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Epidemiological guideline influence on the therapeutic trend and patient outcome of uterine cervical cancer in Japan: Japan society of gynecologic oncology guideline evaluation committee project. Gynecol Oncol 2020; 159:248-255. [PMID: 32718728 DOI: 10.1016/j.ygyno.2020.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Japan Society of Gynecologic Oncology published its first clinical guidelines for uterine cervical cancer in 2007 which has been revised twice in 2011 and 2017. The aim of this study was to investigate the influence of the first guideline publication on the therapeutic trend and patient outcome by analyzing uterine cervical cancer cases registered to the cancer registry organized by the Japan Society of Obstetrics and Gynecology. METHODS Data of uterine cervical cancer cases registered to the cancer registry from 2000 to 2012 were provided. Epidemiological and clinical trend were analyzed by the Chi-squared test with subsequent standardized residual analysis. Overall survival among the patients registered between 2004 and 2009 was analyzed using the Fine and Gray competing risk model. RESULTS 68,707 cases were registered during the study period. A trend analysis revealed that the guideline publication may have led to a decrease in neoadjuvant chemotherapy in parallel with an increase in radiation therapy mainly in stage II and III patients undergoing primary treatment. A survival analysis indicated that the introduction of the guideline may have improved overall survival among stage III uterine cervical cancer patients, even though a significant difference was not observed in all of the cases. CONCLUSIONS This study demonstrated the potential influence of the guideline publication on the clinical trend and patient outcome. As this is the first assessment of the guideline for uterine cervical cancer in Japan, continuous evaluation is necessary to further comprehend the significance of this guideline.
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Brunner TB. The rationale of combined radiotherapy and chemotherapy - Joint action of Castor and Pollux. Best Pract Res Clin Gastroenterol 2016; 30:515-28. [PMID: 27644901 DOI: 10.1016/j.bpg.2016.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/09/2016] [Indexed: 01/31/2023]
Abstract
This article aims to review the rationale behind the combination of radiotherapy and chemotherapy. Theoretical concepts describing the principles of the joint effects of chemoradiotherapy are reviewed. Preclinical and clinical evidence are collected and summarised demonstrating the co-operation between the two modalities which form the mainstay of the treatment of most solid tumours. Initially, the evolution of chemoradiotherapy was mostly empirically driven which is true for both, the early studies and the experimental investigations, rather than relying on scientific rationale. To date, the revised Steel's model proposes five mechanisms, spatial cooperation, cytotoxic enhancement, biological co-operation, temporary modulation and normal tissue protection to describe the interaction between radiotherapy and chemotherapy. Chemoradiotherapy has become the standard modality for most patients with locally advanced solid tumours due to better control of loco-regional disease and prolonged survival. Gradually, molecular prediction of efficacy is integrated such as MGMT status for combining temozolomide with radiotherapy in glioblastoma. As molecular targeted drugs are ready to be taken into triple combinations with chemoradiotherapy it is crucial to have a good understanding of the mechanisms of chemoradiotherapy for the rational development of future combinations.
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Affiliation(s)
- Thomas B Brunner
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, Freiburg, Germany; German Cancer Consortium (DKTK), Freiburg, Germany.
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Kaku S, Ushioda N, Ishii H, Murakami T, Takahashi K, Nakai Y, Shimoya K, Nakamura T. Timing of cisplatin administration for chemoradiotherapy in transgenic mice bearing lens tumors. Oncol Rep 2014; 32:16-22. [PMID: 24858487 PMCID: PMC4067430 DOI: 10.3892/or.2014.3202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/17/2014] [Indexed: 11/11/2022] Open
Abstract
Cisplatin-based concurrent chemoradiotherapy (CCRT) has become a standard treatment for cancer of the uterine cervix. However, there have been no investigations into the optimum timing for administration of anticancer drugs using animal models. The aim of the present study was to determine the appropriate timing for administration of the anticancer drug cisplatin in relation to delivery of radiation by assessing the antitumor activity and adverse effects of 3 different regimens in αT3 transgenic mice bearing lens epithelial tumors. CCRT showed the strongest antitumor activity. There was a significant difference between CCRT and administration of cisplatin before radiotherapy (neoadjuvant therapy) with regard to the apoptotic effect detected by TUNEL staining, but there was no significant difference between CCRT and administration of cisplatin after radiotherapy (adjuvant therapy). Assessment of adverse effects showed that there were no significant differences in the mortality rate, weight loss, anemia and leukopenia among the 3 regimens. In conclusion, these findings obtained in an animal model suggest that cisplatin should probably not be administered before irradiation, since the antitumor effect is significantly weaker than that of CCRT or administration after irradiation, while adverse effects are similar.
