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Chen CS, Huang EY. Comparison of Oncologic Outcomes between Radical Hysterectomy and Primary Concurrent Chemoradiotherapy in Women with Bulky IB and IIA Cervical Cancer under Risk Stratification. Cancers (Basel) 2023; 15:cancers15113034. [PMID: 37296994 DOI: 10.3390/cancers15113034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To stratify patients according to tumor marker and histology and compare the survival outcome between radical hysterectomy (RH) and primary concurrent chemoradiotherapy (CCRT) in bulky IB and IIA cervical cancer. METHODS A total of 442 patients with cervical cancer were enrolled in the Chang Gung Research Database from January 2002 to December 2017. Patients with squamous cell carcinoma (SCC) and carcinoembryonic antigen (CEA) ≥10 ng/mL, adenocarcinoma (AC), or adenosquamous carcinoma (ASC) were stratified into the high-risk (HR) group. The others were classified into the low-risk (LR) group. We compared oncology outcomes between RH and CCRT in each group. RESULTS In the LR group, 5-year overall survival (OS) and recurrence-free survival (RFS) were 85.9% vs. 85.4% (p = 0.315) and 83.6% vs. 82.5% (p = 0.558) in women treated with RH (n = 99) vs. CCRT (n = 179), respectively. In the HR group, the 5-year OS and RFS were 83.2% vs. 73.3% (p = 0.164) and 75.2% vs. 59.6% (p < 0.036) in patients treated with RH (n = 128) vs. CCRT (n = 36), respectively. Regarding recurrence, locoregional recurrence (LRR) (8.1% vs. 8.6%, p = 0.812) and distant metastases (DM) (17.8% vs. 21%, p = 0.609) were similar between RH and CCRT in the LR group. However, lower LRR (11.6% vs. 26.3%, p = 0.023) but equivalent DM (17.8% vs. 21%, p = 0.609) were found for women undergoing RH compared with CCRT in the HR group. CONCLUSIONS There were similar survival and recurrence rates between both treatment modalities in low-risk patients. Meanwhile, primary surgery with or without adjuvant radiation provides better RFS and local control in women with high-risk features. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Chung-Shih Chen
- Departments of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan
| | - Eng-Yen Huang
- Departments of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City 804, Taiwan
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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The Involvement of Natural Polyphenols in the Chemoprevention of Cervical Cancer. Int J Mol Sci 2021; 22:ijms22168812. [PMID: 34445518 PMCID: PMC8396230 DOI: 10.3390/ijms22168812] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022] Open
Abstract
From all types of cancer, cervical cancer manages to be in top four most frequent types, with a 6.5% rate of occurrence. The infectious vector that induces the disease, the high-risk Human papillomavirus (HPV), which is a sexually transmitted virus, is capable of transforming the host cell by modulating some of the principal signaling pathways responsible for cell cycle arrest, proliferation, and survival. Fortunately, like other cancer types, cervical cancer can be treated by chirurgical interventions or chemoradiotherapy, but these methods are not exactly the lucky clover of modern medicine because of the adverse effects they have. That is the reason why in the last years the emphasis has been on alternative medicine, more specifically on phytochemicals, as a substantial number of studies showed that diet contributes to cancer prevention and treatment. All these studies are trying to find new chemopreventive agents with less toxicity but high effectiveness both in vitro and in vivo. The aim of this review is to evaluate the literature in order to underline the advantages and disadvantages of polyphenols, a class of dietary compounds, as chemopreventive and chemotherapeutic agents. This review also aims to present polyphenols from different perspectives, starting with mechanisms of action and ending with their toxicity. The bigger picture illustrates that polyphenols have great potential in cervical cancer prevention, with strong effects on gene modulation.
