K, Zainal Abidin S, Che Mat NF, Abdullah R, Ab Rashid R, Khairil Anuar MA, Rahman WN. Synergetic Influence of Bismuth Oxide Nanoparticles, Cisplatin and Baicalein-Rich Fraction on Reactive Oxygen Species Generation and Radiosensitization Effects for Clinical Radiotherapy Beams. Int J Nanomedicine 2020; 15:7805-7823. [PMID: 33116502 PMCID: PMC7567565 DOI: 10.2147/ijn.s269214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to quantify synergetic effects induced by bismuth oxide nanoparticles (BiONPs), cisplatin (Cis) and baicalein-rich fraction (BRF) natural-based agent on the reactive oxygen species (ROS) generation and radiosensitization effects under irradiation of clinical radiotherapy beams of photon, electron and HDR-brachytherapy. The combined therapeutic responses of each compound and clinical radiotherapy beam were evaluated on breast cancer and normal fibroblast cell line. Methods In this study, individual BiONPs, Cis, and BRF, as well as combinations of BiONPs-Cis (BC), BiONPs-BRF (BB) and BiONPs-Cis-BRF (BCB) were treated to the cells before irradiation using HDR brachytherapy with 0.38 MeV iridium-192 source, 6 MV photon beam and 6 MeV electron beam. The individual or synergetic effects from the application of the treatment components during the radiotherapy were elucidated by quantifying the ROS generation and radiosensitization effects on MCF-7 and MDA-MB-231 breast cancer cell lines as well as NIH/3T3 normal cell line. Results The ROS generated in the presence of Cis stimulated the most substantial amount of ROS compared to the BiONPs and BRF. Meanwhile, the combination of the components had induced the higher ROS levels for photon beam than the brachytherapy and electron beam. The highest ROS enhancement relative to the control is attributable to the presence of BC combination in MDA-MB-231 cells, in comparison to the BB and BCB combinations. The radiosensitization effects which were quantified using the sensitization enhancement ratio (SER) indicate the highest value by BC in MCF-7 cells, followed by BCB and BB treatment. The radiosensitization effects are found to be more prominent for brachytherapy in comparison to photon and electron beam. Conclusion The BiONPs, Cis and BRF are the potential radiosensitizers that could improve the efficiency of radiotherapy to eradicate the cancer cells. The combination of these potent radiosensitizers might produce multiple effects when applied in radiotherapy. The BC combination is found to have the highest SER, followed by the BCB combination. This study is also the first to investigate the effect of BRF in combination with BiONPs (BB) and BC (BCB) treatments.
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Affiliation(s)
- Noor Nabilah Talik Sisin
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia
| | - Khairunisak Abdul Razak
- Material Engineering Programme, School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Penang, Malaysia
| | - Safri Zainal Abidin
- Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | - Nor Fazila Che Mat
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia
| | - Reduan Abdullah
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia.,Nuclear Medicine, Radiotherapy and Oncology Department, Hospital of Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Raizulnasuha Ab Rashid
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia
| | - Muhammad Afiq Khairil Anuar
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia
| | - Wan Nordiana Rahman
- Medical Radiation Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia
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Drokow EK, Zi L, Qian H, Xu L, Foli F, Ahmed HAW, Akpabla GS, Wu G, Agyekum EB, Gao W, Deku MA, Song J, Sun K. Tolerability, Efficacy and Feasibility of Concurrent Gemcitabine and Cisplatin (CGP) Combined With Intensity Modulated Radiotherapy for Loco-Regionally Advanced Carcinoma of the Cervix. J Cancer 2020; 11:2632-2638. [PMID: 32201533 PMCID: PMC7066008 DOI: 10.7150/jca.40276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/20/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Gemcitabine and cisplatin combined with conventional radiotherapy in treating patients with cervical cancer, resulted in a favourable conclusion but accompanied with high toxicity. The objective of our research was to assess the tolerability, efficacy and feasibility of dual chemotherapy in addition to image-guided adaptive brachytherapy and highly conformal external beam radiation therapy. Methods & Materials: From June 2011 to November 2013, 81 cervical cancer patients with FIGO stage IB2-IIIB medical records were retrospectively reviewed. All patients received whole pelvic radiotherapy (WPRT) to a total dose of 50.4 Gy/ 1.8 Gy Chemoradiotherapy prescription objectives were: