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Borghi C, Biagioli E, Mauro J, Roberto A, Borghese M, Buda A. Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2023:ijgc-2023-004863. [PMID: 38011989 DOI: 10.1136/ijgc-2023-004863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with locally advanced cervical cancer. METHODS A systematic search of the literature was performed. MEDLINE through PubMed and Embase databases were searched from inception to June 2023. The study was registered in PROSPERO (ID number CRD42023389806). All women with a pathological diagnosis of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 classification stages IB2-IVA), any age or histology, who underwent intravenous neoadjuvant chemotherapy before radical surgery, and articles only in English language, were included. We conducted a meta-analysis for optimal pathological response after surgery and survival outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale and the Risk of Bias 2 (RoB) tools. The review methods and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS 25 studies with a total number of 1984 patients fulfilled the eligibility criteria of our review and were included for data extraction and efficacy analysis. When compared with a two-drug regimen, the three-drug combination including cisplatin, paclitaxel, and ifosfamide or anthracyclines showed superior efficacy in terms of optimal pathological response with an odds ratio of 0.38 (95% CI 0.24 to 0.61, p<0.0001), with no difference in disease-free survival (hazard ratio (HR) 0.72, 95% CI 0.50 to 1.03, I2=0%, p=0.07) and higher overall survival (HR 0.63, 95% CI 0.41 to 0.97, I2=0%, p=0.03). CONCLUSIONS The three-drug combination of cisplatin, paclitaxel, and ifosfamide or anthracyclines showed a higher rate of complete or optimal partial response, with the triple regimens having an advantage over the platinum-based schedules in terms of overall survival. Neoadjuvant chemotherapy followed by radical surgery should not be considered a standard of care in locally advanced cervical cancer.
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Affiliation(s)
- Chiara Borghi
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
| | - Elena Biagioli
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Jessica Mauro
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
- University of Udine, Udine, Italy
| | - Anna Roberto
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Martina Borghese
- Division of Obstetrics and Gynecology, Ospedale Santa Croce, Cuneo, Piemonte, Italy
| | - Alessandro Buda
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
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Huang Y, Chen L, Cai J, Yang L, Sun S, Zhao J, Xiong Z, Wang Z. Neoadjuvant chemotherapy followed by radical surgery reduces radiation therapy in patients with stage IB2 to IIA2 cervical cancer. World J Surg Oncol 2022; 20:264. [PMID: 35996118 PMCID: PMC9396822 DOI: 10.1186/s12957-022-02731-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate whether carboplatin-liposomal paclitaxel neoadjuvant chemotherapy (NACT) benefits patients with locally advanced cervical cancer (LACC) through avoiding or delaying postoperative radiation. METHODS A total of 414 patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO 2009) stages IB2-IIA2 were included in the retrospective cohort study, who had received carboplatin-liposomal paclitaxel chemotherapy followed by radical surgery (NACT group) or primary radical surgery (PRS group) between 2007 and 2017 at our hospital. The baseline clinicopathological characteristics at diagnosis, postoperative pathological risk factors, and oncological outcomes after surgery, including postoperative radiation (as adjuvant treatment or treatment of recurrent diseases), progression-free survival (PFS), and overall survival (OS), were compared between the groups. Before treatment, the patients in the NACT group had significantly more advanced tumor stages and larger tumor sizes than those in the PRS group. RESULTS The NACT reduced the tumor volumes remarkedly with a response rate of 62.4%, and the tumors in the NACT group were smaller than those in the PRS group when the patients were subjected to radical surgery. Furthermore, postoperative pathology examination revealed less frequent deep stromal invasion in the NACT group than in the PRS group. According to the presence of pathological risk factors for recurrence, 54.82% of women in the NACT group needed adjuvant radiotherapy, while 60.87% in the PRS group, and in fact, 33.00% of NACT patients and 40.09% of PRS patients received adjuvant radiation. In addition, 8.12% of NACT patients and 9.68% of PRS patients underwent radiotherapy after relapse. The cumulative postoperative radiation rate was significantly lower in the NACT group (P = 0.041), while the differences in 5-year OS and PFS were not statistically significant between the groups. CONCLUSIONS NACT reduces the pathological risk factors and the use of radiation without compromising survival in patients with LACC, which may protect younger patients from radiation-related side effects and subsequently improve the quality of life. TRIAL REGISTRATION ISRCTN Registry, ISRCTN24104022.