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Frequent Stools Were Related to Reduced Quality of Life and Capacity in Daily Activities: Weekly Observations During and After Pelvic or Abdominal Radiotherapy. Cancer Nurs 2021; 43:478-488. [PMID: 32452968 DOI: 10.1097/ncc.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Greater knowledge regarding stool frequency and infrequency during pelvic and abdominal irradiation is needed to accurately identify patients at risk of either. OBJECTIVE To describe occurrence of frequent and infrequent stools during pelvic-abdominal radiotherapy, and to compare quality of life (QoL) and activities of daily living (ADLs) of those patients experiencing frequent stools with those of patients experiencing infrequent stools. METHODS Longitudinally during radiotherapy, 193 patients (64% had gynecological tumors) documented stool frequency, medications, and QoL using the Functional Assessment of Cancer Therapy-General. RESULTS Fifty (26%) experienced frequent stools (≥28 stools a week), and 17 (9%) experienced infrequent stools (<3 stools a week). The frequency of stools and the consumption of medication for diarrhea were highest the last week of the radiotherapy period (50% had ≥49 stools a week, and 50% could not even define the number of stools). Thirty-seven of the patients experiencing frequent stools used antidiarrhea medications. Patients with frequent stools experienced lower QoL (P = .035) and capacity in ADLs (P = .023) compared with patients not experiencing frequent stools. CONCLUSIONS A fourth of patients irradiated over pelvic or abdominal fields experienced frequent stools, defined as moderate to severe diarrhea, and those patients experienced lower QoL and capacity in ADLs compared with patients who did not experience frequent stools. Infrequent stools were rarely experienced. IMPLICATIONS FOR PRACTICE Cancer nursing professionals should deliver evidence-based strategies to prevent frequent stools and treat frequent stools as an approach to lower the risk of impaired capacity in daily living and worsened QoL.
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Adegboyega B, Muhammad H, Joseph A, Alabi B, Durosinmi-Etti F. Prospective study on acute toxicities of external beam radiotherapy in the management of pelvic malignancies in Lagos University Teaching Hospital. JOURNAL OF CLINICAL SCIENCES 2020. [DOI: 10.4103/jcls.jcls_85_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Relationship between clinical toxicities and ERCC1 rs3212986 and XRCC3 rs861539 polymorphisms in cervical cancer patients. Int J Biol Markers 2017; 33:116-123. [PMID: 28708208 DOI: 10.5301/ijbm.5000279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Several studies have suggested that there are single nucleotide polymorphisms (SNPs) that can be considered potential biomarkers in the prognosis and therapeutic response of cancer patients. The present study investigated the association between ERCC1 rs3212986 and XRCC3 rs861539 polymorphisms and clinical toxicities induced by chemoradiotherapy (CRT) in cervical cancer. METHODS This hospital-based retrospective cohort study included 260 patients with cervical cancer, FIGO stages Ib2-IVa, who underwent CRT (cisplatin). Genetic polymorphisms analysis was performed by allelic discrimination with real-time polymerase chain reaction (RT-PCR). RESULTS Our results indicated a link between ERCC1 rs3212986 and the onset of late gastrointestinal toxicity (p = 0.038). Furthermore, using a recessive model (AA vs. CC/CA), we found that patients carrying AA homozygous genotype presented a fourfold increased risk of developing late gastrointestinal toxicity when compared with patients with the C allele (odds ratio = 3.727, 95% confidence interval, 1.199-11.588; p = 0.017). No association was found regarding the XRCC3 rs861539 polymorphism and any clinical toxicity event. CONCLUSIONS This is the first study evaluating the relationship between these polymorphisms and clinical toxicities in cervical cancer patients submitted to CRT with cisplatin. These results may contribute toward a better understanding of the influence of genetic polymorphisms in genes associated with DNA repair in the clinical response to CRT of patients with cervical cancer.