concurrent gemcitabine (125 mg/m2) and cisplatin (30 mg/m2) during the 6 weeks of external beam radiation therapy (EBRT) followed by two cycles of gemcitabine (1 g/m2, d1, d8) and cisplatin (25 mg/m2 d1-d3) on the tenth week. External beam radiotherapy was followed by image-guided brachytherapy of 24 Gy/ 4 fractions. Version 4 of the common terminology criteria for adverse events (CTCAE v 4.0) was used in grading the toxicities. Results: Sixty-nine patients obtained complete response (CR), six had a partial response (PR), and five patients had stable disease (SD). The disease control rate (DCR= SD and ORR) and overall response rate (ORR= PR, CR or PR) were 92.6% and 85.2% respectively. The 3-year and 5-year estimated overall survival (OS) was 75.4% and 66.3%, and the 3-year and 5-year estimated progression-free survival (PFS) were 78.2% and 65.4%. The median PFS time and OS time were 36.8 months and 45.5 months, respectively. Distance metastasis was evident in the lung (3 patients), pelvic wall (2 patients), liver (3 patients) and bone (2 patients). Six (6) had a local relapse, and two (2) patients had local relapse plus simultaneous systemic metastatic tumour. Conclusions: Unlike past results, gemcitabine and cisplatin appear to be tolerable, efficient and feasible when combined with conformal radiotherapy.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | - Liu Zi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Han Qian
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | - Lanlan Xu
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | - Francis Foli
- Department of Internal Medicine, Seventh Day Adventist Hospital, Takoradi MC 1034, Ghana
| | - Hafiz Abdul Waqas Ahmed
- Department of Haematology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | | | - Guangyin Wu
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | | | - Weihua Gao
- Department of Radiation Oncology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | - Marie-Anne Deku
- Department of Oncology, Binzhou Medical University, Yantai-Shandong 264003, China
| | - Juanjuan Song
- Department of Haematology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
| | - Kai Sun
- Department of Haematology, Zhengzhou University People's Hospital & Henan Provincial People's Hospital 450003, China
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Sisin NNT, Abdul Razak K, Zainal Abidin S, Che Mat NF, Abdullah R, Ab Rashid R, Khairil Anuar MA, Mohd Zainudin NH, Tagiling N, Mat Nawi N, Rahman WN. Radiosensitization Effects by Bismuth Oxide Nanoparticles in Combination with Cisplatin for High Dose Rate Brachytherapy. Int J Nanomedicine 2019; 14:9941-9954. [PMID: 31908451 PMCID: PMC6927229 DOI: 10.2147/ijn.s228919] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this study was to investigate the potential of the synergetic triple therapeutic combination encompassing bismuth oxide nanoparticles (BiONPs), cisplatin (Cis), and high dose rate (HDR) brachytherapy with Ir-192 source in breast cancer and normal fibroblast cell line. Methods In vitro models of breast cancer cell lines (MCF-7, MDA-MB-231) and normal fibroblast cell line (NIH/3T3) were employed. Cellular localization and cytotoxicity studies were conducted prior to inspection on the radiosensitization effects and generation of reactive oxygen species (ROS) on three proposed radiosensitizers: BiONPs, Cis, and BiONPs-Cis combination (BC). The optimal, non-cytotoxic concentration of BiONPs (0.5 mM) and the 25% inhibitory concentration of Cis (1.30 µM) were applied. The radiosensitization effects were evaluated by using a 0.38 MeV Iridium-192 HDR brachytherapy source over a prescribed dose range of 0 Gy to 4 Gy. Results The cellular localization of BiONPs was visualized by light microscopy and accumulation of the BiONPs within the vicinity of the nuclear membrane was observed. Quantification of the sensitization enhancement ratio extrapolated from the survival curves indicates radiosensitization effects for MCF-7 and MDA-MB-231 when treated with BiONPs, Cis, and BC. However, NIH/3T3 cells exhibited contradictive behavior as it only reacted towards the BC combination. Nonetheless, the MCF-7 cell line loaded with BC shows the highest SER of 4.29. ROS production analysis, on the other hand, shows that Cis and BC radiosensitizers generated the highest free radicals in comparison to BiONPs alone. Conclusion A BiONPs-Cis combination was unveiled as a novel approach that offers promising radiosensitization enhancement that will increase the efficiency of tumor control while preserving the normal tissue at a reduced dose. This data is the first precedent to prove the synergetic implication of BiONPs, Cis, and HDR brachytherapy that will be beneficial for future chemoradiotherapy strategies in cancer care.