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Affiliation(s)
- Shoji Kaku
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Norichika Ushioda
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Hiroshi Ishii
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Kentaro Takahashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Yuichiro Nakai
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Koichiro Shimoya
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Takafumi Nakamura
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
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Al-Mansour Z, Verschraegen C. Locally advanced cervical cancer: what is the standard of care? Curr Opin Oncol 2010; 22:503-12. [PMID: 20473164 DOI: 10.1097/cco.0b013e32833af426] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Carcinoma of the cervix remains a significant health problem for women worldwide. Locally advanced cervical cancer (LACC) is a common presentation that has been extensively studied in the last three decades. This article reviews the standard of care and discusses current topics of clinical research. RECENT FINDINGS A multidisciplinary approach to the treatment of cervical cancer has led to marked improvement in outcome. Main advances are with neoadjuvant chemotherapy, chemoradiation, and preventive vaccination. Concurrent chemoradiation with a platinum-based agent is the recommended treatment for LACC. Palliation with platinum agent remains the standard of care for inoperable patients who have metastatic or recurrent disease. SUMMARY This is a review of published and ongoing studies testing multidisciplinary and medical management of LACC, with a focus on newer chemotherapeutic approaches. Optimal multidisciplinary treatment planning improves the outcome of each patient diagnosed with cervical cancer.
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Affiliation(s)
- Zeina Al-Mansour
- The University of New Mexico Cancer Center, 1201 Camino de Salud, Albuquerque, NM 87131, USA
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Ohara K, Tsunoda H, Tanaka YO, Ohnishi K, Nemoto K, Hashimoto T, Fukumitsu N, Hata M, Sugahara S, Tokuuye K, Yoshikawa H, Akine Y. Explanation for the failure of neoadjuvant chemotherapy to improve outcomes after radiotherapy for locally advanced uterine cervical cancer from the standpoint of the tumor regression rate. ACTA ACUST UNITED AC 2007; 25:53-9. [PMID: 17541513 DOI: 10.1007/s11604-006-0101-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 10/25/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE Treatment outcomes for patients with locally advanced cervical cancer are no better with neoadjuvant chemotherapy (NAC) combined with radiotherapy (RT) than with RT alone. We investigated the reason for this failure from the standpoint of the tumor regression rate (RR). MATERIALS AND METHODS A total of 48 patients with clinical stage IIB-IVA cervical squamous cell carcinoma were treated clinically with cisplatin-based NAC plus RT (n = 15) or RT alone (n = 33). The RR was defined as the slope of a tumor shrinkage curve derived with magnetic resonance images. The local control rate (LCR) and disease-free rate (DFR) were estimated by clinical stage (IIB vs. III-IVA), pretreatment volume (< or = median vs. > median), lymph node status (negative vs. positive), treatment type, overall treatment time (< or =8 weeks vs. >8 weeks), and RR (< or = median vs. > median) using univariate and multivariate analyses. RESULTS RR during NAC or during NAC and RT (n = 15) was not significantly higher than RR by RT alone (n = 33). Low RR and positive nodal status were significantly powerful prognostic factors for both the LCR and DFR, whereas the others were not. CONCLUSION Although effective in reducing tumor volume prior to RT, NAC showed no overall effect in increasing the RR, which was shown to be the most powerful prognostic factor.
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Affiliation(s)
- Kiyoshi Ohara
- Department of Radiation Oncology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan.