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Mason SA, O’Shea TP, White IM, Lalondrelle S, Downey K, Baker M, Behrens CF, Bamber JC, Harris EJ. Towards ultrasound-guided adaptive radiotherapy for cervical cancer: Evaluation of Elekta's semiautomated uterine segmentation method on 3D ultrasound images. Med Phys 2017; 44:3630-3638. [PMID: 28493295 PMCID: PMC5575494 DOI: 10.1002/mp.12325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/10/2017] [Accepted: 03/29/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE 3D ultrasound (US) images of the uterus may be used to adapt radiotherapy (RT) for cervical cancer patients based on changes in daily anatomy. This requires accurate on-line segmentation of the uterus. The aim of this work was to assess the accuracy of Elekta's "Assisted Gyne Segmentation" (AGS) algorithm in semi-automatically segmenting the uterus on 3D transabdominal ultrasound images by comparison with manual contours. MATERIALS & METHODS Nine patients receiving RT for cervical cancer were imaged with the 3D Clarity® transabdominal probe at RT planning, and 1 to 7 times during treatment. Image quality was rated from unusable (0)-excellent (3). Four experts segmented the uterus (defined as the uterine body and cervix) manually and using AGS on images with a ranking > 0. Pairwise analysis between manual contours was evaluated to determine interobserver variability. The accuracy of the AGS method was assessed by measuring its agreement with manual contours via pairwise analysis. RESULTS 35/44 images acquired (79.5%) received a ranking > 0. For the manual contour variation, the median [interquartile range (IQR)] distance between centroids (DC) was 5.41 [5.0] mm, the Dice similarity coefficient (DSC) was 0.78 [0.11], the mean surface-to-surface distance (MSSD) was 3.20 [1.8] mm, and the uniform margin of 95% (UM95) was 4.04 [5.8] mm. There was no correlation between image quality and manual contour agreement. AGS failed to give a result in 19.3% of cases. For the remaining cases, the level of agreement between AGS contours and manual contours depended on image quality. There were no significant differences between the AGS segmentations and the manual segmentations on the images that received a quality rating of 3. However, the AGS algorithm had significantly worse agreement with manual contours on images with quality ratings of 1 and 2 compared with the corresponding interobserver manual variation. The overall median [IQR] DC, DSC, MSSD, and UM95 between AGS and manual contours was 5.48 [5.45] mm, 0.77 [0.14], 3.62 [2.7] mm, and 5.19 [8.1] mm, respectively. CONCLUSIONS The AGS tool was able to represent uterine shape of cervical cancer patients in agreement with manual contouring in cases where the image quality was excellent, but not in cases where image quality was degraded by common artifacts such as shadowing and signal attenuation. The AGS tool should be used with caution for adaptive RT purposes, as it is not reliable in accurately segmenting the uterus on 'good' or 'poor' quality images. The interobserver agreement between manual contours of the uterus drawn on 3D US was consistent with results of similar studies performed on CT and MRI images.
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Affiliation(s)
- Sarah A. Mason
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Tuathan P. O’Shea
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Ingrid M. White
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Susan Lalondrelle
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Kate Downey
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Mariwan Baker
- Department of OncologyHerlev Hospital, University of CopenhagenHerlevDenmark
| | - Claus F. Behrens
- Department of OncologyHerlev Hospital, University of CopenhagenHerlevDenmark
| | - Jeffrey C. Bamber
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Emma J. Harris
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
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Mdletshe S, Munkupa H, Lishimpi K. Acute toxicity in cervical cancer HIV-positive vs. HIV-negative patients treated by radical chemo-radiation in Zambia. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2016. [DOI: 10.1080/20742835.2016.1239356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Li Z, Yang S, Liu L, Han S. A comparison of concurrent chemoradiotherapy and radiotherapy in Chinese patients with locally advanced cervical carcinoma: a multi-center study. Radiat Oncol 2014; 9:212. [PMID: 25245218 PMCID: PMC4262079 DOI: 10.1186/1748-717x-9-212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background We investigated the efficacy of concurrent chemoradiotherapy (CCRT) over radiotherapy (RT) in Chinese patients with locally advanced cervical carcinoma. Patients and methods Between January 2005 and January 2008, 192 patients with squamous cell carcinoma of the cervix were included in the study: 96 in arm A (CCRT with 20 mg/m2 cisplatin for 5 days) and 96 in arm B (RT). The overall response rate was the primary endpoint. The secondary endpoints included overall survival, progression-free survival, and toxicity. Results The 5-year overall response rate was 67% and 53% for the CCRT and RT arms, respectively, and the difference was statistically significant, while the median overall survival was 68 months (range 3-85 months) and 61 months (range 4-83 months), respectively (P = 0.009). In addition, the median progression-free survival for CCRT was 62 months (range 3-83 months), whereas it was 51 months (range 4-81 months) for the RT arm (P = 0.025). The toxicity profile, both acute and late, was comparable in both arms. Conclusion In summary, we demonstrate that CCRT was effective and better tolerated than RT alone in Chinese patients with locally advanced cervical carcinoma. Trial registration Chinese Clinical Trials Register: ChiCTR-TRC-13003979.