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Affiliation(s)
| | - Khairunisak Abdul Razak
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Penang, Malaysia
| | - Safri Zainal Abidin
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
| | - Nor Fazila Che Mat
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Reduan Abdullah
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital of Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | | | | | - Nashrulhaq Tagiling
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norazlina Mat Nawi
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nordiana Rahman
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Tewari KS, Agarwal A, Pathak A, Ramesh A, Parikh B, Singhal M, Saini G, Sushma PV, Huilgol N, Gundeti S, Gupta S, Nangia S, Rawat S, Alurkar S, Goswami V, Swarup B, Ugile B, Jain S, Kukreja A. Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2018. [PMCID: PMC6063013 DOI: 10.1186/s40661-018-0061-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Methods/materials Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. Results This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. Conclusions The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.
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Efficient inhibition of cervical cancer by dual drugs loaded in biodegradable thermosensitive hydrogel composites. Oncotarget 2017; 9:282-292. [PMID: 29416613 PMCID: PMC5787464 DOI: 10.18632/oncotarget.22965] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/09/2017] [Indexed: 01/02/2023] Open
Abstract
Background and Purpose We aimed to explore the anti-tumor effect and mechanism of the combination of cisplatin (DDP)-containing thermosensitive hydrogel (PEG-PCL-PEG, or PECE) and paclitaxel (PTX)-loaded MPEG-PCL polymeric micelles called PDMP on human cervical carcinoma (HeLa) cell. In our previous studies, we found that PDMP in situ treatment of lung cancer will be liable to have potential in Lung cancer patients. Results Compared with other treatments, PDMP was most effective in prolonging survival time (P < 0.05), inhibiting tumor growth (P < 0.05), decreasing expression of CD133 (P < 0.05), CD31 (P < 0.05), and aldehyde dehydrogenase 1 (ALDH1) (P > 0.05), inducing G1 phase arrest (P < 0.05), increasing the apoptosis rate (P < 0.05), and in expressing ATM and γ-H2AX (P < 0.05). Conclusions PDMP is regarded as a promising anti-tumor reactant, when it comes to the treatment of cervical carcinoma. Methods we used a xenograft cervical cancer model to verify the anti-tumor activity of PDMP and to explore its mechanism of action. Mice were intratumorally administered with NS, PECE, PTX+DDP or PDMP. After two days of treatment, three mice per group were sacrificed and tumor tissue was harvested. Levels of histone H2AX phosphorylation (γ-H2AX) were determined by immunohistochemistry and ataxia telangiectasia mutated(ATM) protein levels were measured by western blot analysis. In addition, it would sacrifice each of group of three mice through 10 days’ treatment, what’s more, it would harvest tumor by virtue of flow cytometry and immunohistochemical analysis. It would like to use there maining mice to analyze tumor growth and survival. The remaining mice were analyzed for tumor growth and survival.
