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Xin W, Rixin S, Linrui L, Zhihui Q, Long L, Yu Z. Machine learning-based radiomics for predicting outcomes in cervical cancer patients undergoing concurrent chemoradiotherapy. Comput Biol Med 2024; 177:108593. [PMID: 38801795 DOI: 10.1016/j.compbiomed.2024.108593] [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: 11/22/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSES To investigate the value of machine learning-based radiomics for predicting disease-free survival (DFS) and overall survival (OS) undergoing concurrent chemoradiotherapy (CCRT) for patients with locally advanced cervical cancer (LACC). MATERIALS AND METHODS In this multicentre study, 700 patients with IB2-IVA cervical cancer who underwent CCRT with ongoing follow-up were retrospectively analyzed. Three-dimensional radiomics features of primary lesions and its surrounding 5 mm region in T2WI sequences were collected. Six machine learning methods were used to construct the optimal radiomics model for accurate prediction of DFS and OS after CCRT in LACC patients. Eventually, TCGA and GEO databases were used to explore the mechanisms of radiomics in predicting the progression and survival of cervical cancer. This study adhered CLEAR for reporting and its quality was assessed using RQS and METRICS. RESULTS In the prediction of DFS, the RSF model combined tumor and peritumor radiomics demonstrated the best predictive efficacy, with the AUC for predicting 1-year, 3-year, and 5-year DFS in the training, validation, and test sets of 0.986, 0.989, 0.990, and 0.884, 0.838, 0.823, and 0.829, 0.809, 0.841, respectively. In the prediction of OS, the GBM model best performer, with AUC of 0.999, 0.995, 0.978, and 0.981, 0.975, 0.837, and 0.904, 0.860, 0.905. Differential genes in TCGA and GEO suggest that the prediction of radiomics model may be associated with KDELR2 and HK2. CONCLUSION Machine learning-based radiomics models help to predict DFS and OS after CCRT in LACC patients, and the combination of tumor and peritumor information has higher predictive efficacy, which can provide a reliable basis for therapeutic decision-making in cervical cancer patients.
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Affiliation(s)
- Wang Xin
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Su Rixin
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Li Linrui
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Qin Zhihui
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Liu Long
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Zhejiang University, Hangzhou, 310000, Zhejiang, China.
| | - Zhang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Kang HB, Kim SH, Lee JH, Lee HC, Kang NK, Lee JH. MRI-based volumetric tumor parameters before and during chemoradiation predict tumor recurrence and patient survival in locally advanced cervical cancer: a subgroup analysis of a phase II prospective trial. Int J Clin Oncol 2024; 29:620-628. [PMID: 38530569 DOI: 10.1007/s10147-024-02490-7] [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: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This subgroup analysis of a prospective phase II trial aimed to identify valuable and accessible prognostic factors for overall survival (OS) and progression-free survival (PFS) of patients with locally advanced cervical cancer (LACC). METHODS Patients with FIGO II to IVA cervical cancer were assessed in this study. All patients underwent concurrent chemoradiotherapy (CCRT) followed by brachytherapy. Tumor parameters based on MRI scans before and during CCRT were evaluated for Overall survival (OS) and Progression-free survival (PFS). RESULTS A total of 86 patients were included in this analysis with a median follow-up period of 31.7 months. Three-year OS and PFS rates for all patients were 87.1% and 76.5%, respectively. Univariate Cox regression analysis showed that restaging tumor size (rTS) over 2.55 cm (p < 0.001), initial tumor volume (iTV) over 55.99 cc (p < 0.001), downstaging (p = 0.042), and restaging tumor volume (rTV) over 6.25 cc (p = 0.006) were significantly associated with OS. rTS (p < 0.001), iTV (p < 0.001), downstaging (p = 0.027), and rTV (p < 0.001) were identified as significant prognostic factors for PFS. In the stepwise multivariable analysis, only rTS > 2.55 cm showed statistically significant with OS (HR: 5.47, 95% CI 1.80-9.58, p = 0.035) and PFS (HR: 3.83, 95% CI 1.50-11.45; p = 0.025). CONCLUSIONS Initial tumor size and restaging tumor volume that are easily accessible during radiotherapy provide valuable prognostic information for cervical cancer. MRI-based measurable volumetric scoring system can be readily applied in real-world practice of cervical cancer. CLINICAL TRIAL INFORMATION This study is a subgroup analysis of prospective trial registered at ClinicalTrials.gov Identifier: NCT02993653.
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Affiliation(s)
- Han Byul Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joo Hwan Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Nam Kyu Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Liu L, Deng X, Guo S, Yang S. Successful neoadjuvant chemotherapy plus sintilimab for locally advanced cervical cancer: case series and review of the literature. Diagn Pathol 2023; 18:107. [PMID: 37752528 PMCID: PMC10521576 DOI: 10.1186/s13000-023-01394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The locally advanced cervical cancer (LACC) of FIGO stage IB3-IIA2 is characterized by large local mass, poor prognosis and survival rate. Tumor response to neoadjuvant chemotherapy for LACC, utilized as a surrogate endpoint, is urgently needed to improve. Given that the antitumor immune response can be suppressed by programed death-1 axis, the treatment paradigm of neoadjuvant chemotherapy combined with immunotherapy has been explored as one of the prognostic treatments in a variety of solid carcinoma. So far, the application of sintilimab, a domestic immune checkpoint inhibitor, combined with neoadjuvant chemotherapy is still limited in LACC, especially in large lesions. CASE DESCRIPTION We present three postmenopausal women diagnosed with FIGO stage IB3-IIA2 cervical squamous cell carcinoma with lesions larger than 5 cm. Demographic, clinical, histopathological, laboratory and imaging data were record. At the completion of the neoadjuvant therapy with paclitaxel plus carboplatin combined with sintilimab, all patients underwent hysterectomy. After neoadjuvant treatment, a pathologic complete response in case 1 and partial responses in case 2 and case 3 were achieved, and neither patient showed any relapse during the follow-up period of 16 to 22 months. CONCLUSIONS This report provide evidence to support the combination of sintilimab with neoadjuvant chemotherapy in cervical cancer, which has yet to be validated in prospective studies. More clinical data are needed to verify the effectiveness of the combined regimens. This literature review also collected studies involving potential predictors of response to NACT and immunotherapy, which would be helpful in stratifying patients for future trials.
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Affiliation(s)
- Linlin Liu
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Xianbo Deng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Shuang Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Shouhua Yang
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, People's Republic of China.
- Department of Gynecology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, People's Republic of China.
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4
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Jha AK, Mithun S, Sherkhane UB, Jaiswar V, Osong B, Purandare N, Kannan S, Prabhash K, Gupta S, Vanneste B, Rangarajan V, Dekker A, Wee L. Systematic review and meta-analysis of prediction models used in cervical cancer. Artif Intell Med 2023; 139:102549. [PMID: 37100501 DOI: 10.1016/j.artmed.2023.102549] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women with an incidence of around 6.5 % of all the cancer in women worldwide. Early detection and adequate treatment according to staging improve the patient's life expectancy. Outcome prediction models might aid treatment decisions, but a systematic review on prediction models for cervical cancer patients is not available. DESIGN We performed a systematic review for prediction models in cervical cancer following PRISMA guidelines. Key features that were used for model training and validation, the endpoints were extracted from the article and data were analyzed. Selected articles were grouped based on prediction endpoints i.e. Group1: Overall survival, Group2: progression-free survival; Group3: recurrence or distant metastasis; Group4: treatment response; Group5: toxicity or quality of life. We developed a scoring system to evaluate the manuscript. As per our criteria, studies were divided into four groups based on scores obtained in our scoring system, the Most significant study (Score > 60 %); Significant study (60 % > Score > 50 %); Moderately Significant study (50 % > Score > 40 %); least significant study (score < 40 %). A meta-analysis was performed for all the groups separately. RESULTS The first line of search selected 1358 articles and finally 39 articles were selected as eligible for inclusion in the review. As per our assessment criteria, 16, 13 and 10 studies were found to be the most significant, significant and moderately significant respectively. The intra-group pooled correlation coefficient for Group1, Group2, Group3, Group4, and Group5 were 0.76 [0.72, 0.79], 0.80 [0.73, 0.86], 0.87 [0.83, 0.90], 0.85 [0.77, 0.90], 0.88 [0.85, 0.90] respectively. All the models were found to be good (prediction accuracy [c-index/AUC/R2] >0.7) in endpoint prediction. CONCLUSIONS Prediction models of cervical cancer toxicity, local or distant recurrence and survival prediction show promising results with reasonable prediction accuracy [c-index/AUC/R2 > 0.7]. These models should also be validated on external data and evaluated in prospective clinical studies.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Sneha Mithun
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Umeshkumar B Sherkhane
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinay Jaiswar
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Biche Osong
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Ben Vanneste
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Screening History and Survival Among Women With Cervical Cancer in Puerto Rico. J Low Genit Tract Dis 2022; 27:19-23. [DOI: 10.1097/lgt.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abdalvand N, Sadeghi M, Mahdavi SR, Abdollahi H, Qasempour Y, Mohammadian F, Birgani MJT, Hosseini K. Brachytherapy outcome modeling in cervical cancer patients: A predictive machine learning study on patient-specific clinical, physical and dosimetric parameters. Brachytherapy 2022; 21:769-782. [PMID: 35933272 DOI: 10.1016/j.brachy.2022.06.007] [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: 03/12/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To predict clinical response in locally advanced cervical cancer (LACC) patients by a combination of measures, including clinical and brachytherapy parameters and several machine learning (ML) approaches. METHODS Brachytherapy features such as insertion approaches, source metrics, dosimetric, and clinical measures were used for modeling. Four different ML approaches, including LASSO, Ridge, support vector machine (SVM), and Random Forest (RF), were applied to extracted measures for model development alone or in combination. Model performance was evaluated using the area under the curve (AUC) of receiver operating characteristics curve, sensitivity, specificity, and accuracy. Our results were compared with a reference model developed by simple logistic regression applied to three distinct clinical features identified by previous papers. RESULTS One hundred eleven LACC patients were included. Nine data sets were obtained based on the features, and 36 predictive models were built. In terms of AUC, the model developed using RF applied to dosimetric, physical, and total BT sessions features were found as the most predictive [AUC; 0.82 (0.95 confidence interval (CI); 0.79 -0.93), sensitivity; 0.79, specificity; 0.76, and accuracy; 0.77]. The AUC (0.95 CI), sensitivity, specificity, and accuracy for the reference model were found as 0.56 (0.52 ...0.68), 0.51, 0.51, and 0.48, respectively. Most RF models had significantly better performance than the reference model (Bonferroni corrected p-value < 0.0014). CONCLUSION Brachytherapy response can be predicted using dosimetric and physical parameters extracted from treatment parameters. Machine learning algorithms, including Random Forest, could play a critical role in such predictive modeling.