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Affiliation(s)
- Yuhui Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lei Chen
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lu Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Si Sun
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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Huang Y, Zhu Q, Xue L, Zhu X, Chen Y, Wu M. Machine Learning-Assisted Ensemble Analysis for the Prediction of Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer. Front Oncol 2022; 12:817250. [PMID: 35425697 PMCID: PMC9001844 DOI: 10.3389/fonc.2022.817250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical benefit of neoadjuvant chemotherapy (NACT) before concurrent chemoradiotherapy (CCRT) vs. adjuvant chemotherapy after CCRT is debated. Non-response to platinum-based NACT is a major contributor to poor prognosis, but there is currently no reliable method for predicting the response to NACT (rNACT) in patients with locally advanced cervical cancer (LACC). In this study we developed a machine learning (ML)-assisted model to accurately predict rNACT. We retrospectively analyzed data on 636 patients diagnosed with stage IB2 to IIA2 cervical cancer at our hospital between January 1, 2010 and December 1, 2020. Five ML-assisted models were developed from candidate clinical features using 2-step estimation methods. Receiver operating characteristic curve (ROC), clinical impact curve, and decision curve analyses were performed to evaluate the robustness and clinical applicability of each model. A total of 30 candidate variables were ultimately included in the rNACT prediction model. The areas under the ROC curve of models constructed using the random forest classifier (RFC), support vector machine, eXtreme gradient boosting, artificial neural network, and decision tree ranged from 0.682 to 0.847. The RFC model had the highest predictive accuracy, which was achieved by incorporating inflammatory factors such as platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, neutrophil-to-albumin ratio, and lymphocyte-to-monocyte ratio. These results demonstrate that the ML-based prediction model developed using the RFC can be used to identify LACC patients who are likely to respond to rNACT, which can guide treatment selection and improve clinical outcomes.
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Affiliation(s)
- Yibao Huang
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Zhu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liru Xue
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoran Zhu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Chen
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingfu Wu
- Department of Gynecology, National Clinical Research Center for Obstetrical and Gynecological Diseases, Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tian X, Yang F, Li F, Ran L, Chang J, Li J, Hong W, Shan L, Du Y, Hu L, Mei F, He M, Li Y, Wang H, Zuo K, Zhou B, Chen S, Mao W. A Comparison of Different Schemes of Neoadjuvant Chemotherapy Followed by Concurrent Chemotherapy and Radiotherapy for Locally Advanced Cervical Cancer: A Retrospective Study. Cancer Manag Res 2021; 13:8307-8316. [PMID: 34764693 PMCID: PMC8572729 DOI: 10.2147/cmar.s328309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the clinical significance of unoperated cervical cancer patients treated with different neoadjuvant chemotherapy (NACT) schemes followed by concurrent chemotherapy and radiotherapy (CCRT). Methods This retrospective analysis included women with locally advanced cervical cancer treated with NACT-CCRT between September 2011 and September 2014. Neoadjuvant chemotherapy included paclitaxel plus cisplatin (TP group; 62 patients) or paclitaxel plus loplatin (TL group; 58 patients), which were administered three weekly, and cisplatin or loplatin, which were administered weekly for synchronous chemotherapy. External beam radiation therapy (50.4–56.35 Gy/28 f, 180–215 cGy/f, 5 f/w) was followed by intracavitary brachytherapy (5 Gy per fraction, mostly 5 fractions, Ir192 based). Results One hundred twenty women were included in the analysis. The complete/partial response rate was 99.2% after treatment. The one-year, three-year, and five-year survival rates were 99.2%, 82.5%, and 70.8%, respectively. In the TP and TL groups, the three-year and five-year survival rates were 85.5% vs 77.6% and 75.8% vs 65.5%, respectively, with no significant difference. The 5-year overall survival (OS) rates between patients with stage IIB and stage IIIB disease were not significantly different (69.2% vs 64.7%). In the TP group, grade 3 or 4 digestive reactions were more frequent than those in the TL group. Leukopenia, neutropenia, and thrombocytopenia were more common in the TL group. No significant difference was found in anemia, radiation enteritis, radiation proctitis, or radiation cystitis between the groups. Conclusion Lobaplatin may be used as an alternative drug for patients with severe digestive system reactions or contraindications to cisplatin, but hematological toxicity must be considered, particularly in dose-intensive schemes. Neoadjuvant chemotherapy followed by concurrent chemotherapy and radiotherapy (NACT-CCRT) warrants further prospective study in cervical cancer patients with a wide range of tumor invasion (eg, mass size ≥5 cm or stage IIIB).
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Affiliation(s)
- Xue Tian
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Feiyue Yang
- Department of Gynecologic Oncology, Guizhou Provincial People's Hospital, Guiyang, 550004, People's Republic of China
| | - Fenghu Li
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Li Ran
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Jianying Chang
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Jiehui Li
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Wei Hong
- Department of Radiotherapy, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Lang Shan
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yanjun Du
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Lili Hu
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Fan Mei
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Mingyuan He
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Yongxia Li
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Heran Wang
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Kai Zuo
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Bo Zhou
- Surgical Department of Gynecological Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Shuying Chen
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
| | - Wanli Mao
- Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China
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Çakır C, Kılıç F, Dur R, Yüksel D, Ünsal M, Korkmaz V, Kılıç Ç, Kimyon Cömert G, Boran N, Türkmen O, Koç S, Turan T. Neoadjuvant chemotherapy for locally advanced stage (IB2-IIA2-IIB) cervical carcinoma: Experience of a tertiary center and comprehensive review of the literature. Turk J Obstet Gynecol 2021; 18:190-202. [PMID: 34580469 PMCID: PMC8480215 DOI: 10.4274/tjod.galenos.2021.70493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: This study aimed to evaluate neoadjuvant chemotherapy (NACT) for locally advanced stage cervical carcinoma. Materials and Methods: Data of 43 patients with locally advanced cervical carcinoma who had NACT were reviewed. NACT protocols implemented included cisplatin/5-fluorauracil, cisplatin/UFT, and carboplatin/paclitaxel. After NACT, the patients were re-examined, and patients who had a tumor size ≤40 mm underwent Piver-Rutledge type III radical hysterectomy, while other patients received radiotherapy. Following NACT, clinical responses were assessed according to the criteria of the World Health Organization. Results: The mean age of the patients was 49.4 years, and the median follow-up duration was 48 (range, 5-228) months. The median tumor sizes were 50 and 30 mm before and after NACT, respectively. Complete clinical response was observed in 4 (9.3%) patients, partial clinical response in 8 (18.6%), and pathologic complete response in 3 (6.9%). Stable disease was noted in 30 (69.9%) patients and progression in 1 (2.3%) patient. After NACT, 31 patients have undergone radical surgical procedures. The 5-year disease-free survival rate was 72%, and the 5-year disease-specific survival rate was 91%. Age, International Federation of Gynaecology and Obstetrics 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT, and lymph node metastasis were not associated with disease-free survival. Conclusion: Following NACT, a significant reduction in tumor dimension was observed, and the probability of radical surgery is increased. However, clinical response was not predictive of survival.