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Xu S, Tang YY, Yu YX, Yun Q, Yang JP, Zhang H, Peng Q, Sun X, Yang LL, Fu S, Wu JB. Novel composite drug delivery system as a novel radio sensitizer for the local treatment of cervical carcinoma. Drug Deliv 2017; 24:1139-1147. [PMID: 28797171 PMCID: PMC8241059 DOI: 10.1080/10717544.2017.1362676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 01/07/2023] Open
Abstract
In this study, we investigated in vivo radiosensitizing effects of a gel-based dual drug delivery system (DDS) (PECE/DDP + mPEG-PCL/PTX, or PDMP) in a cervical cancer model, and determined its possible mechanisms of action. A xenograft cervical cancer model was used to investigate the radio sensitization effect of PDMP. Mice underwent paclitaxel (PTX) + cisplatin (DDP), PECE, or PDMP treatment followed by single radiation doses ranging from 0 Gy to 20 Gy. Radio sensitization was analyzed by tumor regrowth delay (TGD). The sensitization enhancement ratio (SER) was calculated by the doses needed to yield TGD when using radiation treatment alone and when using radiation plus drug treatment. The impact of irradiation and drugs on TGD was determined, and an optimum radiation dose was chosen for further evaluation of radio sensitizing effects. The data showed that PDMP yielded the highest radio sensitization (SER was 1.3) and a radiation dose of 12 Gy was chosen for further investigation. PDMP + radiotherapy treatment was most effective in inhibiting tumor growth, prolonging survival time, decreasing expression of CD31, CD133, and aldehyde dehydrogenase 1 (ALDH1), inducing G2/M phase arrest, apoptosis, and expression of Ataxia telangiectasia mutated (ATM) and histone H2AX phosphorylation (γ-H2AX). Thus, our data indicated that PDMP is a promising anti-tumor and radio sensitization reagent for the treatment of cervical carcinoma.
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Affiliation(s)
- Shan Xu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- Department of Oncology, MianYang Central Hospital, Mianyang, Sichuan Province, China
| | - Yu Ying Tang
- MianYang Central Hospital, Mianyang, Sichuan Province, China
| | - Yan Xin Yu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qin Yun
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jing Pin Yang
- Department of Oncology, The First People's Hospital of Guangyuan, Guangyuan, Sichuan Province, China
| | - Heng Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qiuxia Peng
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xiaoyang Sun
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Ling Lin Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - ShaoZhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jing Bo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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A phase I study of adjuvant intensity-modulated radiotherapy with concurrent paclitaxel and cisplatin for cervical cancer patients with high risk factors. Med Oncol 2015; 32:247. [PMID: 26433959 DOI: 10.1007/s12032-015-0689-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/21/2015] [Indexed: 02/05/2023]
Abstract
The aim of the study is to determine the maximum tolerated dose (MTD) and acute dose-limiting toxicities (DLTs) of adjuvant concurrent paclitaxel and cisplatin (TP) with pelvic intensity-modulated radiotherapy (IMRT) for early-stage cervical cancer patients with high risk factors. Women who underwent radical hysterectomy and pelvic lymphadenectomy for stages IB-IIA cervical cancer and had high risk factors were enrolled. One cycle of TP was delivered before and after concurrent chemoradiotherapy, respectively. Then 3 weeks after the start of the initial cycle of the chemotherapy, patients received IMRT in a total dose of 50-50.4 Gy in 25-28 fractions with two cycles of concurrent TP, which was administered with escalating doses. Eighteen patients were enrolled at three dose levels. At dose level 1 (paclitaxel 90 mg/m(2), cisplatin 40 mg/m(2)) and level 2 (paclitaxel 90 mg/m(2), cisplatin 50 mg/m(2)), DLT (grade 3 leukopenia) was observed in one patient, respectively. At level 3 (paclitaxel 105 mg/m(2), cisplatin 50 mg/m(2)), two DLTs (grade 3 leukopenia) were observed in two patients. The MTD of paclitaxel and cisplatin was then defined as 90 and 50 mg/m(2), respectively. Pelvic IMRT and concurrent TP is a safe and tolerable adjuvant treatment regimen for cervical cancer patients with high risk factors. The MTD of concurrent chemotherapy is paclitaxel 90 mg/m(2) and cisplatin 50 mg/m(2). Trial registration Current controlled trials ChiECRCT-2014025.