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Affiliation(s)
- Neda Abdalvand
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sadeghi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Radiologic Technology, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Younes Qasempour
- Student Research Committee, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Mohammadian
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | | | - Khadijeh Hosseini
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
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7
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Meng Q, Wang W, Liu X, Wang D, Zhang F. Nomograms Predicting Survival of Cervical Cancer Patients Treated With Concurrent Chemoradiotherapy Based on the 2018 FIGO Staging System. Front Oncol 2022; 12:870670. [PMID: 35646645 PMCID: PMC9130963 DOI: 10.3389/fonc.2022.870670] [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: 02/07/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background In 2018, a revised staging system was released for cervical cancer, which defined pelvic and paraaortic lymph node metastasis as stages IIIC1 and IIIC2, respectively. In this study, we constructed and validated nomograms to predict the 3- and 5-year survival of patients with cervical cancer based on the revised International Federation of Gynecology and Obstetrics (FIGO) staging system. Methods We retrospectively examined patients with 2009 FIGO stage IB–IVA cervical cancer who were treated at our institute between 2011 and 2015. Patients were randomized into the model development and validation cohorts (2:1). Univariate and multivariate analyses were conducted for the model development cohort to identify prognostic factors. In the multivariate analysis, nomograms were built to predict overall survival (OS) and disease-free survival (DFS) using significant variables. The nomograms were assessed based on the discrimination and calibration in both cohorts. Discrimination was assessed using the concordance index. Calibration was performed by comparing the mean nomogram estimated survival and the mean observed survival. Results We included 1,192 patients, with 795 and 397 patients in the model development and validation cohorts, respectively. In the model development cohort, the median follow-up period was 49.2 months. After multivariate analysis, age, histology, 2018 FIGO stage, and pelvic lymph node number were independent factors for OS. Histology, 2018 FIGO stage, squamous cell carcinoma antigen, and pelvic lymph node number were significant predictors of DFS. The nomograms constructed to predict OS and DFS were based on these factors. In both model cohorts, the concordance index for the nomogram-predicted OS and DFS was 0.78 and 0.75 and 0.74 and 0.67, respectively. The calibration curve revealed good agreement between the nomogram predictions and actual values. Conclusion We constructed robust nomograms to predict the OS and DFS of patients with cervical cancer undergoing treatment with concurrent chemoradiotherapy based on the 2018 FIGO staging system.
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Affiliation(s)
- Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dunhuang Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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8
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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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9
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Ramos da Silva J, Ramos Moreno AC, Silva Sales N, de Oliveira Silva M, Aps LRMM, Porchia BFMM, Bitencourt Rodrigues K, Cestari Moreno N, Venceslau-Carvalho AA, Menck CFM, de Oliveira Diniz M, de Souza Ferreira LC. A therapeutic DNA vaccine and gemcitabine act synergistically to eradicate HPV-associated tumors in a preclinical model. Oncoimmunology 2021; 10:1949896. [PMID: 34367730 PMCID: PMC8312617 DOI: 10.1080/2162402x.2021.1949896] [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: 11/09/2022] Open
Abstract
Although active immunotherapies are effective strategies to induce activation of CD8+ T cells, advanced stage tumors require further improvements for efficient control. Concerning the burden of cancer-related to Human papillomavirus (HPV), particularly the high incidence and mortality of cervical cancer, our group developed an approach based on a DNA vaccine targeting the HPV-16 E7 oncoprotein (pgDE7h). This immunotherapy is capable of inducing an antitumour CD8+ T cell response but show only partial control of tumors in more advanced growth stages. Here, we combined a chemotherapeutic agent (gemcitabine- Gem) with pgDE7h to overcome immunosuppression and improve antitumour responses in a preclinical mouse tumor model. Our results demonstrated that administration of Gem had synergistic antitumor effects when combined with pgDE7h leading to eradication of both early-stages and established tumors. Overall, the antiproliferative effects of Gem observed in vitro and in vivo provided an optimal window for immunotherapy. In addition, the enhanced antitumour responses induced by the combined therapeutic regimen included enhanced frequencies of antigen-presenting cells (APCs), E7-specific IFN-γ-producing CD8+ T cells, and cytotoxic CD8+ T cells and, concomitantly, less pronounced accumulation of immunosuppressive myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs). These findings demonstrated that the combination of Gem and an active immunotherapy strategy show increased effectiveness, leading to a reduced need for multiple drug doses and, therefore, decreased deleterious side effects avoiding resistance and tumor relapses. Altogether, our results provide evidence for a new and feasible chemoimmunotherapeutic strategy that supports future clinical translation.
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Affiliation(s)
- Jamile Ramos da Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Ramos Moreno
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Natiely Silva Sales
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mariângela de Oliveira Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Luana R M M Aps
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Bruna F M M Porchia
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil.,Laboratory of Tumor Immunology, Department of Immunology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Karine Bitencourt Rodrigues
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Natália Cestari Moreno
- DNA Repair Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil.,Mitochondrial Genetics Lab. Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | | | - Carlos Frederico M Menck
- DNA Repair Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mariana de Oliveira Diniz
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil.,Division of Infection and Immunity, University College London, 5 University St, Bloomsbury, London, UK
| | - Luís Carlos de Souza Ferreira
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil
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10
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Ohno A, Iwata T, Katoh Y, Taniguchi S, Tanaka K, Nishio H, Nakamura M, Morisada T, Chen G, Saito M, Yaguchi T, Kawakami Y, Aoki D. Tumor-infiltrating lymphocytes predict survival outcomes in patients with cervical cancer treated with concurrent chemoradiotherapy. Gynecol Oncol 2020; 159:329-334. [PMID: 32829964 DOI: 10.1016/j.ygyno.2020.07.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To (i) identify correlations between selected immunogenic factors and clinicopathological characteristics, (ii) determine whether intratumoral abundance of various specific tumor-infiltrating lymphocytes (TILs) is a prognostic indicator in women with Stage II and III cervical cancer who undergo treatment with cisplatin-based concurrent chemoradiotherapy (CCRT), and (iii) investigate subtypes of FOXP3+ T cells in 15 fresh samples of cervical cancer. METHODS In this retrospective study, intratumoral lesions in colposcopic biopsies from 55 women with advanced cervical cancer who subsequently underwent CCRT at our institution were subjected to automatic immunological staining using the following six mouse monoclonal antibodies: anti-CD3, anti-CD4, anti-CD8, anti-CD20, anti-CD206, and anti-FOXP3. Associations between the findings on automatic scoring of the number of each type of TIL in each specimen and various clinicopathological characteristics were analyzed, as were associations between the abundance of various specific types of TIL and survival. Subtypes of FOXP3+ TILs in 15 additional fresh tumor samples were also investigated using flow cytometry. RESULTS Infiltration with CD8+ TILs was associated with pelvic lymph node metastasis. Abundant infiltration by CD3+, CD4+, CD8+, CD206+, and FOXP3+ TILs were statistically significant indicators of better progression-free and overall survival. Regarding subtypes of FOXP3+ TILs, non-Tregs (Fr-III) were found in all samples tested for this. CONCLUSIONS The abundance of various specific intratumoral TILs may be prognostic indicators in patients with advanced cervical cancer undergoing CCRT.
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Affiliation(s)
- Akiko Ohno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan; Department of Obstetrics and Gynecology, National Hospital Organization Tokyo Medical Center, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan; Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan.
| | - Yuki Katoh
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan; Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, Japan
| | - Shiho Taniguchi
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan
| | - Kohsei Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Hiroshi Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Masaru Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Guanliang Chen
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan
| | - Miyuki Saito
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Tomonori Yaguchi
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan; Department of Immunology, School of Medicine, International University of Health and Welfare, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
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11
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Widayanti DM, Qomaruddin MB, Irawandi D. Mother's knowledge and attitudes towards Visual Acetate Acid Inspection test in Surabaya. J Public Health Res 2020; 9:1815. [PMID: 32728561 PMCID: PMC7376483 DOI: 10.4081/jphr.2020.1815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The incidence of cervical cancer in Indonesia is still high due to the poor awareness of married women about the necessity to check themselves with a pap smear/IVA test for early detection and possible cure. The implementation of the IVA examination still experiences obstacles due to lack of knowledge and fear. Design and Methods: This study aims to determine the relationship between knowledge and attitudes of mothers with IVA test, using the analytical and cross-sectional study. Data were obtained from mothers that visited the family planning section of the Maternal and Child Health (MCH) Center. Out of a total of 184 mothers, 126 samples were chosen by purposive sampling technique. Results: The results showed that 59.5% of respondents had scarce knowledge on IVA tests, 66.7% had unsupportive attitudes towards it, and 54.8% were not willing to carry out the tests. This study explains that there is a significant relationship between knowledge and attitude with a P-value of 0.000. Conclusions: In conclusion, various factors influence the participation of IVA examination, namely lack of knowledge, inability to access information, and fear.