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Affiliation(s)
| | | | | | - Shiyu Han
- Department of Gynaecology and Obstetrics, Fourth Affiliated Hospital of Harbin Medical University, No,37 Yiyuan Street, Nangang District, Harbin, Heilongjiang Province 150001, China.
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Kumaran A, Guruvare S, Sharan K, Rai L, Hebbar S. Chemoradiation Related Acute Morbidity in Carcinoma Cervix and Correlation with Hematologic Toxicity: A South Indian Prospective Study. Asian Pac J Cancer Prev 2014; 15:4483-6. [DOI: 10.7314/apjcp.2014.15.11.4483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Berveling MJ, Langendijk JA, Beukema JC, Mourits MJE, Reyners AKL, Pras E. Health-related quality of life and late morbidity in concurrent chemoradiation and radiotherapy alone in patients with locally advanced cervical carcinoma. J Gynecol Oncol 2011; 22:152-60. [PMID: 21998757 PMCID: PMC3188713 DOI: 10.3802/jgo.2011.22.3.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 12/02/2022] Open
Abstract
Objective Concurrent chemoradiation has improved survival of patients with cervical carcinoma. However, follow-up of randomized studies is relatively short and data on long term toxicity are scarce, as is information on their health-related quality of life. This study assesses and compares incidences of late side-effects among patients treated with radiotherapy or chemoradiation using two toxicity scoring systems, and investigates impact on health-related quality of life. Methods Between 1985 and 1993, 114 patients underwent radiotherapy (n=39) or chemoradiation (n=75) for stage IIA-IVB cervical carcinoma. Late side-effects were scored retrospectively by reviewing medical charts using standardised checklists, focusing on bladder- and intestinal side effects. Health-related quality of life was assessed once using the EORTC QLQ-C30. Results No significant differences in late treatment-related side-effects between radiotherapy and chemoradiation groups were found. Grade ≥ 2 toxicity was found in 33% (bladder), and in 6% (bowel). Only 1.8% had both grade 3-4 toxicity. Bladder syndrome with high urinary frequency, urine incontinence and small bowel toxicity had a significant impact on health-related quality of life. Conclusion Grade 2 are relatively frequent late side effects in curatively treated patients, but are not enhanced by the addition of chemotherapy. Their negative impact on health-related quality of life stresses the importance of new radiation techniques, aiming at reduction of these side effects.
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Affiliation(s)
- Maaike J Berveling
- Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands
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Ntekim A, Adenipekun A, Akinlade B, Campbell O. High Dose Rate Brachytherapy in the Treatment of cervical cancer: preliminary experience with cobalt 60 Radionuclide source-A Prospective Study. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2010; 4:89-94. [PMID: 20838638 PMCID: PMC2934612 DOI: 10.4137/cmo.s5269] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Iridium-192 is widely used for high-dose rate brachytherapy. Co-60 source with similar geometric and dosimetric properties are now available. It has a longer half life but higher energy than Iridium-192. If Co-60 source can produce similar results, it will be more economical for low resource settings.