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Luo Y, Li JL, Yang L, Zhang W. Chemotherapy with gemcitabine plus cisplatin in patients with advanced thymic squamous cell carcinoma: Evaluation of efficacy and toxicity. Thorac Cancer 2015; 7:167-72. [PMID: 27042218 PMCID: PMC4773311 DOI: 10.1111/1759-7714.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022] Open
Abstract
Background Squamous cell carcinoma of the thymus is a rare thymic epithelial neoplasm that tends to widely metastasize at initial presentation. Because of its rarity, the optimal chemotherapeutic regimen remains uncertain. A gemcitabine and cisplatin regimen has shown promising efficacy in the treatment of other squamous cell carcinomas. We assessed the efficacy and toxicity of this regimen in patients with advanced thymic squamous cell carcinoma. Methods Between January 2003 and December 2012, 13 patients with untreated or unresectable recurrent thymic squamous cell carcinomas, who were treated with gemcitabine and cisplatin, were retrospectively analyzed. The endpoints in this study were clinical response rate, disease control rate, progression‐free survival, and overall survival. Significant hematological and non‐hematological toxicities were also assessed. Results Three patients were in Masaoka stage IVa and 10 were in stage IVb. The median number of treatment cycles for the present chemotherapy regimen was four. The clinical response and disease control rates were 61.5% and 92.3%, respectively. The median progression‐free and median overall survival rates were 14.5 months (95% confidence interval, 9.2–19.8 months) and 50.7 months (95% confidence interval, 24.9–76.5 months), respectively. Grade 3/4 hematological toxicities were observed in seven (53.8%) patients, and non‐hematological toxicities were mild. Conclusion This retrospective analysis demonstrated that gemcitabine plus cisplatin was active against advanced thymic squamous cell carcinoma with manageable toxicity. Gemcitabine may be a novel and alternative agent for advanced thymic squamous cell carcinoma.
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Affiliation(s)
- Yang Luo
- Department of Medical Oncology Cancer Institute/Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Jun-Ling Li
- Department of Medical Oncology Cancer Institute/Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Lin Yang
- Department of Pathology Cancer Institute/Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Wen Zhang
- Department of Medical Oncology Cancer Institute/Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
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Ikeda M, Matsumoto K, Nishi M, Tabata KI, Fujita T, Ishiyama H, Hayakawa K, Iwamura M. Comparison of radical cystectomy and chemoradiotherapy in patients with locally advanced bladder cancer. Asian Pac J Cancer Prev 2015; 15:6519-24. [PMID: 25169480 DOI: 10.7314/apjcp.2014.15.16.6519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followed by radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033) but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.
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Affiliation(s)
- Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan E-mail :
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Zamaniah WIW, Mastura MY, Phua CE, Adlinda A, Marniza S, Rozita AM. Definitive concurrent chemoradiotherapy in cervical cancer--a University of Malaya Medical Centre experience. Asian Pac J Cancer Prev 2014; 15:8987-92. [PMID: 25374241 DOI: 10.7314/apjcp.2014.15.20.8987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre. MATERIALS AND METHODS A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin (40 mg/m2) concurrent with daily EBRT to pelvis of 45-50 Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated. RESULTS The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients. CONCLUSIONS The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.
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Affiliation(s)
- W I Wan Zamaniah
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia E-mail :
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Serrano-Olvera A, Cetina L, Coronel J, Duenas-Gonzalez A. Follow-Up Consultations for Cervical Cancer Patients in a Mexican Cancer Center. Comparison with NCCN Guidelines. Asian Pac J Cancer Prev 2014; 15:8749-52. [DOI: 10.7314/apjcp.2014.15.20.8749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kumaran A, Guruvare S, Sharan K, Rai L, Hebbar S. Chemoradiation Related Acute Morbidity in Carcinoma Cervix and Correlation with Hematologic Toxicity: A South Indian Prospective Study. Asian Pac J Cancer Prev 2014; 15:4483-6. [DOI: 10.7314/apjcp.2014.15.11.4483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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