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Affiliation(s)
- Dini Mei Widayanti
- Doctoral Program of Public Health, Faculty of Public Health.,Stikes Hang Tuah, Surabaya, Indonesia
| | - Mochammad Bagus Qomaruddin
- Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Universitas Airlangga, Mulyorejo
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12
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Yan H, Luo M, Wang L, Qiu Z, Mo Z, Xiang Z, Zhang Y, Chen G, Zhong Z, Wang X, Gao F, Zhang F. Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes. Cancer Imaging 2020; 20:25. [PMID: 32252826 PMCID: PMC7137200 DOI: 10.1186/s40644-020-00299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the unique anatomical location of retroperitoneal metastatic lymph nodes, current treatment options are limited. This study was designed to explore the clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the treatment of retroperitoneal metastatic lymph nodes. METHODS We retrospectively evaluated 92 patients received 125I brachytherapy for retroperitoneal metastatic lymph nodes. A layered Cox proportional hazards model was established to filter out the independent factors affecting local tumor progression-free survival (LTPFS). RESULTS The median LTPFS was 8 months. Metastatic lymph node with uniform density (p-0.009), clear boundaries (p-0.011), regular morphology (P < 0.001), and < 3 organs at risk of metastasis (p-0.020) were associated with better LTPFS. Necrotic lymph nodes (p < 0.001), fusion (p-0.003), and invasion of vessels visible on images (p < 0.001) were associated with poor LTPFS. Puncture path through abdominal wall or paravertebral approach were also associated with better LTPFS than a hepatic approach (P < 0.05). A maximum diameter ≤ 3 cm (P-0.031) or 3-5 cm (P-0.018) were also associated with significantly better LTPFS than a maximum diameter ≥ 5 cm. The Cox proportional hazards model suggested that lymph nodes invaded the large vessels visible on images, maximum diameter and puncture path were independent risk factors for LTPFS. CONCLUSION CT-guided 125I brachytherapy is an optional palliative treatment modality for retroperitoneal metastatic lymph nodes, which can provide high local control without severe complications. Better preoperative planning, intraoperative implementation, better choice of puncture path, and selection of appropriate tumor size are important factors that can improve the clinical efficacy of 125I brachytherapy for retroperitoneal metastatic lymph nodes.
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Affiliation(s)
- Huzheng Yan
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Ma Luo
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Lifei Wang
- The Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Zhenkang Qiu
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Zhiqiang Mo
- Department of Interventional Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, 510060 China
| | - Zhanwang Xiang
- The Third affiliated hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanling Zhang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Guanyu Chen
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Zhihui Zhong
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Xiuchen Wang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Fei Gao
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
| | - Fujun Zhang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 China
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road, East, Guangzhou, 510060 China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road, East, Guangzhou, 510060 China
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13
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Lee WK, Chong GO, Jeong SY, Lee HJ, Park SH, Ryu JM, Choi YS, Kang S, Koo YJ, Lee DH, Kong E, Lee SW. Prognosis-Predicting Model Based on [ 18F]fluorodeoxyglucose PET Metabolic Parameters in Locally Advanced Cervical Cancer Patients Treated with Concurrent Chemoradiotherapy: Multi-Center Retrospective Study. J Clin Med 2020; 9:jcm9020427. [PMID: 32033340 PMCID: PMC7074470 DOI: 10.3390/jcm9020427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
This study aimed to develop a prognosis-predicting model based on [18F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and clinicopathologic factors in locally advanced cervical cancer patients treated with concurrent chemoradiotherapy (CCRT). The medical records of 270 locally advanced cervical cancer patients who were treated with CCRT were collected from three institutions and reviewed retrospectively. A nomogram was used for predicting 2-year disease-free survival (DFS) and 5-year overall survival (OS) based on Cox proportional hazards regression. Predictor variables included nodal maximum standardized uptake value (SUVmax), primary tumor SUVmax, age, tumor size, stage, serum squamous cell carcinoma antigen level, and human papillomavirus status. Internal nomogram validation was performed. A nomogram for predicting the 2-year DFS and 5-year OS was constructed using six and seven parameters, respectively. With a focus on 2-year DFS, our model found nodal SUVmax to be the highest weighted negative prognostic factor. With a focus on 5-year OS, young age was the highest weighted negative prognostic factor. The concordance index was 0.75 and 0.78 for the 2-year DFS and 5-year OS, respectively. This nomogram is a predictive tool that can be used to counsel patients for predicting survival outcomes. Moreover, our prognosis-predicting model may make it possible to personalize treatment.
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Affiliation(s)
- Won Kee Lee
- Medical Research Collaboration Center in Kyungpook National University Hospital, Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (H.J.L.); (S.-W.L.)
- Correspondence: (G.O.C.); (S.Y.J.); Tel.: +82-53-200-2684 (G.O.C.); +82-53-200-2852 (S.Y.J.); Fax: 82-53-200-2028 (G.O.C.); 82-53-200-2029 (S.Y.J.)
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (G.O.C.); (S.Y.J.); Tel.: +82-53-200-2684 (G.O.C.); +82-53-200-2852 (S.Y.J.); Fax: 82-53-200-2028 (G.O.C.); 82-53-200-2029 (S.Y.J.)
| | - Hyun Jung Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (H.J.L.); (S.-W.L.)
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Shin-Hyung Park
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu 41944, Korea;
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jung Min Ryu
- Department of Obstetrics and Gynecology, School of medicine, Daegu Catholic University, Daegu 42472, Korea; (J.M.R.); (Y.S.C.)
| | - Youn Seok Choi
- Department of Obstetrics and Gynecology, School of medicine, Daegu Catholic University, Daegu 42472, Korea; (J.M.R.); (Y.S.C.)
| | - Sungmin Kang
- Department of Nuclear Medicine, School of Medicine, Daegu Catholic University, Daegu 42472, Korea;
| | - Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University Medical School and Hospital, Daegu 42415, Korea; (Y.-J.K.); (D.H.L.)
| | - Dae Hyung Lee
- Department of Obstetrics and Gynecology, Yeungnam University Medical School and Hospital, Daegu 42415, Korea; (Y.-J.K.); (D.H.L.)
| | - Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University Medical School and Hospital, Daegu 42415, Korea;
| | - Sang-Woo Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (H.J.L.); (S.-W.L.)
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
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14
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Results from chemoradiotherapy for squamous cell cervical cancer with or without intracavitary brachytherapy. J Contemp Brachytherapy 2019; 11:417-422. [PMID: 31749849 PMCID: PMC6854858 DOI: 10.5114/jcb.2019.88116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/27/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose The aim of this study is to compare the outcomes of intracavitary high-dose-rate brachytherapy (BT-IC) boost and external beam radiotherapy (EBRT) boost in patients treated with concomitant chemoradiotherapy for squamous cell carcinoma of the cervix. Material and methods It is a retrospective review of 92 patients with stage IB1-IVA cervical cancer treated with concomitant chemoradiotherapy between 2008 and 2013. All patients received pelvic 3D conformal EBRT (range, 45-50.4 Gy) concomitant with weekly cisplatin (40 mg/m2), and a BT-IC boost (37 patients: 4 fractions of 6 Gy prescribed to a point A) to the tumor or a 3D conformal EBRT boost (55 patients: 16.2 Gy), if the former was not technically feasible. Results The 5-year overall survival and recurrence-free survival rates for both groups were 68% and 55%, respectively. The 5-year overall survival and recurrence-free survival were better and statistically significant in the BT-IC group with 82% and 79%, respectively, as compared to the EBRT group with 58% and 38%, respectively. In multivariate analysis controlling for maximum tumor dimension, lymph node status, and FIGO stage, EBRT boost was associated with a statistical significant increase in the risk of recurrence (HR: 3.56; 95% CI: 1.27-10.02; p = 0.016) and a trend towards an increase in the risk of death (HR: 3.14; 95% CI: 0.97-10.17; p = 0.056). Lymph node status was also significantly associated with a greater risk of recurrence. Conclusions BT-IC boost was associated with a lower recurrence rate and better overall survival and recurrence-free survival. EBRT boost patients had a three-fold increase in the risk of recurrence. Brachytherapy is essential in the treatment of cervical cancer and improved alternatives are needed for patients who are not candidates for standard brachytherapy applicators.
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15
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Yang J, Tian G, Pan Z, Zhao F, Feng X, Liu Q, Lyu J. Nomograms for predicting the survival rate for cervical cancer patients who undergo radiation therapy: a SEER analysis. Future Oncol 2019; 15:3033-3045. [PMID: 31452393 DOI: 10.2217/fon-2019-0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To integrate multiple independent risk factors to establish prognostic nomograms for better predicting overall survival and disease-specific survival in patients with cervical cancer receiving radiation therapy. Materials & methods: Cox analysis used to construct nomograms. The C-index, time-dependent receiver operating characteristic and calibration plots were used to evaluate the performance. The discrimination abilities were compared using the decision curve analysis, net reclassification improvement and integrated discrimination improvement. Results: After randomization, 2869 and 1230 cervical cancer patients were included in the training and validation sets, respectively. Nomograms that incorporated all of the significant independent factors for predicting the 3- and 5-year overall survival and disease-specific survival in the training cohort were established. Conclusion: Compared with the International Federation of Gynecology and Obstetrics staging system, the proposed nomograms exhibit superior prognostic discrimination and survival prediction.
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Affiliation(s)
- Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Guoxiang Tian
- Seventh Medical Center, PLA General Hospital, Beijing, 100853, PR China
| | - Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
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16
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Prophylactic Extended-Field Irradiation for Patients With Cervical Cancer Treated With Concurrent Chemoradiotherapy: A Propensity-Score Matching Analysis. Int J Gynecol Cancer 2019; 28:1584-1591. [PMID: 30153215 PMCID: PMC6166702 DOI: 10.1097/igc.0000000000001344] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Supplemental digital content is available in the text. Objective The aim of the study was to evaluate the efficacy and toxicity of prophylactic extended-field radiation therapy (RT) for cervical cancer patients treated with concurrent chemoradiotherapy (CCRT). Methods Records of patients with cervical cancer without para-aortic metastatic lymph nodes who were treated with definitive RT or CCRT between January 2011 and December 2014 were reviewed. Patients were classified into the pelvic RT and extended-field RT groups. An additional dose of 50.4 Gy in 28 fractions was delivered to para-aortic lymph node regions for patients in the extended-field RT group. Cox regression and propensity-score matching (1:1) were used to compare the overall survival (OS), disease-free survival (DFS), distant failure, and para-aortic lymph node failure (PALNF) between the pelvic RT and extended-field RT groups. Results A total of 778 patients were analyzed. Of them, 624 patients were treated with pelvic RT and 154 patients received extended-field RT. The median follow-up period was 37.5 months. In multivariate analysis, extended-field RT was an independent prognostic factor of distant failure (hazard ratio [HR] = 0.49, 95% confidence interval [CI] = 0.26–0.90, P = 0.023) and PALNF (HR = 0.012, 95% CI = 0.00–0.49, P = 0.019). However, it was not significant in predicting OS (P = 0.546) and DFS (P = 0.187). With propensity-score matching, 108 pairs of patients were selected. The 3-year OS, DFS, local control, distant failure, and PALNF rates in the pelvic RT and extended-field RT groups were 87.1% and 85.7% (P = 0.681), 71.0% and 80.6% (P = 0.199), 86.6% and 85.0% (P = 0.695), 21.7% and 7.0% (P = 0.016), and 6.6% and 0% (P = 0.014), respectively. The incidences of grade 3 or greater chronic toxicities were 3.5% and 6.5% in the pelvic RT and extended-field RT groups, respectively (P = 0.097). Conclusions Prophylactic extended-field RT was associated with decreased distant failure and PALNF and showed a trend in improving DFS in patients with cervical cancer treated with CCRT.