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Affiliation(s)
- Atara Ntekim
- Department of Radiation Oncology, University College Hospital Ibadan, Nigeria
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Tan LT. Chemoradiotherapy for cervical cancer--do questions remain? Clin Oncol (R Coll Radiol) 2010; 22:586-7. [PMID: 20584594 DOI: 10.1016/j.clon.2010.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/07/2010] [Indexed: 11/18/2022]
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Spensley S, Hunter RD, Livsey JE, Swindell R, Davidson SE. Clinical outcome for chemoradiotherapy in carcinoma of the cervix. Clin Oncol (R Coll Radiol) 2008; 21:49-55. [PMID: 19081712 DOI: 10.1016/j.clon.2008.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 09/30/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
AIMS Two recent meta-analyses have shown a survival advantage for the addition of concurrent chemotherapy to radiotherapy in the treatment of cervical cancer. However, there is insufficient information available on late toxicity and few data from UK practice. The aims of this study were to examine treatment outcomes (survival and toxicity) in patients with cervical cancer treated with chemoradiation and to compare these with outcomes in patients treated with radiation alone. MATERIALS AND METHODS Between July 2000 and December 2003, 75 patients with cervical cancer were treated with chemoradiation. Case notes were reviewed retrospectively. Acute and late toxicity were recorded, with late toxicity graded using the Franco-Italian glossary. The median age was 47 years. All patients were staged with examination under anaesthesia and magnetic resonance imaging scans. Forty-two patients were treated with concurrent chemoradiation alone and 33 patients were treated with a combination of neoadjuvant and concurrent chemoradiation. This was due to waiting list problems. The chemotherapy used was cisplatin 40 mg/m(2) weekly with radiotherapy, (the neoadjuvant dose was 60 mg/m(2) 3 weekly). External beam radiotherapy was given to the pelvis (40-45 Gy/20 fractions/4 weeks) followed by low dose rate brachytherapy (22.5-32.5 Gy to point A). Patients who were unable to have brachytherapy were given an external beam boost (15-20 Gy/8-10 fractions). RESULTS The 3-year overall survival rate was 70%, with an estimated 5-year overall survival rate of 60%. The 3-year disease-free survival was 63.6%, with an estimated 5-year disease-free survival rate of 55%. Compared with the cohort of 183 patients from the Christie Hospital in a 1993 audit, there was a trend towards improved overall survival from 49 to 60% (P=0.06), which may become significant with longer follow-up. There were seven patients (9.3%) with grade 3 toxicity and no cases of grade 4 toxicity. In comparison with patients treated in the 1993 audit, the late toxicity rate has increased from 3.4 to 9.3%, but this was not statistically significant (P=0.14). CONCLUSION There was a trend towards improved survival with concurrent chemoradiation in this cohort of patients that may become significant with longer follow-up.
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Affiliation(s)
- S Spensley
- Department of Clinical Oncology, Christie Hospital, Manchester, UK.
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Long-term survival and late toxicity after chemoradiotherapy for cervical cancer--the Addenbrooke's experience. Clin Oncol (R Coll Radiol) 2008; 20:358-64. [PMID: 18395427 DOI: 10.1016/j.clon.2008.03.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 02/18/2008] [Accepted: 03/04/2008] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the long term cause-specific survival and late toxicity of chemoradiotherapy for carcinoma of the cervix treated outside research settings. MATERIALS AND METHODS Between May 1999 and April 2003, 74 patients with carcinoma of the cervix were treated with radical radiotherapy given concurrently with weekly cisplatin chemotherapy. Three patients died during treatment, leaving 71 patients available for analysis of long-term survival and late toxicity of treatment. In total, 56 patients (78.9%) received chemoradiotherapy as primary radical treatment. Ten patients (14.1%) received chemoradiotherapy as adjuvant treatment after radical surgery. The remaining five patients (7.0%) received chemoradiotherapy as salvage treatment for pelvic recurrences after previous surgery. Forty-seven (66.2%) patients had squamous cell carcinomas, whereas 24 (33.8%) patients had adenocarcinomas. RESULTS The median follow-up for surviving patients was 64 months. The actuarial 5-year cause-specific survival for the 66 patients undergoing primary treatment (chemoradiotherapy+/-surgery) was 54.6%. The cause-specific survival by International Federation of Gynecology and Obstetrics (FIGO) disease stage was 58.3% for stage I disease, 69.9% for stage II disease and 20.8% for stage III disease. The actuarial 5-year pelvic control rate for the same group of patients was 73.3% overall (stage I=79.2%, stage II=89.0%, stage III=33.3%). Four of the five patients treated for recurrent disease are alive and well with a median follow-up of 70 months. Of the 66 patients undergoing primary treatment, seven (10.6%) had persistent disease after chemoradiotherapy. Of the 22 patients (33.3%) who relapsed >6 months after treatment, eight (36.4%) relapsed within the pelvis alone, 12 (54.5%) had metastatic disease alone, whereas two (9.1%) had both local and distant relapse. The overall rates of pelvic and distant relapse were 25.8 and 21.2%, respectively. Eight of 23 patients (34.8%) with adenocarcinomas developed metastatic disease compared with only six of 43 patients (14.0%) with squamous cell tumours. Thirteen patients (18.3%) had at least one complication that was classified as grade 3 or 4. Six patients (8.5%) had grade 3 or 4 urinary complications, five (7.0%) had grade 3 or 4 bowel complications and six (8.5%) had grade 3 or 4 complications affecting other organs. Five patients had grade 3 or 4 complications affecting more than one organ. The actuarial rate for grade 3 or 4 urinary complications was 14.5%, 9.4% for grade 3 or 4 bowel complications and 11.4% for grade 3 or 4 complications affecting other organs. The overall actuarial risk for grade 3 or 4 long-term morbidity in the study group was 28.2%. There were no significant correlations between the incidence of serious late toxicity and disease stage, field arrangement, treatment volumes or postoperative radiotherapy. CONCLUSIONS Our study has shown that the addition of chemotherapy to radiotherapy for cervical cancer probably improves the survival of patients treated outside research settings, but the benefit may not be as large as that obtained in clinical trials and the risk of serious late toxicity is increased. Further developments to improve survival and local control and to minimise toxicity are therefore necessary.