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Affiliation(s)
- Caner Çakır
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Fatih Kılıç
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Dilek Yüksel
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Ünsal
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Vakkas Korkmaz
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Çiğdem Kılıç
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Günsu Kimyon Cömert
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Nurettin Boran
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Osman Türkmen
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Sevgi Koç
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Taner Turan
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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Mahantshetty U, Lavanya G, Grover S, Akinfenwa CA, Carvalho H, Amornwichet N. Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries. Clin Oncol (R Coll Radiol) 2021; 33:e363-e371. [PMID: 34274204 DOI: 10.1016/j.clon.2021.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022]
Abstract
Cervical cancer is one of the most common cancers in developing nations. It has had a tremendous impact on the lifetime of millions of women over the last century and continues to do so. In this collaborative clinicians' review, we highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low- and middle-income countries (LMICs) across Asia, South America, South Africa and Eastern Europe. With the cervical cancer burden and locally advanced cancers being high, the majority of LICs/LMICs have been striving to adhere to optimal evaluation and treatment guidelines. However, the huge gap in resource availability, rural versus urban disparity and access to resources have led to poor compliance to evaluation, treatment and post-treatment rehabilitation. To mitigate the overwhelming numbers, various treatment strategies like neoadjuvant chemotherapy, hypofractionation radiation schedules (both external and brachytherapy) have been attempted with no major success. Also, the compliance to concurrent chemoradiation in various regions is a major challenge. With the burden of advanced cancers, the lack of palliative care services and their integration in cancer care is still a reality.
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Affiliation(s)
- U Mahantshetty
- Radiation Oncology Homi Bhabha Cancer Hospital and Research Centre (a Unit of Tata Memorial Centre, Mumbai), Visakhapatnam, India.
| | - G Lavanya
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Botswana-UPENN Partnership, Gaborone, Botswana
| | - C A Akinfenwa
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - H Carvalho
- Department of Radiology and Oncology, Radiotherapy Division, University of São Paulo, São Paulo, Brazil; Department of Radiotherapy - Hospital Sírio-Libanês, São Paulo, Brazil
| | - N Amornwichet
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn, University, Bangkok, Thailand
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7
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Tian X, Wang X, Cui Z, Liu J, Huang X, Shi C, Zhang M, Liu T, Du X, Li R, Huang L, Gong D, Tian R, Cao C, Jin P, Zeng Z, Pan G, Xia M, Zhang H, Luo B, Xie Y, Li X, Li T, Wu J, Zhang Q, Chen G, Hu Z. A Fifteen-Gene Classifier to Predict Neoadjuvant Chemotherapy Responses in Patients with Stage IB to IIB Squamous Cervical Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2001978. [PMID: 34026427 PMCID: PMC8132153 DOI: 10.1002/advs.202001978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/01/2021] [Indexed: 05/09/2023]
Abstract
Neoadjuvant chemotherapy (NACT) remains an attractive alternative for controlling locally advanced cervical cancer. However, approximately 15-34% of women do not respond to induction therapy. To develop a risk stratification tool, 56 patients with stage IB-IIB cervical cancer are included in 2 research centers from the discovery cohort. Patient-specific somatic mutations led to NACT non-responsiveness are identified by whole-exome sequencing. Next, CRISPR/Cas9-based library screenings are performed based on these genes to confirm their biological contribution to drug resistance. A 15-gene classifier is developed by generalized linear regression analysis combined with the logistic regression model. In an independent validation cohort of 102 patients, the classifier showed good predictive ability with an area under the curve of 0.80 (95% confidence interval (CI), 0.69-0.91). Furthermore, the 15-gene classifier is significantly associated with patient responsiveness to NACT in both univariate (odds ratio, 10.8; 95% CI, 3.55-32.86; p = 2.8 × 10-5) and multivariate analysis (odds ratio, 17.34; 95% CI, 4.04-74.40; p = 1.23 × 10-4) in the validation set. In conclusion, the 15-gene classifier can accurately predict the clinical response to NACT before treatment, representing a promising approach for guiding the selection of appropriate treatment strategies for locally advanced cervical cancer.