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17
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Tsuruoka S, Kataoka M, Hamamoto Y, Tokumasu A, Uwatsu K, Kanzaki H, Takata N, Ishikawa H, Ouchi A, Mochizuki T. Tumor growth patterns on magnetic resonance imaging and treatment outcomes in patients with locally advanced cervical cancer treated with definitive radiotherapy. Int J Clin Oncol 2019; 24:1119-1128. [PMID: 31079257 DOI: 10.1007/s10147-019-01457-3] [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: 01/12/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the prognostic value of tumor growth patterns on magnetic resonance (MR) images in patients with locally advanced cervical cancer (LACC) treated with definitive radiotherapy or concurrent chemoradiotherapy (RT/CCRT). METHODS We retrospectively reviewed 102 patients with LACC who received definitive RT/CCRT and who underwent MR imaging before RT/CCRT. Growth patterns on pretreatment T2-weighted MR images were classified into expansive or infiltrative type according to tumor morphologic patterns in the myometrium and/or parametrial space. RESULTS The median age was 60 years (range 26-90 years). The median follow-up time was 47.7 months (range 5.7-123 months). The numbers of patients with stages IB, II, III, and IVA were 17, 39, 43, and 3, respectively. The 3-year overall survival (OS) rates for stages IB, II, III, and IV were 87%, 76%, 74%, and 67%, respectively. Regarding growth patterns on MR images, 31 were of expansive type and 71 were of infiltrative type. The infiltrative type was significantly associated with lower OS and locoregional recurrence-free survival (LRRFS) than the expansive type (3-year OS, 70% vs. 93%, p = 0.003; 3-year LRRFS, 64% vs. 94%, p = 0.001). On multivariate analysis, infiltrative tumor growth patterns were a significant independent factor for low OS (hazard ratio [HR], 3.81; 95% confidence interval [CI] 1.26-16.7; p = 0.015) and low LRRFS (HR, 4.27; 95% CI 1.43-18.5; p = 0.007). CONCLUSION Tumor growth patterns on MR images could be an indicator of survival and locoregional control in patients with LACC treated with definitive RT/CCRT.
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Affiliation(s)
- Shintaro Tsuruoka
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan.
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Masaaki Kataoka
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Yasushi Hamamoto
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akifumi Tokumasu
- Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Kotaro Uwatsu
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Noriko Takata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hirofumi Ishikawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Ayaka Ouchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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18
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Nomograms predicting survival and patterns of failure in patients with cervical cancer treated with concurrent chemoradiotherapy: A special focus on lymph nodes metastases. PLoS One 2019; 14:e0214498. [PMID: 30986236 PMCID: PMC6464190 DOI: 10.1371/journal.pone.0214498] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023] Open
Abstract
Objective To construct nomograms predicting survival and patterns of failure in patients with cervical cancer treated with concurrent chemoradiotherapy (CCRT). Methods A total of 833 patients with cervical cancer treated with definitive radiotherapy or CCRT in our institute from January 2011 to December 2014 were included. Cox proportional hazard regression models were used in univariate and multivariate analysis. The following variables were included in the univariate analysis: histology, FIGO stage, lymph node metastases (para-aortic, pelvic, common iliac, binary pelvic, and binary common iliac LNMs), the number of pelvic metastatic lymph nodes (MLNs), and the diameter of pelvic MLNs. Nomograms predicting the 3- and 5-year overall survival (OS), disease-free survival (DFS), local control (LC) and distant metastasis-free (DMF) were constructed. The nomograms were internally validated with respect to discrimination and calibration. Results The median follow-up period was 36.4 months (range,1.0 to 76.2 months). After univariate and multivariate analysis, histology, FIGO stage, para-aortic LNM, pelvic LNM, number of MLNs and diameter of pelvic MLNs significantly predicted OS, DFS, LC or DMF. Nomograms predicting the 3- and 5-year OS, DFS, LC and DMF were constructed incorporating these significant variables. These nomograms showed good discrimination and calibration, with a concordance index of 0.73 for predicting OS, 0.71 for DFS, 0.73 for LC and 0.67 for DMF. Conclusion We constructed nomograms predicting survival and patterns of failure with a special focus on regional LNM in patients with cervical cancer treated with concurrent chemoradiotherapy.
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Dang YZ, Li P, Li JP, Zhang Y, Zhao LN, Li WW, Wei LC, Shi M. Efficacy and Toxicity of IMRT-Based Simultaneous Integrated Boost for the Definitive Management of Positive Lymph Nodes in Patients with Cervical Cancer. J Cancer 2019; 10:1103-1109. [PMID: 30854117 PMCID: PMC6400667 DOI: 10.7150/jca.29301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/04/2019] [Indexed: 01/06/2023] Open
Abstract
Background: The optimal radiotherapy regimen for treating metastatic lymphadenopathy in patients with locally advanced cervical cancer remains controversial. This study aimed to investigate the clinical outcomes, as well as associated toxicities, of intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) for pelvic and para-aortic lymph nodes (LNs). Methods: Between 2011 and 2015, 74 patients with 2014 International Federation of Gynecology and Obstetrics stage IIB-IVB cervical cancer exhibiting pelvic or para-aortic LN involvement were examined. The pelvic field planning dose was 45-50 Gy in 25 fractions, and an SIB of 62.5 Gy in 25 fractions was delivered to positive LNs. Next, CT-guided brachytherapy was performed 24 Gy in 3 fractions to 42 Gy in 6 fractions once or twice weekly. Results: The median follow-up duration was 36 (range: 3-62) months. The 3-year local control, distant metastasis-free survival, and overall survival rates were 91.7%, 75.7%, and 71.4%, respectively. No residual or recurrent LNs were detected. Six patients developed grade 3 acute gastrointestinal (GI) toxicity. Twenty-nine (39.2%) and 3 (4.1%) patients developed grade 3 and 4 hematological toxicities, respectively. Twenty patients (28.5%) developed grade ≥2 chronic GI toxicity. Only 1 patient (1.4%) experienced a grade 4 rectovaginal fistula, and 3 patients (4.2%) developed grade 2 genitourinary toxicities. SIB to the LNs did not influence acute or chronic toxicity rates. Conclusions: Our findings demonstrate that a dose of 62.5 Gy to positive LNs using the IMRT with SIB method can achieve excellent clinical outcomes with acceptable toxicity.
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Affiliation(s)
- Yun-Zhi Dang
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.,State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Pei Li
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Jian-Ping Li
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Ying Zhang
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Li-Na Zhao
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Wei-Wei Li
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Li-Chun Wei
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital. The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
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Pergialiotis V, Bellos I, Thomakos N, Haidopoulos D, Perrea DN, Kontzoglou K, Daskalakis G, Rodolakis A. Survival outcomes of patients with cervical cancer and accompanying hydronephrosis: A systematic review of the literature. Oncol Rev 2019; 13:387. [PMID: 30746036 PMCID: PMC6340308 DOI: 10.4081/oncol.2019.387] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/03/2019] [Indexed: 01/24/2023] Open
Abstract
Hydronephrosis is a sign of advanced stage disease in patients with cervical cancer. Its presence is believed to negatively affect the survival of patients. To date, however, consensus in this field is still lacking. The purpose of the present systematic review is to gather the available data and to provide directions for future research in the field. We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRA and Google Scholar databases from inception till June 2018. Overall, 22 studies were included in the present systematic review that evaluated outcomes from 8521 patients with cervical cancer. The findings of our systematic review support that hydronephrosis negatively affects the overall survival of cervical cancer patients. Specifically, the reported 5- year OS hazards ratio for hydronephrosis ranged between 1.34 and 3.74. Outcomes concerning the disease-free survival of these patients were, however, less discrete. None of the included studies reported whether the decreased survival of patients with hydronephrosis was attributed to complications of obstructive uropathy such as uremia and sepsis. Thus, it remains, to date, unclear whether placement of ureteral stents or percutaneous nephrostomy may actually benefit these patients. More studies are needed to evaluate the actual impact of hydronephrosis on survival rates at the various stages of cervical cancer and to help establish consensus regarding the optimal mode of management of these patients.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens.,1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Thomakos
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Despina N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens
| | - Konstantinos Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens
| | - Georgios Daskalakis
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Alexandros Rodolakis
- 1 Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
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Wang SC, Lin LC, Kuo YT, Lin YW. Radiographic Number of Positive Pelvic Lymph Nodes as a Prognostic Factor in Cervical Cancer Treated With Definitive Concurrent Chemoradiotherapy or Intensity-Modulated Radiotherapy. Front Oncol 2018; 8:546. [PMID: 30555798 PMCID: PMC6284041 DOI: 10.3389/fonc.2018.00546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background: This study aims to assess the prognostic significance of radiographic numbers of positive pelvic lymph nodes (PLNs) in patients with cervical cancer treated with definitive concurrent chemoradiotherapy (CCRT) or intensity-modulated radiotherapy (IMRT). Methods: We conducted a retrospective study that included 164 eligible adult patients with cervical cancer who were treated with definitive CCRT or IMRT at our institution from 2009 to 2016. After exclusion of 50 patients, a total of 114 patients whose clinicopathological data and follow-up were finally analyzed. The radiographic numbers of positive PLNs were assessed by pretreatment magnetic resonance imaging (MRI) or computed tomography (CT). The criterion for a positive lymph node was defined as a short-axis diameter >1 cm. Using the Kaplan–Meier method and the Cox proportional hazards regression model, we assessed the overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). Results: The median follow-up duration was 40 (range: 2–100) months. For patients with 0, 1–2, and ≥3 positive PLNs, the estimated 3-year OS were 85.4% vs. 82.4% vs. 59.7% (p = 0.035), CSS were 90.1% vs. 86.1% vs. 62.9% (p = 0.010), DMFS were 89.4% vs. 91.3% vs. 49.6% (p < 0.001), and LRFS were 77.8% vs. 73.4% vs. 70% (p = 0.690). Per the multivariate Cox regression, positive PLNs ≥3 (HR, 2.51; 95% CI: 1.09–5.80; p = 0.031) and non-squamous cell carcinoma type (HR, 2.82; 95% CI: 1.19–6.69; p = 0.018) were unfavorable factors for the OS. Besides, positive PLNs ≥3 was the independent factor for the CSS (HR, 3.38; 95% CI: 1.32–8.67; p = 0.011) and DMFS (HR, 6.83; 95% CI: 2.62–17.83; p < 0.001). The patients that were treated without intracavitary brachytherapy exhibited inferior LRFS (HR, 13.15; 95% CI: 2.66–65.10; p = 0.002). Conclusions: The radiographic number of positive PLNs (≥ 3) is an independent prognostic factor for OS, CSS, and DMFS in patients treated with definitive CCRT or IMRT.