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Zahra MA, Taylor A, Mould G, Coles C, Crawford R, Tan LT. Concurrent weekly cisplatin chemotherapy and radiotherapy in a haemodialysis patient with locally advanced cervix cancer. Clin Oncol (R Coll Radiol) 2008; 20:6-11. [PMID: 18191389 DOI: 10.1016/j.clon.2007.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 09/14/2007] [Accepted: 10/12/2007] [Indexed: 11/15/2022]
Abstract
AIMS Concurrent cisplatin chemo-radiotherapy improves outcome in cervical carcinoma. In haemodialysis patients, cisplatin is potentially hazardous. We report the treatment of a haemodialysis patient with cervix cancer using cisplatin-based chemo-radiation. Mathematical modelling using toxicity data from a range of cisplatin dosages and schedules reported in published studies was undertaken. MATERIALS AND METHODS The patient was treated using weekly cisplatin chemotherapy 25mg/m(2). The serum platinum levels were measured. Correlations between reported toxicity and platinum levels for a variety of cisplatin schedules in published studies were evaluated. RESULTS Treatment was completed with no interruptions and minimum acute toxicity. The platinum levels rose progressively. The elimination half-life was prolonged at 6.6-7.5 days. The percentage extraction varied between 7.7 and 41.0%. The cumulative cisplatin dose correlated with neurotoxicity (P=0.002). Myelotoxicity correlated with the peak cisplatin level in the first 15 days of treatment (P=0.01). With an elimination half-life of 7.5 days, 35 mg/m(2) weekly is predicted to have the same risk of myelotoxicity and neurotoxicity as 40 mg/m(2) weekly in a patient with normal renal function. CONCLUSIONS Weekly cisplatin chemotherapy 25mg/m(2) can be delivered safely in a haemodialysis patient. Dialysis is effective in eliminating platinum even if carried out more than 3h after infusion, but it should commence as soon as possible after cisplatin infusion, as the incidence of myelotoxicity is related to the peak platinum level.