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Affiliation(s)
- Xun Tian
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Xin Wang
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Zifeng Cui
- Department of Gynecological and OncologyThe First Affiliated Hospital of Sun Yat‐sen UniversityZhongshan 2nd Road, YuexiuGuangzhouGuangdong510080China
| | - Jia Liu
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Xiaoyuan Huang
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Caixia Shi
- Department of Gynecological and OncologyHunan Cancer HospitalThe Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityJiefang Avenue 1095#WuhanHubei430030China
| | - Min Zhang
- NGS Research CenterNovogene Co, LtdBuilding 301, Zone A10 JiuxianqiaoBeijing100015China
| | - Ting Liu
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Xiaofang Du
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Rui Li
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Lei Huang
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Danni Gong
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Rui Tian
- Department of Gynecological and OncologyThe First Affiliated Hospital of Sun Yat‐sen UniversityZhongshan 2nd Road, YuexiuGuangzhouGuangdong510080China
| | - Chen Cao
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Ping Jin
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Zhen Zeng
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Guangxin Pan
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Meng Xia
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Hongfeng Zhang
- Department of PathologyThe Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyShengli Street 26#, Jiang'an DistrictWuhanHubei430030China
| | - Bo Luo
- Department of PathologyThe Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyShengli Street 26#, Jiang'an DistrictWuhanHubei430030China
| | - Yonghui Xie
- Department of PathologyThe Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyShengli Street 26#, Jiang'an DistrictWuhanHubei430030China
| | - Xiaoming Li
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Tianye Li
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Jun Wu
- NGS Research CenterNovogene Co, LtdBuilding 301, Zone A10 JiuxianqiaoBeijing100015China
| | - Qinghua Zhang
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Gang Chen
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
| | - Zheng Hu
- Department of Obstetrics and GynecologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
- Department of Obstetrics and GynecologyAcademician expert workstation, The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue 1095#WuhanHubei430030China
- Department of Gynecological and OncologyThe First Affiliated Hospital of Sun Yat‐sen UniversityZhongshan 2nd Road, YuexiuGuangzhouGuangdong510080China
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8
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Sala P, Bogliolo S, Barra F, Fazio A, Maramai M, Cassani C, Gardella B, Babilonti L, Giannelli F, Mammoliti S, Spinillo A, Ferrero S, Valenzano Menada M, Costantini S, Bruzzi P, Marchiolè P. Neoadjuvant Chemotherapy Followed by Radical Surgery versus Concurrent Chemo-Radiotherapy in the Treatment of Locally Advanced Cervical Cancer: A Multicenter Retrospective Analysis. J INVEST SURG 2020; 35:308-314. [PMID: 33289585 DOI: 10.1080/08941939.2020.1856239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study aims to evaluate oncological outcomes in women affected by locally advanced cervical cancer (LACC) treated by neoadjuvant chemotherapy before radical surgery (NACT + RS) or concurrent chemo-radiotherapy (CCRT). METHODS This was a multicenter retrospective analysis of data related to women with LACC (FIGO stage IB2-IVA), who were treated by NACT + RS or CCRT between November 2006 and January 2018. The first endpoints were the evaluation of disease-free survival (DFS) and overall survival (OS); univariate and multivariate analyses were performed for identifying the prognostic factors independently associated with these oncological outcomes. RESULTS Overall, 106 women were included in the analysis; 55 of them (51.9%) underwent NACT + RS and 51 (48.1%) CCRT, respectively. Patients in the NACT + RS group had a significant better five-year DFS and five-year OS than those in the CCRT group (77.4% vs. 33.4%, p < .001 and 93.8% vs. 56.5%, p = .003). In the multivariate analyses, treatment choice (NACT + RS or CCRT) was the only independent prognostic factor for predicting both DFS (HR = 3.954; 95 CI = 1.898-8.236; p < 0.001) and OS (HR = 5.330; 95 CI = 1.563-18.178; p = 0.008). CONCLUSIONS This retrospective study demonstrated an improved survival outcome for patients undergoing NACT + RS compared with those undergoing CCRT. Our findings seem to support the use of NACT before RS as an effective alternative option to CCRT standard therapy.