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Nguyen D, de la Rochefordière A, Chauveinc L, Cosset JM, Clough KB, Beuzeboc P, Mouret-Fourme E, Guyonnet M. [Chemoradiotherapy in locally advanced cancers of the uterine neck. Retrospective study of 92 patients treated at the Institute Curie between 1986 and 1998]]. Cancer Radiother 2002; 6:201-8. [PMID: 12224486 DOI: 10.1016/s1278-3218(02)00196-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The prognosis of locally advanced cervix cancers is poor with metastatic and local recurrence risks. Recent publications reported that concurrent chemotherapy and pelvic radiation increased local control compared to radiotherapy alone. Chemotherapy could also decrease metastatic recurrences. We report 92 cases of patients with locally advanced cervix cancer treated between 1986 and 1998 at the Institut Curie. PATIENTS AND METHODS Concurrent chemoradiation was exclusive in 51 cases and added to surgery in 41 cases. Chemotherapy with 5FU-Cisplatin-Mitomycin C-Vindesin (protocol A) was performed for 43% of patients and 57% of them received 5FU-Cisplatin alone (protocol B). RESULTS Median follow-up was 64 months (6-149 months). Five-year disease-free survival rate was 47% and local control rate was 70%. Disease-free survival was correlated with therapeutic response. After exclusive chemoradiation, the good responsive patients had a better DFS (54% vs 26%, p = 0.018). In the surgery group, those patients with sterilized lymph nodes and tumours had also a higher DFS (76% vs 47%, p = 0.036). Toxicity was higher with protocol A. CONCLUSION From our study, it appears that local control of advanced cervix cancers is better with combined chemoradiotherapy but disease-free survival stays low according to the metastatic evolution. Metastasis without local recurrence remained frequent in our study. 5FU-CDDP chemotherapy has a lower toxicity and is as effective as 5FU-CDDP-Mitomycin C-Vindesin protocol, in association with radiotherapy.
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Affiliation(s)
- D Nguyen
- Département de radiothérapie, institut Curie, 26, rue d'Ulm 75005 Paris, France.
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MacLeod C, O'Donnell A, Tattersall MH, Dalrymple C, Firth I. Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience. AUSTRALASIAN RADIOLOGY 2001; 45:491-5. [PMID: 11903183 DOI: 10.1046/j.1440-1673.2001.00961.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can downstage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n=6) or surgical intervention (n=2) were recorded in eight patients (7.5%). On univariate analysis stage (P=0.04), tumour size (P=0.01), lymph node status (P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P=0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial.
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Affiliation(s)
- C MacLeod
- Department of Radiation Oncology, Murray Valley Cancer Centre, Wodonga, Victoria, Australia.
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Abstract
Traditionally, small cell lung cancer has been considered as a disease with early onset of distant metastases. Therefore, the role of locoregional therapy (radiotherapy or surgery) was thought to be very limited. This was supported by the first trials investigating the role of radiotherapy since there was no improvement of median survival. Recently, two meta-analyses changed this point of view: radiotherapy is essential to achieve long term survival. The possible biological explanation may be that uncontrolled distant metastases may cause the death of patients during the first months of their disease. The longer patients survive the more important local therapy becomes. Today, there is growing acceptance that adequate systemic and local therapy contributes to better treatment results of limited small cell lung cancer.
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Affiliation(s)
- J Dunst
- Department of Radiotherapy, Martin-Luther-University Halle-Wittenberg, Dryanderstrasse 4, D-06097, Halle, Germany.
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Nair CK, Parida DK, Nomura T. Radioprotectors in radiotherapy. JOURNAL OF RADIATION RESEARCH 2001; 42:21-37. [PMID: 11393887 DOI: 10.1269/jrr.42.21] [Citation(s) in RCA: 294] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C K Nair
- Radiation Biology Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
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Horii N, Nishimura Y, Okuno Y, Kanamori S, Hiraoka M, Shimada Y, Imamura M. Impact of neoadjuvant chemotherapy on Ki-67 and PCNA labeling indices for esophageal squamous cell carcinomas. Int J Radiat Oncol Biol Phys 2001; 49:527-32. [PMID: 11173150 DOI: 10.1016/s0360-3016(00)01468-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The effects of neoadjuvant chemotherapy (CT) on Ki-67 and proliferating cell nuclear antigen (PCNA) labeling index (LI) were analyzed, using biopsy and surgical specimens of esophageal cancer. METHOD AND MATERIALS Immunohistochemical staining for Ki-67 and PCNA was performed for biopsy and surgical specimens of 35 patients with esophageal squamous cell carcinoma. Seventeen patients were treated with neoadjuvant CT (CT group), while no preoperative treatment was performed for the remaining 18 patients (control group). As neoadjuvant CT, cisplatin of 50 mg/body/week was administered 2-5 times (100-250 mg in total) until 7-10 days before subtotal esophagectomy. RESULT Significant correlation between the LIs of biopsy and surgical specimens was observed for the control group (p = 0.006 for Ki-67 and p = 0.005 for PCNA), although both LIs of surgical specimens were significantly higher than those of biopsy specimens (p < 0.05). However, no significant correlation between LIs of biopsy specimens and those of surgical specimens was observed for the CT group. In addition, the LIs of the surgical specimens of the CT group were significantly lower than the LIs of the control group (p < 0.005 for Ki-67 and p < 0.05 for PCNA). Significant decrease in Ki-67 LI after neoadjuvant CT was noted especially for well or moderately differentiated squamous cell carcinomas and/or tumors treated with high-dose cisplatin (150-250 mg). CONCLUSION Significant correlation of Ki-67 and PCNA LIs between biopsy and surgical specimens was demonstrated for the control group. Neoadjuvant CT decreased the percentage of cycling and proliferative tumor cells of esophageal cancer.