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Affiliation(s)
- M A Zahra
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
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King M, McConkey C, Latief TN, Hartley A, Fernando I. Improved survival after concurrent weekly cisplatin and radiotherapy for cervical carcinoma with assessment of acute and late side-effects. Clin Oncol (R Coll Radiol) 2006; 18:38-45. [PMID: 16477918 DOI: 10.1016/j.clon.2005.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS A recent meta-analysis has shown a survival advantage for the addition of concurrent chemotherapy to radiotherapy in the treatment of cervical carcinoma. Controversy persists about the most appropriate chemotherapy schedule and whether similar results for tumour control and toxicity may be achieved with optimally delivered radiotherapy. A single-centre experience of a concurrent chemotherapy regimen is presented. MATERIALS AND METHODS All women treated with concurrent chemoradiotherapy at a university hospital from 1 January 1999 to 1 May 2002 were identified. Acute and late complications were scored using the National Cancer Institute Common Toxicity Criteria and RTOG/ EORTC system, respectively. Univariate and multivariate analyses were carried out to examine the relationship between demographics, stage, overall treatment time, radiotherapy dose, selectron insertion, number of chemotherapy cycles and occurrence of acute and late toxicity. RESULTS Seventy-nine women received concurrent weekly cisplatin (40 mg/m2) with radiotherapy. Thirty-eight per cent had early tumours (FIGO IIA or less) and 62% had locally advanced tumours. Twenty-eight per cent of women had surgery as part of primary treatment. Radiation technique included external-beam pelvic radiotherapy (EBRT) (45-50.4 Gy in 25-28 fractions) and medium-dose rate brachytherapy single insertion (25-27 Gy to point A) or EBRT alone. Median overall treatment time was 49 days (range 23-91 days). Three-year survival rate was 87% (95% confidence interval [CI] 79-95%). Three-year, progression-free survival rate was 75% (95% CI 65-85%). At a median follow-up of 35 months: 27 (34%) women experienced 45 episodes of acute grade 3 or 4, and eight women (10%) experienced 12 late grade 3 or 4 complications. CONCLUSIONS Weekly cisplatin 40 mg/m2 concurrent with radiotherapy is well tolerated when given to an unselected population of patients. Survival rates seem to be excellent, with both local control and overall survival being at least as good as those in published randomised trials.
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Affiliation(s)
- M King
- Deansley Centre, New Cross Hospital, Wolverhampton, UK.
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Cetina L, Rivera L, Hinojosa J, Poitevin A, Uribe J, López-Graniel C, Cantú D, Candelaria M, de la Garza J, Dueñas-González A. Routine management of locally advanced cervical cancer with concurrent radiation and cisplatin. Five-year results. BMC WOMENS HEALTH 2006; 6:3. [PMID: 16464243 PMCID: PMC1420274 DOI: 10.1186/1472-6874-6-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 02/07/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Globally, cervical cancer primarily affects socially disadvantaged women. Five randomized trials were the foundation for adopting cisplatin-based chemotherapy during radiation as the standard of care for high-risk patients after primary radical hysterectomy who require adjuvant radiation and for locally advanced patients treated with definitive radiation. These results were obtained in clinical trials performed in carefully prepared academic centers; hence, we sought to determine whether these results could be reproduced when patients were treated on an out-of-protocol basis. METHODS We reviewed the files of 294 patients with locally advanced cervical cancer who received radiation plus weekly cisplatin as routine management between 1999 to 2003, and analyzed treatment compliance, response rate, toxicity, and survival. RESULTS A total of 294 patients who received radiation and cisplatin were analyzed. Mean age was 43.8 years (range, 26-68 years). The majority of cases were squamous cell carcinoma (87.8%), and distribution according to International Federation of Gynecology and Obstetrics (FIGO) stage was as follows: IB2-IIA, 23%; IIB, 53.3%, and IIIB, 23%; there were only two IVA cases. Overall, 96% of patients completed external beam, and intracavitary therapy. The majority of patients (67%) received the planned six courses of weekly cisplatin. Complete responses were achieved in 243 (83%) patients, whereas 51 (17%) had either persistent (32 patients, 10.8%) or progressive (19 patients, 6.4%) disease. At median follow-up (28 months; range, 2-68 months), 36 patients (12.2%) have relapsed (locally 30.5, and systemically, 69.5%). The most common toxicities were hematologic and gastrointestinal, in the majority of cases considered mild-moderate. At median follow-up (28 months; range, 2-68 months), overall and progression-free survival are 76.5 and 67%, respectively. CONCLUSION Our results support use of chemoradiation with six weekly applications of cisplatin at 40 mg/m2 during external radiation for routine management of locally advanced cervical cancer.
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Affiliation(s)
- Lucely Cetina
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Lesbia Rivera
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - José Hinojosa
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - Adela Poitevin
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - Jesús Uribe
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - David Cantú
- Division of Surgical Oncology, INCan, Mexico City, Mexico
| | - Myrna Candelaria
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jaime de la Garza
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Alfonso Dueñas-González
- Unit of Biomedical Research on Cancer, Instituto de Investigaciones Biomédicas (IIB), Universidad Nacional Autónoma de México (UNAM)/INCan, Mexico City, México
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