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Affiliation(s)
- Paolo Sala
- Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Bogliolo
- Department of Obstetrics and Gynecology, Service of Medical and Surgical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Gynecologic Oncology, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - Fabio Barra
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alessandra Fazio
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Mattia Maramai
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, Service of Medical and Surgical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Service of Medical and Surgical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luciana Babilonti
- Department of Obstetrics and Gynecology, Service of Medical and Surgical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flavio Giannelli
- Unit of Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Serafina Mammoliti
- Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Service of Medical and Surgical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Ferrero
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Mario Valenzano Menada
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Sergio Costantini
- Academic Unit of Clinical Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Paolo Bruzzi
- Unit of Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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9
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Huang Y, Liu L, Cai J, Yang L, Sun S, Zhao J, Xiong Z, Wang Z. The Efficacy and Response Predictors of Platinum-Based Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer. Cancer Manag Res 2020; 12:10469-10477. [PMID: 33122946 PMCID: PMC7588671 DOI: 10.2147/cmar.s270258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/17/2020] [Indexed: 01/05/2023] Open
Abstract
Objective To assess the efficacy of platinum-based neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) and investigate the pretreatment predictors of the response. Patients and Methods A total of 219 patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB2-IIA2 LACC who received platinum-based NACT from December 2007 to December 2017 were reviewed, and their clinical-pathological characteristics and follow-up data were retrospectively collected and analyzed. The baseline characteristics of age, FIGO stage, histology, tumor differentiation, tumor size, and clinical outcomes, including post-operative pathological risk factors, overall survival (OS), and progression-free survival (PFS) were compared between the responders and non-responders. Results The overall response rate was 58.9% (129/219), and 19 (8.7%) patients achieved pathologically complete remission. NACT responders showed significantly better OS and PFS than non-responders (POS= 0.002, PPFS= 0.002). The response to NACT was identified as an independent risk factor for OS (hazard ratio [HR] = 2.453, 95% confidence intervals [95% CI], 1.125-5.348, P = 0.024) and PFS (HR = 2.196, 95% CI, 1.183-4.076, P = 0.013), and patients with IB2/IIA1 and a tumor size of <5 cm tended to receive better response than patients with IIA2 (P = 0.004) and a tumor size of ≥5 cm (P = 0.027). Conclusion The response rate of platinum-based NACT was approximately 60%. The response to NACT was an independent risk factor for prognosis, and patients with earlier stage and smaller tumor tended to respond better to NACT.
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Affiliation(s)
- Yuhui Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Lin Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Lu Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Si Sun
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, People's Republic of China
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10
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Sims TT, Klopp AH. Intensified Systemic Therapy Regimens in Combination With Definitive Radiation for Treatment of Cervical Cancer. Semin Radiat Oncol 2020; 30:265-272. [PMID: 32828382 DOI: 10.1016/j.semradonc.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Definitive standard chemoradiation for locoregionally advanced carcinomas of the uterine cervix includes multimodality therapy consisting of concurrent cisplatin based chemoradiation comprising of external-beam radiotherapy with systemic chemotherapy followed by intracavitary brachytherapy. New developments in radiotherapy, such as intensity-modulated radiotherapy, which aim to improve tumor control rates and reduce associated toxicity have reopened the discussion regarding the benefit of intensification of concomitant or sequential systemic therapy in the treatment of cervical cancer. Intensification of systemic chemotherapy used in standard chemoradiation for cervical cancer is an attractive approach to improve disease control, but given the concerns regarding toxicity deserves further evaluation to ensure their safe use in patients. This is a review of published and ongoing studies investigating intensification of systemic chemotherapy in the treatment of locally advanced cervical cancer.
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Affiliation(s)
- Travis T Sims
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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11
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Tripathi A, Rawat S. Comparative Study of Neoadjuvant Chemotherapy Followed by Definitive Chemoradiotherapy Versus Definitive Chemoradiotherapy Alone in Locally Advanced Carcinoma of Cervix. J Obstet Gynaecol India 2019; 69:546-552. [PMID: 31844371 PMCID: PMC6889094 DOI: 10.1007/s13224-019-01236-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Carcinoma in the cervix is the most common malignancy and the fourth most common cause of death in females worldwide. It is the most common malignancy in India, the increasing incidence of cancer is escalating burden over radiation. This is a prospective randomized study comparing NACT followed by definitive chemoradiation versus chemoradiation. MATERIALS AND METHODS This prospective randomized study analyzed 80 cervical cancer patients who were treated at our center during March 2017 and July 2018. Patients were divided into two arms: one received NACT and definitive CT/T and the other received definitive CT/RT. Statistical analysis was done using SPSS V.20 software. RESULTS Overall response rate in our study was found to be 96.2%. In the study group, it was 97.5%, whereas in the control group, it was 95%. Majority of patients were in the age group 41-50 years, mainly stage IIb and IIIb. Tumor response in both the arms was similar and statistically significant (Chi2 = 0.348; p > 0.05). The hematologic toxicities ( p > 0.05) were more in the NACT group than in the CCRT group, while gastrointestinal toxicities were slightly higher in the control (statistically insignificant). CONCLUSION NACT with taxane/platin followed by definitive CT/RT is as effective as the standard care in the treatment of locally advanced cervical cancer. It has even shown better results (p value > .005) and is also helpful in reducing systemic micrometastasis and bulk of the disease. It can be used as an alternative to the standard care at the places of long waiting time for the definitive treatment, without compromising the outcome.