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Affiliation(s)
- Shih-Chang Wang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Li-Ching Lin
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yu-Wei Lin
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
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Ma Y, Yang J, Wang R, Zhang Z, Qi X, Liu C, Ma M. Aurora-A affects radiosenstivity in cervical squamous cell carcinoma and predicts poor prognosis. Oncotarget 2018; 8:31509-31520. [PMID: 28404933 PMCID: PMC5458225 DOI: 10.18632/oncotarget.15663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/27/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Definitive radiation therapy (RT) (with or without cisplatin-based chemotherapy) is one of the most effective treatments for cervical squamous cell carcinoma (CSCC), but efficacy is limited due to resistance. In the present study, we investigated the relationship between the expression of Aurora kinase A (Aurora-A, AURKA)and response to RT in patients with CSCC. METHODS The expression of Aurora-A in biopsy specimens of untreated primary tumors in 129 Uyghur patients with CSCC was investigated immunohistochemically. Primary treatment in these patients was definitive radical RT, which consisted of pelvic RT plus brachytherapy (total point A dose:70-85 Gy) (with or without cisplatin-based chemotherapy). The prognostic value of tumoral Aurora-A expression and patients' clinical outcomes were evaluated. RESULTS Aurora-A expression was significantly associated with lymph node metastasis (P<0.001), large tumor size (P<0.001), low hemoglobin (Hb) level (P=0.011) and recurrence (P<0.001), but not other clinicopathological factors. Definitive RT was unfavorable in patients with high Aurora-A expression (P < 0.001). In 129 enrolled patients, lymph node metastasis, large tumor size, low Hb level, and AURKA overexpression were prognostic factors for both recurrent free survival (RFS) and overall survival (OS) in univariate analysis. However, only high AURKA expression was an adverse independent risk factor for both RFS (hazard ratio, 3.953; 95% CI, 1.473-10.638; P = 0.006) and OS (hazard ratio 9.091; 95%CI 2.597-32.258; P<0.001) in multivariate analyses. CONCLUSIONS Aurora-A may serve as a predictive biomarker of radiation response and a therapeutic target to reverse radiation therapy resistance.
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Affiliation(s)
- Yuhua Ma
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China.,The Department of Radiation Oncology, Tumor Hospital Affilated To Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jie Yang
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Ruozheng Wang
- The Department of Radiation Oncology, Tumor Hospital Affilated To Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zegao Zhang
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Xiaoli Qi
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Chunhua Liu
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Miaomiao Ma
- Radiotherapy Second Department, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
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23
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The Prognosis and Risk Stratification Based on Pelvic Lymph Node Characteristics in Patients With Locally Advanced Cervical Squamous Cell Carcinoma Treated With Concurrent Chemoradiotherapy. Int J Gynecol Cancer 2018; 26:1472-9. [PMID: 27400321 DOI: 10.1097/igc.0000000000000778] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine the prognostic significance of pelvic lymph node (PLN) characteristics and perform risk stratification in patients undergoing concurrent chemoradiotherapy for locally advanced cervical squamous cell carcinoma. METHODS We retrospectively reviewed the records of 609 patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage II to IVa who underwent concurrent chemoradiotherapy, compared overall survival (OS), distant metastasis-free survival (DMFS), and pelvic recurrence-free survival between patients with or without PLN involvement. We further analyzed prognostic factors for OS and DMFS including FIGO stage, tumor volume, and lymph node (LN) characteristics in 300 patients with PLN involvement. RESULTS The 3-year OS rate was 81.7% versus 92.8% (P = 0.002) and the 3-year DMFS rate was 79.3% versus 92.7% (P = 0.006) in patients with or without PLN involvement, respectively. With univariable analysis, FIGO stage, LN-volume, LN-number, LN-diameter, and matted/necrotic LN affected both OS and DMFS. Based on multivariable analysis, we created a risk stratification model. For OS, the independent risk factors were FIGO stage III or IVa, LN-volume of 3 cm or more, LN-diameter of 1.5 cm or more, and matted/necrotic LN. The low-risk group (no risk factors), mid-risk group (1 or 2 risk factors), and high-risk group (3 or 4 risk factors) had a 3-year OS of 96.6%, 84.9%, and 64.7%, respectively (P = 0.005). For DMFS, LN-diameter of 1.5 cm or more, LN-number of 3 or more, and matted/necrotic LN were the independent risk factors. The subgroups for DMFS were the low-risk group (no risk factors), the mid-risk group (1 risk factor), and the high-risk group (2 or 3 risk factors), and the 3-year DMFS was 92.4%, 76.2%, and 64.6%, respectively (P = 0.001). CONCLUSIONS The prognosis was significantly poorer for patients with high-risk lymph node characteristics. Using this risk stratification, we should select the most appropriate and individualized treatment modality to improve outcomes in those patients with a poorer prognosis.
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Oh J, Seol KH, Lee HJ, Choi YS, Park JY, Bae JY. Prophylactic extended-field irradiation with concurrent chemotherapy for pelvic lymph node-positive cervical cancer. Radiat Oncol J 2017; 35:349-358. [PMID: 29262671 PMCID: PMC5769878 DOI: 10.3857/roj.2017.00367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). Materials and Methods A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of the patients had paraaortic lymph node (PALN) metastases. The patients were classified to two groups, namely, those treated with EF-PRT, including prophylactic para-aortic radiotherapy, and those treated only with WPRT. The median dose to the PALN area in patients treated with EF-PRT was 45 Gy. All patients received concurrent cisplatin-based chemotherapy. Results Overall, 52 and 74 patients underwent EF-PRT and WPRT, respectively. Patient characteristics and irradiated dose were not significantly different, except the dose to the para-aortic area, between the two groups. The median follow-up period was 75.5 months (range, 5 to 195 months). The 10-year cumulative recurrence rate of PALN for EF-PRT vs. WPRT was 6.9% and 10.1% (p = 0.421), respectively. The 10-year disease-free survival and overall survival for EF-PRT vs. WPRT were 69.7% vs. 66.1% (p = 0.748) and 71.7% vs. 72.3% (p = 0.845), respectively. Acute gastrointestinal complications were significantly higher in EF-PRT (n = 21; 40.4%) than WPRT (n = 26; 35.1%) (p = 0.046). Late toxicities were not significantly different in both groups. Conclusion In this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.
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Affiliation(s)
- Jinju Oh
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun Joo Lee
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Youn Seok Choi
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ji Y Park
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
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25
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Zheng D, Mou HP, Diao P, Li XM, Zhang CL, Jiang J, Chen JL, Wang LS, Wang Q, Zhou GY, Chen J, Lin C, Yuan ZP. Chemoradiotherapy in combination with radical surgery is associated with better outcome in cervical cancer patients. Oncotarget 2017; 9:2866-2875. [PMID: 29416819 PMCID: PMC5788687 DOI: 10.18632/oncotarget.23165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/16/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To retrospectively assess the influence of radical surgery following concurrent chemoradiotherapy (CCRT) on outcomes in cervical cancer (CC) patients. Methods Patients diagnosed with cervical squamous cell carcinoma or adenocarcinoma (FIGO stages IB2 to IIB) at the Yinbin Second People's Hospital between September 2008 and September 2013, were included in this study. Patients were classified into 2 groups based on the treatment received: surgery group (CCRT plus radical surgery) and non-surgery groups (CCRT only). In addition to clinical information, inter-group differences with respect to local control rate (LCR), local recurrence rate (LRR), metastasis rate, overall survival (OS), progress free survival(PFS) and complications were assessed. Results A total of 314 patients were included in the analysis. Parametrial invasion, pelvic lymph node metastasis, tumor diameter > 4 cm and presence of residual disease were risk factors for recurrence in the non-surgery group. In patients with risk factors, radical surgery significantly improved their clinical outcome. The 3-year/5-year LCR in the surgery and non-surgery groups was 88.3%/87.4% and 82.3%/77.5%, respectively (P = 0.04). The 3-year/5-year OS rate in the two groups was 87.1%/81.7% and 72.8%/67.3%, respectively (P = 0.001). The 3-year/5-year LRR in the two groups were 11.7%/12.6% and 17.7%/22.5%, respectively (P = 0.04). The metastasis rates in the two groups were 19.9% and 24.8%, respectively (P = 0.09). Conclusions Surgery following CCRT could improve overall survival and progressfree survival. Radical surgery following CCRT appears to confer significant benefits including an increase in LCRs and decrease in LRR in CC patients with risk factors.