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Affiliation(s)
- N Horii
- Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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De Jonge ETM, Lindeque BG, Burger W, Nesland JM, Holm R. Predicting response to neoadjuvant chemotherapy in patients with cervical carcinoma: can we do without any longer? Int J Gynecol Cancer 2000; 10:137-142. [PMID: 11240665 DOI: 10.1046/j.1525-1438.2000.00022.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of the study was to identify variables that may predict the response to neoadjuvant chemotherapy (NACT) in patients with cervical cancer as maturing data from the literature indicate that this therapeutic strategy might be beneficial to some but harmful to others. Clinico-pathologic variables including age, histology, tumor differentiation, as well as immunohistochemical overexpression of p53, mdm2, c-erbB-2, and cathepsin D in 37 of these patients were evaluated as possible predictors of response to the NACT. Fifty-five patients with stage IIB cervical cancer submitted to two courses of cisplatin/ifosfamide/mesna prior to definitive treatment with radical surgery or radiation therapy were the subjects of this study. The clinical response rate was 80% but none of the variables was able to predict response to NACT. Unless methods are found enabling us to predict response and therefore to identify those patients that could benefit from including NACT in the treatment of locally advanced cervical cancer, only women with primarily resectable tumors should be selected for this multimodality approach as a result of the possibility of cross-resistance with radiation therapy in nonresponders.
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Affiliation(s)
- E. T. M. De Jonge
- Department of Obstetrics and Gynecology, Kalafong Academic Hospital, University of Pretoria, South Africa;Department of Medical Oncology, Pretoria Academic Hospital, University of Pretoria, South Africa;Department of Pathology, The Norwegian Radium Hospital, University of Oslo, Oslo, Norway
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Coucke PA, Maingon P, Ciernik IF, Phuoc Do H. A survey on staging and treatment in uterine cervical carcinoma in the Radiotherapy Cooperative Group of the European Organization for Research and Treatment of Cancer. Radiother Oncol 2000; 54:221-8. [PMID: 10738080 DOI: 10.1016/s0167-8140(00)00146-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The treatment outcome of advanced stage uterine cervical carcinoma remains unsatisfactory. In order to elaborate a novel trial within The Radiotherapy Cooperative Group (RCG) of the European Organization for Research and Treatment of Cancer (EORTC), we conducted a survey in 1997-1998 to determine the variability of pre-treatment assessment and treatment options. The variability of choosing surgery, defined radiation therapy techniques and chemotherapy are investigated, as well as the center's choices of future treatment strategies. METHODS Fifty two of 81 RCG centers from the RCG have participated in the survey. As one would expect, there is a large variation in the techniques used for pretreatment evaluation and treatment options. There is no 'standard' for reporting acute and late side effects. Chemotherapy is used neither systematically nor uniformly, and some centers continue to use neadjuvant chemotherapy modalities. RESULTS Furthermore, the survey reveals that there is a strong demand for the reduction of overall treatment-time, for clinical investigation of novel combined modality treatment strategies, especially chemo-radiation therapy, and also for the use of new radiation sensitizers. CONCLUSION We conclude that a more homogeneous approach to the pretreatment evaluation as well as treatment techniques is required in order to allow adequate quality control in any future trial of the RCG in the EORTC.