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Affiliation(s)
- Aradhna Tripathi
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | - Shyamji Rawat
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
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12
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Bhatla N, Rajaram S, Maheshwari A. The Revised FIGO Staging of Cervical Cancer (2018): Implications for India and the LMICs. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0346-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Morgan S, Slodkowska E, Parra-Herran C, Mirkovic J. PD-L1, RB1 and mismatch repair protein immunohistochemical expression in neuroendocrine carcinoma, small cell type, of the uterine cervix. Histopathology 2019; 74:997-1004. [PMID: 30667073 DOI: 10.1111/his.13825] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/18/2019] [Indexed: 01/02/2023]
Abstract
AIMS Neuroendocrine carcinoma, small cell type, of the uterine cervix (SmCC-Cx) is a rare human papilloma virus (HPV) related tumour with limited therapeutic options. Merkel cell carcinoma, another virus-associated neuroendocrine malignancy, has significant programmed death ligand 1 (PD-L1) expression rates. PD-L1 expression has been reported in other malignancies of the cervix. We aimed to determine the prevalence of PD-L1 in the context of mismatch repair protein (MMR) and RB1 expression status in SmCC-Cx. METHODS AND RESULTS Ten cases of SmCC-Cx were tested by immunohistochemistry for expression of PD-L1, MLH1, MSH2, MSH6, PMS2, RB1, CD3, CD20 and for HPV by in-situ hybridisation (ISH). PD-L1 expression was scored quantitatively (H-score) in tumour cells and lymphocytes (tumoral/peritumoral). PD-L1 positivity was seen in seven cases, focal in most (H-score range 3-140). Three of nine cases showed MMR deficiency. PD-L1 expression levels correlated with MMR expression status: all three MLH1/PMS2-deficient cases had a ≥5% PD-L1 staining and an H-score ≥10 (P = 0.01). RB1 was lost in four of nine cases, all PD-L1 positive, but this correlation was not statistically significant. Seven of nine tumours were positive for HPV-ISH; two of these had MLH1/PMS2 loss. Of the two HPV-ISH negative tumours, one had MLS1/PMS2 loss. CONCLUSIONS PD-L1 expression, predominantly focal, is seen in 70% of SmCC-Cx, while loss of MMR expression is seen in 33% of SmCC-Cx in our cohort. PD-L1 expression in more than 10% of tumour cells is seen in a subset of tumours in association with loss of MMR expression. These patients may be amenable to immune checkpoint inhibitor therapy as a promising alternative for this aggressive disease.
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Affiliation(s)
- Sarah Morgan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Elzbieta Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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14
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Neoadjuvant Chemotherapy with Taxane and Platinum Followed by Radical Hysterectomy for Stage IB2-IIB Cervical Cancer: Impact of Histology Type on Survival. J Clin Med 2019; 8:jcm8020156. [PMID: 30704058 PMCID: PMC6406495 DOI: 10.3390/jcm8020156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022] Open
Abstract
The current study examined the histology-specific impact of neoadjuvant chemotherapy (NACT) with a taxane/platinum regimen on survival in women with locally-advanced cervical cancer who underwent radical hysterectomy. This nation-wide retrospective cohort study examined women with clinical stage IB2-IIB cervical cancer who received NACT prior to radical hysterectomy from 2004–2008 (n = 684). NACT type (taxane/platinum versus others) was correlated with survival based on histology: 511 squamous versus 173 non-squamous. Taxane/platinum chemotherapy use was more common in non-squamous compared to squamous tumors (53.8% versus 20.7%, P < 0.001). In both histology types, the taxane/platinum regimen was more frequently utilized over time (both, P < 0.01). Among squamous tumors, women who received taxane/platinum chemotherapy had survival comparable to those who received other regimens: 5-year rates for disease-free survival, 69.0% versus 70.1%, P = 0.98; and cause-specific survival, 80.0% versus 81.0%, P = 0.93. Similarly, in non-squamous tumors, disease-free survival (5-year rates: 60.4% versus 59.0%, P = 0.86) and cause-specific survival (74.7% versus 76.3%, P = 0.70) were similar. In conclusion, use of taxane/platinum regimens for NACT significantly increased during the study period. Irrespective of histology type, in women with clinical stage IB2-IIB cervical cancer who underwent NACT prior to radical hysterectomy, taxane/platinum regimens had a similar effect on survival compared to non-taxane/platinum regimens.
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15
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Yuan L, Guo J, Zhang X, Chen M, Xu C, Yao L. Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center. Onco Targets Ther 2018; 11:5527-5533. [PMID: 30275701 PMCID: PMC6157997 DOI: 10.2147/ott.s173208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although definitive chemoradiotherapy is considered as a standard of care for FIGO stage IIB cervical cancer in many countries, the role of surgery remains controversial. We aimed to evaluate the feasibility and outcomes of patients with FIGO stage IIB cervical cancer who received radical surgery in China. Patients and methods A total of 74 women with FIGO stage IIB cervical cancer were treated with radical hysterectomy, with or without adjuvant radio/chemoradiotherapy, at the Obstetrics and Gynecology Hospital of Fudan University between 2004 and 2015. Medical charts and clinical data were retrospectively reviewed. The Kaplan–Meier method and Cox regression models were used for survival analyses. In addition, prognostic nomograms predicting overall survival (OS) and progression-free survival (PFS) were constructed. Results Pathological parametrial involvement (PMI) was only identified in 28.3% (21/74) of all patients and 47.3% (9/19) of patients without neoadjuvant treatment. Major surgical complications, including bladder fistula, intestinal obstruction and ureteral injury, were found in 6.8% (5/74) of patients. Although the use of imaging technologies including magnetic resonance imaging (MRI)/positron emission tomography–computed tomography (PET–CT) has increased after 2010 compared to that prior to 2010, the accuracy of MRI/PET–CT in detecting pathological PMI was lower than that of physical examination under anesthesia (P<0.05). Neoadjuvant treatment was the only risk factor affecting the accuracy of pre- and postoperative accordance of PMI (OR: 3.283 [95% CI: 1.363–7.908], P=0.008). The 2- and 5-year OS rates were 84.1% and 68.9%, respectively, while the 2- and 5-year cumulative recurrence rates were 26.9% and 39.9%, respectively. Cox regression analyses indicated that pre- and postoperative accordance of PMI, common iliac lymph node metastasis and major surgical complications were significant prognostic factors for both OS and PFS. Conclusion Radical hysterectomy might be a feasible alternative for FIGO stage IIB cervical cancer. As pre- and postoperative accordance of PMI is relatively low, strategies to appropriately select patients who will benefit from surgery via pretreatment evaluation need to be further investigated.