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Affiliation(s)
- Dan Zheng
- Department of Head and Neck and Mammary Gland Oncology, and Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, The Cancer Center, Chengdu, Sichuan, 610041, P.R. China
| | - Hua-Ping Mou
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Peng Diao
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, 3 University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, P.R. China
| | - Xiao-Ming Li
- Department of Hematology, The First Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Chuan-Li Zhang
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jing Jiang
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jia-Lian Chen
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Li-Shuai Wang
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Qiu Wang
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Guang-Yuan Zhou
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jie Chen
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Chuan Lin
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Zhi-Ping Yuan
- Department of Hematology, The First Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China.,Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
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26
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Weaver J, Harmon G, Harkenrider MM, Surucu M, Wood A, Alite F, Small W. Delineating the relationship between Point A prescription dose and pelvic lymph node doses in intracavitary high-dose-rate brachytherapy treatment of cervical cancer for use in low- and middle-income countries. Brachytherapy 2017; 17:201-207. [PMID: 29066085 DOI: 10.1016/j.brachy.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To define the relationship between the Point A prescription dose and the dose delivered to various pelvic lymph node groups during high-dose-rate (HDR) brachytherapy treatment of cervical cancer. In less developed countries, brachytherapy is often done without three-dimensional image guidance, instead relying on plain radiography and prescription to Point A. A defined relationship between Point A dose and lymph node doses would help physicians in these health care settings to more accurately estimate nodal doses. METHODS AND MATERIALS Treatment data from 50 fractions of HDR brachytherapy of cervical cancer were reviewed, the pelvic lymph nodes were contoured, and dose-volume histogram parameters were obtained. Dose-volume histogram parameters for each contour were normalized as a percentage of the corresponding Point A dose. All nodal groups were divided into left and right sides, except the presacral nodal group. RESULTS AND CONCLUSIONS Mean Point A doses were bilateral (Bil) 5.92 Gy ± 0.58, left (L) 5.93 ± 0.59, and right (R) 5.92 ± 0.59. Mean normalized D90 values for the various lymph node groups were as follows-obturator: Bil 20.3% ± 4.5, L 20.5% ± 4.4, and R 20.2% ± 5.2; external iliac: Bil 9.5% ± 2.9, L 10.0% ± 3.1, and R 9.5% ± 3.0; internal iliac: Bil 12.2% ± 3.5, L 12.1% ± 3.4, and R 12.9% ± 4.7; common iliac: Bil 4.3% ± 1.6, L 4.3% ± 1.6, and R 4.3% ± 1.7; and presacral: 8.7% ± 3.4. These relationships can serve as a useful tool for evaluating lymph node doses during HDR brachytherapy of cervical cancer in facilities performing two-dimensional treatment planning and those with limited resources.
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Affiliation(s)
- John Weaver
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Grant Harmon
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Murat Surucu
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Abbie Wood
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Fiori Alite
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.
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Marchetti C, De Felice F, Di Pinto A, Romito A, Musella A, Palaia I, Monti M, Tombolin V, Muzii L, Benedetti Panici P. Survival Nomograms after Curative Neoadjuvant Chemotherapy and Radical Surgery for Stage IB2-IIIB Cervical Cancer. Cancer Res Treat 2017; 50:768-776. [PMID: 28724282 PMCID: PMC6056954 DOI: 10.4143/crt.2017.141] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to develop nomograms for predicting the probability of overall survival (OS) and progression-free survival (PFS) in locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical surgery. Materials and Methods Nomograms to predict the 5-year OS rates and the 2-year PFS rates were constructed. Calibration plots were constructed, and concordance indices were calculated. Evaluated variableswere body mass index, age, tumor size, tumor histology, grading, lymphovascular space invasion, positive parametria, and positive lymph nodes. Results In total 245 patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy and radical surgery were included for the construction of the nomogram. The 5-year OS and PFS were 72.6% and 66%, respectively. Tumor size, grading, and parametria status affected the rate of OS, whereas tumor size and positive parametria were the main independent PFS prognostic factors. Conclusion We constructed a nomogram based on clinicopathological features in order to predict 2-year PFS and 5-year OS in locally advanced cervical cancer primarily treated with neoadjuvant chemotherapy followed by radical surgery. This tool might be particularly helpful for assisting in the follow-up of cervical cancer patients who have not undergone concurrent chemoradiotherapy.
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Affiliation(s)
- Claudia Marchetti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Anna Di Pinto
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Alessia Romito
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Angela Musella
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Innocenza Palaia
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Marco Monti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolin
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - PierLuigi Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
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Nomogram Predicting Overall Survival in Operable Cervical Cancer Patients. Int J Gynecol Cancer 2017; 27:987-993. [DOI: 10.1097/igc.0000000000000987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Lora D, Gómez de la Cámara A, Fernández SP, Enríquez de Salamanca R, Gómez JFPR. Prognostic models for locally advanced cervical cancer: external validation of the published models. J Gynecol Oncol 2017; 28:e58. [PMID: 28657220 PMCID: PMC5540718 DOI: 10.3802/jgo.2017.28.e58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/12/2017] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To externally validate the prognostic models for predicting the time-dependent outcome in patients with locally advanced cervical cancer (LACC) who were treated with concurrent chemoradiotherapy in an independent cohort. METHODS A historical cohort of 297 women with LACC who were treated with radical concurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital (H12O), Madrid, Spain. The external validity of prognostic models was quantified regarding discrimination, calibration, measures of overall performance, and decision curve analyses. RESULTS The review identified 8 studies containing 13 prognostic models. Different (International Federation of Gynecology and Obstetrics [FIGO] stages, parametrium involvement, hydronephrosis, location of positive nodes, and race) but related cohorts with validation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%; average age of 50; and over 79% squamous cell) were evaluated. The following models exhibited good external validity in terms of discrimination and calibration but limited clinical utility: the OS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristic curve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models of DFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 years from Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrence model at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%). CONCLUSION The external validation revealed the statistical and clinical usefulness of 4 prognostic models published in the literature.
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Affiliation(s)
- David Lora
- Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Agustín Gómez de la Cámara
- Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario 12 de Octubre, Madrid, Spain
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Validation of Nomograms for Survival and Metastases after Hysterectomy and Adjuvant Therapy in Uterine Cervical Cancer with Risk Factors. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2917925. [PMID: 28536694 PMCID: PMC5425848 DOI: 10.1155/2017/2917925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 11/18/2022]
Abstract
Background. Three nomogram models for early stage uterine cervical cancer have been developed (KROG 13-03 for overall survival [OS], SNUH/AMC for disease-free survival [DFS], and KROG 12-08 for distant metastases-free survival [DMFS]) after radical hysterectomy (RH) and pelvic lymph node dissection (PLND). This study aimed to validate these models using our cohort with adjuvant radiotherapy. Methods. According to the eligibility criteria of nomogram studies, patients were enrolled in Group A (N = 109) for the two KROG models (RH with PLND and whole pelvic irradiation) and Group B (N = 101) for the SNUH/AMC model (RH with PLND and squamous histology). Using Cox-regression hazard models, the prognostic factors of our cohorts were evaluated. The risk probabilities induced from published nomogram scores were calculated and the concordance indices were evaluated. Results. Group A had 88.1% 5-year OS and 86.0% 5-year DMFS. Group B had 83.0% 5-year DFS. In multivariate analyses, large tumor size for OS (HR 8.62, P < 0.001) and DMFS (HR 5.13, P = 0.003), young age (≤40 versus 41-64 years) for OS (HR 4.63, P = 0.097) and DFS (HR 3.44, P = 0.051), and multiple lymph node metastases (0 versus ≥3) for DMFS (HR 4.03, P = 0.031) and DFS (HR 3.90, P = 0.038) were significantly correlated. The concordance indices for OS, DMFS, and DFS were 0.612 (P = 0.002), 0.597 (P = 0.014), and 0.587 (P = 0.020), respectively. Conclusion. The developed nomogram models after RH and PLND are clinically useful in predicting various types of survival with significance.
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Multimodality imaging of locally recurrent and metastatic cervical cancer: emphasis on histology, prognosis, and management. Abdom Radiol (NY) 2016; 41:2496-2508. [PMID: 27357415 DOI: 10.1007/s00261-016-0825-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The management of recurrent and metastatic cervical cancer is evolving in concert with the available advanced imaging techniques and molecular targeted therapy. The purpose of this review is to provide an overview of imaging and treatment of cervical cancer patients with locoregional recurrence and metastatic disease, with emphasis on characteristic patterns of spread based on histology (squamous cell carcinoma and other subtypes), prognostic factors, diagnosis, and treatment response assessment, as well as updated therapeutic options.
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Complementary Prognostic Value of Pelvic Magnetic Resonance Imaging and Whole-Body Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Pretreatment Assessment of Patients With Cervical Cancer. Int J Gynecol Cancer 2016; 25:1461-7. [PMID: 26397068 DOI: 10.1097/igc.0000000000000519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the incremental prognostic value of pelvic magnetic resonance imaging (MRI) and whole-body F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings compared with clinical-histopathologic factors in patients with newly diagnosed cervical cancer. METHODS The institutional review board approved this retrospective study of 114 patients (median age, 40.6 years) with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVB cervical cancer who underwent pretreatment MRI and PET/CT. All scans were reviewed for locoregional tumor extent, pelvic or/and para-aortic lymphadenopathy, and distant metastases. Univariate Cox proportional hazard regression was performed to evaluate associations between clinical-histopathologic factors, imaging findings, and progression-free survival (PFS). Multivariate models were built using independent predictors for PFS. Harrell C was used to measure concordance (C index). RESULTS Forty patients progressed within a median time of 10.4 months (range, 0.4-40.3 months). At univariate analysis, age, FIGO stage, tumor histology, tumor grade, and all MRI and PET/CT features were significantly associated with PFS (P < 0.0001 to P = 0.0474). A multivariate model including clinical and imaging parameters (parametrial invasion on MRI and para-aortic lymphadenopathy/distant metastases on PET/CT) had significantly higher concordance for predicting PFS than a model including clinical parameters only (C index: 0.81 [95% confidence interval, 0.75-0.87] vs 0.68 [95% confidence interval, 0.59-0.78]; P < 0.001). The comparison of C indices for the combined clinical and imaging model approached significance when compared with a FIGO stage model (C index: 0.81 [95% confidence interval, 0.75-0.87] vs 0.75 [95% confidence interval, 0.69-0.82]; P = 0.058). CONCLUSIONS In patients with newly diagnosed cervical cancer, a prognostic model including combined MRI and PET/CT findings provides information that complements clinical and histopathologic factors.