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Affiliation(s)
- P A Coucke
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, 1011 Bugnon, Lausanne, Switzerland
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Dunst J, Sauer R. [Simultaneous radiochemotherapy with cisplatin improves survival in cervical cancer]. Strahlenther Onkol 1999; 175:257-8. [PMID: 10392165 DOI: 10.1007/bf02743575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tierney JF, Stewart LA, Parmar MK. Can the published data tell us about the effectiveness of neoadjuvant chemotherapy for locally advanced cancer of the uterine cervix? Eur J Cancer 1999; 35:406-9. [PMID: 10448290 DOI: 10.1016/s0959-8049(98)00404-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The effect of neoadjuvant chemotherapy on survival of patients with locally advanced cervical cancer was investigated by conducting a systematic review and meta-analysis of the published data. Of the 21 randomised trials that we identified, only 15 were published. Furthermore, 2-year survival data could be extracted from only seven trial reports and 3-year survival from only nine trial reports. Meta-analyses of the published data at 2 and 3 years are neither clearly in favour of neoadjuvant chemotherapy nor control (2 years: odds ratio (OR) = 1.09, 95% confidence interval (CI) = 0.83-1.45, P = 0.37; 3 years: OR = 0.96, 95% confidence interval (CI) = 0.73-1.25, P = 0.45). Being restricted to only some of the data from a relatively small fraction of the randomised trials, these analyses potentially suffer from a number of biases and are therefore inconclusive. The only reliable way to judge the value of neoadjuvant chemotherapy in this disease is to perform a meta-analysis of centrally collected, updated, individual data on all patients from all known randomised trials. Such an analysis is currently being carried out by an international collaborative group.
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Eisbruch A, Robertson JM, Johnston CM, Tworek J, Reynolds KR, Roberts JA, Lawrence TS. Bromodeoxyuridine alternating with radiation for advanced uterine cervix cancer: a phase I and drug incorporation study. J Clin Oncol 1999; 17:31-40. [PMID: 10458215 DOI: 10.1200/jco.1999.17.1.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Preclinical studies show a significant increase in the ratio of the radiosensitizer bromodeoxyuridine (BUdR) in tumors versus the intestinal mucosa during the drug elimination period, compared with the ratio during drug infusion. We constructed a phase I study in patients with locally advanced cervix cancer, using alternating cycles of BUdR and radiation therapy (RT). PATIENTS AND METHODS Eighteen patients with stage IIB to IVA cervix cancer participated. A treatment cycle consisted of a 4-day BUdR infusion followed by a week of pelvic RT, 15 Gy twice daily in 1.5-Gy fractions. After three cycles, additional BUdR was infused, followed by brachytherapy. The fraction of thymidine replaced by BUdR and the fraction of cells incorporating BUdR were determined in rectal mucosa and tumor biopsies at the end of the first BUdR infusion (day 5), at the middle of the first RT week (day 10), and at the time of brachytherapy. RESULTS Dose-limiting toxicity was observed in one of 16 patients receiving 1,000 mg/m2/d x 4 days and in both patients receiving 1,333 mg/m2/d x 4 days each cycle. After a median follow-up of 39 months, 12 patients (66%) were free of pelvic disease and nine (50%) were alive and disease free. The ratio of tumor to rectum BUdR incorporation averaged 1.5 to 1.8 and did not differ significantly between day 5 and day 10. A trend toward reduced ratio was observed at brachytherapy. Drug-containing cells in rectal biopsies migrated from the crypts to the mucosal surface. CONCLUSION In this schedule, 1,000 mg/m2/d is the maximum-tolerated dose of BUdR. BUdR incorporation levels in tumors were consistent with clinically significant radiosensitization. The migration of BUdR-containing rectal mucosa cells from the crypts to the surface at the time of RT suggests that this regimen may offer a relative sparing of the mucosa from radiosensitization.
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Affiliation(s)
- A Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA.
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Lindner H. [How toxic and effective is simultaneous radiochemotherapy with hydroxyurea, 5-FU and cisplatin in cervix carcinoma?]. Strahlenther Onkol 1998; 174:601-2. [PMID: 9830445 DOI: 10.1007/bf03038301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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