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Affiliation(s)
- Lei Yuan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Jiaqi Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Xiaochun Zhang
- Department of Obstetrics and Gynecology, Fenyi People's Hospital, Jiangxi, People's Republic of China
| | - Mo Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Liangqing Yao
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
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16
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Okazawa-Sakai M, Yokoyama T, Fujimoto E, Okame S, Shiroyama Y, Yokoyama T, Takehara K. Long-term outcomes of postoperative taxane/platinum chemotherapy for early stage cervical cancer: a retrospective study. Int J Clin Oncol 2018; 23:715-725. [DOI: 10.1007/s10147-018-1249-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/07/2018] [Indexed: 11/24/2022]
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17
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Cisplatin with dose-dense paclitaxel before and after radical hysterectomy for locally advanced cervical cancer: a prospective multicenter phase II trial with a dose-finding study. Med Oncol 2017; 34:134. [DOI: 10.1007/s12032-017-0992-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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18
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Neoadjuvant Weekly Paclitaxel-Carboplatin Is Effective in Stage I–II Cervical Cancer. Int J Gynecol Cancer 2017; 27:1256-1260. [DOI: 10.1097/igc.0000000000001021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveNeoadjuvant chemotherapy (NACT) followed by surgery in cervical cancer is widely studied with paclitaxel-ifosfamide-cisplatinum 3 weekly (TIP). Although the response rates with TIP are high, the toxicity is substantial. Therefore, this study evaluates dose-dense paclitaxel-carboplatin (TC) as an alternative.MethodsIn this prospective phase 2 study trial, we included 36 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IIB cervical cancer, who received 9 weeks’ NACT dose-dense TC (median weekly dose paclitaxel 60 mg/m2, carboplatinum area under the curve 2.7). Radiological response was evaluated by RECIST (Response Evaluation Criteria in Solid Tumors). Optimal pathologic response (OPT) was defined as complete disappearance of tumor (complete response [CR]) or residual disease with less than 3-mm stromal invasion (PR1). Suboptimal pathologic response consisted of persistent residual disease with more than 3-mm stromal invasion (PR2).ResultsNine patients had a FIGO stage IB1 (25%), 7 had stage IB2(19%), 3 had stage IIA (8%), and 17 had stage IIB disease (47%). Evaluation by magnetic resonance imaging after NACT showed 32 RECIST responses (89%) (CR in 11, PR in 21). Patients who were inoperable had insufficient reduction of the tumor to be operable (4 patients), progressive disease (1 patient), or stable disease (1 patient). Thirty patients were suitable for surgery after NACT. Pathology showed OPT in 50% (CR in 10, PR1 in 5). Thirteen patients had pathologic lymph nodes on radiological evaluation before start of chemotherapy. After chemotherapy, the lymph nodes were negative in 6 (47%) of these patients (pathologic complete remission). Postoperative chemoradiotherapy was administered in 11 patients (2 because of close resection margins, 5 because of metastatic lymph node after surgery, 2 because of close resection margins and metastatic lymph nodes after surgery, and 1 tumor >4 cm after NACT). Hematologic toxicity was acceptable with no febrile neutropenia and a low nonhematologic toxicity. The estimated 5-year overall survival was 70.8%.ConclusionsNeoadjuvant TC dose-dense in cervical carcinoma has a high response rate, comparable with TIP, and an acceptable toxicity.