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Yao L, Jiang Y, Jiang P, Wang H, Meng N, Qu A, Tian S, Sun H, Liu C, Wang J, Zhang K. CT-guided permanent 125I seed interstitial brachytherapy for recurrent retroperitoneal lymph node metastases after external beam radiotherapy. Brachytherapy 2015; 14:662-9. [PMID: 26138110 DOI: 10.1016/j.brachy.2015.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/20/2015] [Accepted: 05/23/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the feasibility, efficacy, and safety of permanent (125)I seed interstitial brachytherapy reirradiation in patients with retroperitoneal lymph node recurrence under CT guidance. METHODS AND MATERIALS Seventeen patients with 19 retroperitoneal lymph node recurrence after external beam radiotherapy underwent CT-guided (125)I seed implant brachytherapy from October 2007 to August 2014. Treatment for all patients was preplanned using a three-dimensional radiation therapy planning system 3-5 days before brachytherapy; dosimetry verification was performed immediately after brachytherapy. RESULTS The actuarial D90 (dose delivered to 90% of the target volume) was 100-198 Gy (median, 126.5 Gy). In 9 patients, pain intensity decreased to mild pain 1-3 weeks after brachytherapy. Pain-free survival ranged 2-15 months (median, 5 months; 95% confidence interval [CI]: 0.1, 9.9). The overall response rate was 19 of 19 (100%). The median local control time was 15 months (95% CI: 2.3, 27.7). The 6-, 12-, and 24-month local control rate was 88.0%, 63.2%, and 42.1%, respectively. Twelve patients (70.6%) developed distant metastases and died. Two patients (11.8%) are alive with distant metastases but no evidence of local recurrence. Three patients (17.6%) are alive with no evidence of local recurrence. Median overall survival was 10 months (95% CI: 5.7, 14.3); the 1- and 2-year survival rates were 38.1% and 15.3%, respectively. No major complications related to the procedure occurred during or after brachytherapy. CONCLUSIONS Reirradiation with CT-guided permanent (125)I seed interstitial brachytherapy is feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent retroperitoneal lymph nodes.
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Affiliation(s)
- Lihong Yao
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Na Meng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Chen Liu
- Department of Radiology, Peking University Third Hospital, Beijing, P. R. China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China.
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, Shangdong, P. R. China.
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Zhou H, Li X, Zhang Y, Jia Y, Hu T, Yang R, Huang KC, Chen ZL, Wang SS, Tang FX, Zhou J, Chen YL, Wu L, Han XB, Lin ZQ, Lu XM, Xing H, Qu PP, Cai HB, Song XJ, Tian XY, Zhang QH, Shen J, Liu D, Wang ZH, Xu HB, Wang CY, Xi L, Deng DR, Wang H, Lv WG, Shen K, Wang SX, Xie X, Cheng XD, Ma D, Li S. Establishing a Nomogram for Stage IA-IIB Cervical Cancer Patients after Complete Resection. Asian Pac J Cancer Prev 2015; 16:3773-7. [DOI: 10.7314/apjcp.2015.16.9.3773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kyung MS, Kim HB, Seoung JY, Choi IY, Joo YS, Lee MY, Kang JB, Park YH. Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis. Oncol Lett 2015; 9:2218-2224. [PMID: 26137044 DOI: 10.3892/ol.2015.3015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/22/2015] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to investigate the prognostic role of a number of clinical factors in advanced cervical cancer patients. Patients (n=157) with stage IIA-IIB cervical cancer treated at four Hallym Medical Centers in South Korea (Hallym University Sacred Heart Hospital; Kangnam Sacred Heart Hospital; Chuncheon Sacred Heart Hospital; and Kangdong Sacred Heart Hospital) between 2006 and 2010 were retrospectively enrolled. Univariate analysis identified significant predictive values in the following eight factors: i) Cancer stage (P<0.0001); ii) tumor size (≤4 vs. 4-6 cm, P=0.0147; and ≤4 vs. >6 cm, P<0.0001); iii) serum squamous cell carcinoma antigen level (≤2 vs. >15 ng/ml; P=0.0291); iv) lower third vaginal involvement (P<0.0001); v) hydronephrosis (P=0.0003); vi) bladder/rectum involvement (P=0.0015); vii) pelvic (P=0.0017) or para-aortic (P=0.0019) lymph node (LN) metastasis detected by imaging vs. no metastasis; and viii) pelvic LN metastasis identified by pathological analysis (P=0.0289). Furthermore, multivariate analysis determined that tumor size (≤4 vs. 4-6 cm, P=0.0371; and ≤4 vs. >6 cm, P=0.0024) and pelvic LN metastasis determined by imaging vs. no metastasis (P=0.0499) were independent predictive variables. Therefore, tumor size and pelvic LN metastasis measured by imaging were independent predictive factors for the prognosis of advanced cervical cancer. These factors may provide more clinically significant prognostic information compared with the currently used International Federation of Gynecology and Obstetrics staging system.
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Affiliation(s)
- Min Sun Kyung
- Department of Obstetrics and Gynecology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Hwasung, Gyeonggi 445-907, Republic of Korea
| | - Hong Bae Kim
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul 150-950, Republic of Korea
| | - Jung Yeob Seoung
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Gyeonggi 431-070, Republic of Korea
| | - In Young Choi
- Department of Medicine, Hallym University College of Medicine, Chuncheon, Gangwon 200-702, Republic of Korea
| | - Young Soo Joo
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Gyeonggi 431-070, Republic of Korea
| | - Me Yeon Lee
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Gyeonggi 431-070, Republic of Korea
| | - Jung Bae Kang
- Department of Obstetrics and Gynecology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Hwasung, Gyeonggi 445-907, Republic of Korea
| | - Young Han Park
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Gyeonggi 431-070, Republic of Korea
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Vargo JA, Kim H, Choi S, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Beriwal S. Extended Field Intensity Modulated Radiation Therapy With Concomitant Boost for Lymph Node–Positive Cervical Cancer: Analysis of Regional Control and Recurrence Patterns in the Positron Emission Tomography/Computed Tomography Era. Int J Radiat Oncol Biol Phys 2014; 90:1091-8. [DOI: 10.1016/j.ijrobp.2014.08.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/25/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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A nomogram predicting the risks of distant metastasis following postoperative radiotherapy for uterine cervical carcinoma: a Korean radiation oncology group study (KROG 12-08). Radiother Oncol 2014; 111:437-41. [PMID: 24909094 DOI: 10.1016/j.radonc.2014.03.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 01/24/2014] [Accepted: 03/09/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE To develop a nomogram predicting the risks of distant metastasis following postoperative adjuvant radiation therapy for early stage cervical cancer. MATERIALS AND METHODS We reviewed the medical records of 1069 patients from ten participating institutions. Patients were divided into two cohorts: a training set (n=748) and a validation set (n=321). The demographic, clinical, and pathological variables were included in the univariate Cox proportional hazards analysis. Clinically established and statistically significant prognostic variables were utilized to develop a nomogram. RESULTS The model was constructed using four variables: histologic type, pelvic lymph node involvement, depth of stromal invasion, and parametrial invasion. This model demonstrated good calibration and discrimination, with an internally validated concordance index of 0.71 and an externally validated c-index of 0.65. Compared to FIGO staging, which showed a broad range in terms of distant metastasis, the developed nomogram can accurately predict individualized risks based on individual risk factors. CONCLUSIONS The devised model offers a significantly accurate level of prediction and discrimination. In clinical practice it could be useful for counseling patients and selecting the patient group who could benefit from more intensive/further chemotherapy, once validated in a prospective patient cohort.
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Lee HJ, Han S, Kim YS, Nam JH, Kim HJ, Kim JW, Park W, Kim BG, Kim JH, Cha SD, Kim J, Lee KH, Yoon MS, Kim SM, Kim JY, Yoon WS, Lee NW, Choi JH, Park SY, Kim JY. Individualized prediction of overall survival after postoperative radiation therapy in patients with early-stage cervical cancer: a Korean Radiation Oncology Group study (KROG 13-03). Int J Radiat Oncol Biol Phys 2013; 87:659-64. [PMID: 24138914 DOI: 10.1016/j.ijrobp.2013.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE A nomogram is a predictive statistical model that generates the continuous probability of a clinical event such as death or recurrence. The aim of the study was to construct a nomogram to predict 5-year overall survival after postoperative radiation therapy for stage IB to IIA cervical cancer. METHODS AND MATERIALS The clinical data from 1702 patients with early-stage cervical cancer, treated at 10 participating hospitals from 1990 to 2011, were reviewed to develop a prediction nomogram based on the Cox proportional hazards model. Demographic, clinical, and pathologic variables were included and analyzed to formulate the nomogram. The discrimination and calibration power of the model was measured using a concordance index (c-index) and calibration curve. RESULTS The median follow-up period for surviving patients was 75.6 months, and the 5-year overall survival probability was 87.1%. The final model was constructed using the following variables: age, number of positive pelvic lymph nodes, parametrial invasion, lymphovascular invasion, and the use of concurrent chemotherapy. The nomogram predicted the 5-year overall survival with a c-index of 0.69, which was superior to the predictive power of the International Federation of Gynecology and Obstetrics (FIGO) staging system (c-index of 0.54). CONCLUSIONS A survival-predicting nomogram that offers an accurate level of prediction and discrimination was developed based on a large multi-center study. The model may be more useful than the FIGO staging system for counseling individual patients regarding prognosis.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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Risk assessment model for overall survival in patients with locally advanced cervical cancer treated with definitive concurrent chemoradiotherapy. Gynecol Oncol 2013; 128:54-59. [DOI: 10.1016/j.ygyno.2012.09.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/20/2012] [Accepted: 09/30/2012] [Indexed: 11/18/2022]
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Kudaka W, Nagai Y, Toita T, Inamine M, Asato K, Nakamoto T, Wakayama A, Ooyama T, Tokura A, Murayama S, Aoki Y. Long-term results and prognostic factors in patients with stage III-IVA squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy from a single institution study. Int J Clin Oncol 2012; 18:916-21. [PMID: 22898910 DOI: 10.1007/s10147-012-0457-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We evaluated the longer-term efficacy and safety of concurrent chemoradiotherapy (CCRT) incorporating high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a lower cumulative radiotherapy (RT) protocol and analyzed prognostic risk factors for survival among patients with FIGO stage III-IVA squamous cell carcinoma (SCC) of the cervix. PATIENTS AND METHODS Ninety-nine patients with FIGO stage III-IVA SCC of the cervix between 1997 and 2008 were treated with CCRT using cisplatin 20 mg/m(2) for 5 days every 3 weeks or 40 mg/m(2) weekly. Acute and late toxicities were evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. RESULTS Median age was 53.5 years. Median follow-up period was 58 months (range 6-170 months). Pathologically complete response was achieved in 93 patients (96.9%). The 5-year OS and DFS were 72.0 and 69.3%, respectively. The 5-year local and distant DFS were 83.0 and 75.1%, respectively. Thirty-one patients (31.3%) experienced recurrence. Multivariate analysis showed that tumor size and pretreatment hemoglobin level remained an independent risk factor for OS and DFS. Acute toxicity was moderate. In terms of late adverse effects, 2 patients (2.0%) suffered from grade 4 late intestinal toxicity because of radiation enterocolitis, with both requiring intestinal surgery. CONCLUSIONS Our study demonstrates that the CCRT schedule in patients with FIGO stage III-IVA SCC is efficacious and safe. In addition, the assessment of tumor size and pretreatment anemia can provide valuable prognostic information.
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Affiliation(s)
- Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Polterauer S, Grimm C, Hofstetter G, Concin N, Natter C, Sturdza A, Pötter R, Marth C, Reinthaller A, Heinze G. Nomogram prediction for overall survival of patients diagnosed with cervical cancer. Br J Cancer 2012; 107:918-24. [PMID: 22871885 PMCID: PMC3464766 DOI: 10.1038/bjc.2012.340] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Nomograms are predictive tools that are widely used for estimating cancer prognosis. The aim of this study was to develop a nomogram for the prediction of overall survival (OS) in patients diagnosed with cervical cancer. Methods: Cervical cancer databases of two large institutions were analysed. Overall survival was defined as the clinical endpoint and OS probabilities were estimated using the Kaplan–Meier method. Based on the results of survival analyses and previous studies, relevant covariates were identified, a nomogram was constructed and validated using bootstrap cross-validation. Discrimination of the nomogram was quantified with the concordance probability. Results: In total, 528 consecutive patients with invasive cervical cancer, who had all nomogram variables available, were identified. Mean 5-year OS rates for patients with International Federation of Gynecologists and Obstetricians (FIGO) stage IA, IB, II, III, and IV were 99.0%, 88.6%, 65.8%, 58.7%, and 41.5%, respectively. Seventy-six cancer-related deaths were observed during the follow-up period. FIGO stage, tumour size, age, histologic subtype, lymph node ratio, and parametrial involvement were selected as nomogram covariates. The prognostic performance of the model exceeded that of FIGO stage alone and the model’s estimated optimism-corrected concordance probability was 0.723, indicating accurate prediction of OS. We present the prediction model as nomogram and provide a web-based risk calculator (http://www.ccc.ac.at/gcu). Conclusion: Based on six easily available parameters, a novel statistical model to predict OS of patients diagnosed with cervical cancer was constructed and validated. The model was implemented in a nomogram and provides accurate prediction of individual patients’ prognosis useful for patient counselling and deciding on follow-up strategies.
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Affiliation(s)
- S Polterauer
- Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
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FDG-PET-based prognostic nomograms for locally advanced cervical cancer. Gynecol Oncol 2012; 127:136-40. [PMID: 22735785 DOI: 10.1016/j.ygyno.2012.06.027] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/13/2012] [Accepted: 06/17/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE We previously found several individual FDG/PET-based prognostic factors for cervical cancer, specifically cervical tumor SUVmax, tumor volume, and highest level of lymph node (LN) involvement. For this study, we evaluate the combined use of these three prognostic factors assessed on pretreatment FDG-PET for predicting recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). PATIENTS AND METHODS The study included 234 cervical cancer patients, FIGO stage Ib1-IVa, treated with definitive radiation or chemoradiation therapy. All patients underwent FDG-PET or FDG-PET/CT at diagnosis, from which cervical tumor volume, SUVmax, and LN status were recorded. Using these PET-based factors, prognostic nomograms were created for RFS, DSS, and OS, and their prediction accuracies were measured using the concordance index (c-statistic). RESULTS Fifty-three percent of patients had FDG-avid LN on PET; the highest level of nodal involvement was pelvic in 84, para-aortic in 41, and supraclavicular in 10. The average cervix tumor SUVmax was 12.4 (range, 2.1-50.4) and PET tumor volume average was 66.4 cm3 (range, 3.0-535.7 cm3). The median follow-up was 40.7 months for patients alive at last follow-up. PET LN status had the greatest influence on outcome. The c-statistics for the 3 nomograms were 0.741 for RFS, 0.739 for DSS, and 0.658 for OS. The PET-based nomograms performed better than FIGO stage with c-statistics of 0.605, 0.600 and 0.559 for RFS, DSS and OS, respectively. CONCLUSIONS Pretreatment FDG-PET LN status, cervical tumor SUVmax, and tumor volume combined in a nomogram create good models for predicting cervical cancer RFS, DSS, and OS.
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Hydronephrosis as a prognostic indicator of survival in advanced cervix cancer. Int J Gynecol Cancer 2012; 21:1091-6. [PMID: 21738045 DOI: 10.1097/igc.0b013e31821cabc8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine whether hydronephrosis is an independent prognostic indicator of survival among patients with advanced cervical carcinoma. Moreover, we wanted to demonstrate the relationship between unilateral and bilateral hydronephrosis and overall survival. METHODS Retrospective analysis of 197 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical carcinoma or higher treated between 1990 and 2007 was conducted. Inclusion criteria were clinical staging according to FIGO criteria, standardized radiation treatment and cisplatin-based chemosensitization regimens. Associations between hydronephrosis and covariates-age, race, histopathologic diagnosis, pelvic sidewall involvement, stage, nodal involvement, and Gynecologic Oncology Group/Eastern Cooperative Oncology Group performance status (PS)-were determined. Statistical analysis including Kaplan-Meier, log-rank test, proportional hazards regression, Fisher exact test, and Mann-Whitney test were used where appropriate, with P < 0.05 considered significant. RESULTS Of 143 included patients, 73 patients had no hydronephrosis (HN), 39 patients had unilateral HN, and 31 patients had bilateral HN. Twenty-nine patients (40%) with no HN died compared to 24 patients (61.5%) with unilateral HN and 21 patients (67.7%) with bilateral HN. Median time to death was significantly shorter for patients with unilateral HN (27 months; 95% confidence interval [CI], 10-48) and bilateral HN (12 months; 95% CI, 6-23) versus patients without HN (68 months; 95% CI, 39-∞; P < 0.001). Unadjusted hazard ratio (HR) for HN (both unilateral and bilateral) was 2.4 (95% CI, 1.5-3.8); P < 0.001. Of potential covariates evaluated, PS and sidewall involvement were significantly associated with HN (P = 0.021 and P = 0.014, respectively). Proportional hazards regression revealed that controlling for use of radiation, chemotherapy, and for PS, HN was still significantly associated with poor prognosis (HR unilateral HN = 2.0, 95% CI, 1.2-3.5; HR bilateral HN = 3.2, 95% CI, 1.7-6.0); P ≤ 0.001. CONCLUSION Hydronephrosis is an independent poor prognostic indicator of survival in patients with advanced cervical cancer. Bilateral hydronephrosis compared to unilateral involvement confers a worse overall prognosis. Additional studies are needed to determine if FIGO staging should be amended.
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Contribution of pelvic and para-aortic lymphadenectomy with sentinel node biopsy in patients with IB2-IIB cervical cancer. Br J Cancer 2011; 106:39-44. [PMID: 22146520 PMCID: PMC3251874 DOI: 10.1038/bjc.2011.541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Detection of lymph node involvement in women with IB2–IIB cervical cancer could have a positive effect on survival. We set out to evaluate the incidence of pelvic and/or para-aortic lymph node involvement using the sentinel node (SN) biopsy and its impact on survival. Methods: From 2002 to 2010, 66 women with IB2–IIB cervical cancer underwent a pelvic and paraaortic lymphadenectomy with SN biopsy. Survival between groups according to lymph node status was evaluated. Results: Mean tumour size was 43.5 mm. At least one SN was detected in 69% of the 45 SN procedures performed. Sixteen of these patients had metastatic SN and the false negative rate was 20%. Metastatic pelvic SNs or non-SNs were detected in 33 patients (50%), including pelvic-positive nodes in 26 (40%), pelvic- and paraaortic-positive lymph nodes in seven (11%), and paraaortic skip metastases in two (6%). Positive paraaortic node was the sole determinant for disease-free survival (DFS) and overall survival (OS; P<0.001). Differences in DFS and OS between groups according to the nodal status were observed (P<0.001). Conclusion: SN procedure gave a higher rate of metastasis detection. Further studies are required to evaluate whether pre-therapeutic node staging, including paraaortic and pelvic lymphanedectomy, should be performed.
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Chéreau E, Ballester M, Daraï E. Re: "Rate of para-aortic lymph node micrometastasis in patients with locally advanced cervical cancer". Gynecol Oncol 2011; 122:689; author reply 690. [PMID: 21620449 DOI: 10.1016/j.ygyno.2011.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
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Polterauer S, Hefler L, Seebacher V, Rahhal J, Tempfer C, Horvat R, Reinthaller A, Grimm C. The impact of lymph node density on survival of cervical cancer patients. Br J Cancer 2010; 103:613-6. [PMID: 20628380 PMCID: PMC2938249 DOI: 10.1038/sj.bjc.6605801] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/16/2010] [Accepted: 06/18/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate the prognostic value of lymph node density (LND) in patients with lymph node-positive cervical cancer. METHODS A total of 88 consecutive patients were included in our study. Patients were treated with cisplatin-based concomitant chemoradiotherapy after surgical staging was performed at the Medical University of Vienna. Lymph node density, that is, the ratio of positive lymph nodes to the total number of lymph nodes removed, was assessed pathologically. Patients were stratified into two groups according to LND: patients with LND 10%. Lymph node density was correlated with clinicopathological parameters by chi(2)-tests. Univariate log-rank tests and multivariate Cox regression models were used to evaluate the association between LND and survival. RESULTS A significant correlation between LND and FIGO stage (P=0.03), but not patients' age (P=0.2), histological grade (P=0.8), and histological type (P=0.5), was observed. In a univariate survival analysis, LND (P=0.01; P=0.01), FIGO stage (P=0.01; P=0.008), and histological grade (P=0.03; P=0.04) were associated with disease-free and overall survival, respectively. Patients with LND >10% had impaired disease-free and overall survival rates compared with patients with LND CONCLUSIONS LND >10% is associated with an impaired disease-free and overall survival. Lymph node density may be used as an independent prognostic parameter in patients with lymph node-positive cervical cancer.
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Affiliation(s)
- S Polterauer
- Department of Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20,Vienna A-1090, Austria.
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