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19
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Haque N, Uddin AFMK, Dey BR, Islam F, Goodman A. Challenges to cervical cancer treatment in Bangladesh: The development of a women's cancer ward at Dhaka Medical College Hospital. Gynecol Oncol Rep 2017; 21:67-72. [PMID: 28725676 PMCID: PMC5502821 DOI: 10.1016/j.gore.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Cervical cancer is the second most common cause of female cancer mortality worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with stages IB2 to IVa cervical cancer. Unfortunately radiation therapy capacity is severely limited to non-existent in many Low and Middle-Income Countries. One solution has been to use chemotherapy to reduce tumor size to allow for radical surgery or in the case of inoperable cancers, as a placeholder until radiation is available. In Bangladesh, there has been the progressive development of resources for the treatment of women with gynecologic cancers. However, radiation therapy resources are limited with a six-month waiting period to receive radiation. Neoadjuvant chemotherapy (NACT) remains the main primary treatment intervention for women with advanced cervical cancer in Bangladesh. This implementation study summarizes of the experience and challenges to caring for women in a new gynae-oncology ward at Dhaka Medical College Hospital, a 2600 bed government hospital in Dhaka, Bangladesh. The literature on cervical cancer treatment in Bangladesh is nonexistent. The majority of women are diagnosed with stages III and IV cervical cancers. Radiation therapy is an extremely limited resource in Bangladesh with only one machine per over 10 million people. The strategy has been to treat woman with chemotherapy in the hopes of making their cancers surgically resectable. Systematic reviews of neoadjuvant chemotherapy show pathologic responses but no improvement in long term survival.
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Affiliation(s)
- N Haque
- Department of Obstetrics and Gynecology, Gynae Oncology Unit, Dhaka Medical College, Dhaka, Bangladesh
| | - A F M K Uddin
- Department of Radiation Oncology, National Institute of ENT, Dhaka, Bangladesh
| | - B R Dey
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F Islam
- Department of Obstetrics and Gynecology, Gynae Oncology Unit, Dhaka Medical College, Dhaka, Bangladesh
| | - A Goodman
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Phase I Dose-Escalation Study of Weekly Paclitaxel and Cisplatin Followed by Radical Hysterectomy in Stages IB2 and IIA2 Cervical Cancer. Am J Clin Oncol 2017; 40:241-249. [DOI: 10.1097/coc.0000000000000147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen Q, Tian WJ, Huang ML, Liu CH, Yao TT, Guan MM. Association Between HIF-1 Alpha Gene Polymorphisms and Response in Patients Undergoing Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer. Med Sci Monit 2016; 22:3140-6. [PMID: 27593081 PMCID: PMC5021021 DOI: 10.12659/msm.897486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study was to assess whether HIF-1α polymorphisms have an effect on the response to chemotherapy of locally advanced cervical cancer (LACC) patients treated with platinum-based neoadjuvant chemotherapy (NACT) and radical surgery. Material/Methods We conducted a retrospective study in 162 LACC patients. Hypoxia-inducible factor 1α C1772T and G1790A genetic polymorphisms were ascertained using direct sequencing methods. Results The C1772T polymorphism was significantly related to response to chemotherapy (P=0.002), and there was an increased chance of treatment response in patients with the C/C genotype (OR=4.7; 95% CI: 1.67–13.49; P=0.004). The C1772T polymorphism was also associated with poor tumor grade (adjusted OR, 2.98; 95% CI: 1.08–8.13; P=0.037). However, The G1790A polymorphism was not associated with response (P>0.05). Conclusions The C1772T polymorphism was significantly related to response to chemotherapy and poor tumor grade. Our results may help to better manage individual patients and to improve clinical decision making regarding use of NACT.
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Affiliation(s)
- Qing Chen
- Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Wei-Jie Tian
- Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China (mainland)
| | - Miao-Ling Huang
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Chang-Hao Liu
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Ting-Ting Yao
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Mei-Mei Guan
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
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Iwata T, Miyauchi A, Suga Y, Nishio H, Nakamura M, Ohno A, Hirao N, Morisada T, Tanaka K, Ueyama H, Watari H, Aoki D. Neoadjuvant chemotherapy for locally advanced cervical cancer. Chin J Cancer Res 2016; 28:235-40. [PMID: 27199522 PMCID: PMC4865617 DOI: 10.21147/j.issn.1000-9604.2016.02.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Neoadjuvant chemotherapy followed by surgery (NCS) has not been fully evaluated clinically. Currently, the main regimen of neoadjuvant chemotherapy (NAC) used in NCS includes cisplatin. The antitumor effects of NAC reduce lymph node metastasis and the tumor diameter in patients prior to surgery, and this can reduce the number of high risk patients who require postoperative radiation therapy. Many randomized controlled trials (RCTs) have examined the long-term prognosis of NCS compared to primary surgery, but the utility of NCS remains uncertain. The advent of concurrent chemoradiotherapy (CCRT) has markedly improved the outcome of radiotherapy (RT), and CCRT is now used as a standard method in many cases of advanced bulky cervical cancer. NCS gives a better treatment outcome than radiation therapy alone, but it is important to verify that NCS gives a similar or better outcome compared to CCRT.
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Affiliation(s)
- Takashi Iwata
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Azumi Miyauchi
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yukako Suga
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Nishio
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Nakamura
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Ohno
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Nobumaru Hirao
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Tohru Morisada
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kyoko Tanaka
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Ueyama
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hidemichi Watari
- 2Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Daisuke Aoki
- 1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Tanaka YO, Okada S, Satoh T, Matsumoto K, Saida T, Minami M, Yoshikawa H. Uterine cervical cancer volumetry using T2- and diffusion-weighted MR images in patients treated by primary surgery and neoadjuvant chemotherapy. Acta Radiol 2016; 57:378-83. [PMID: 25838450 DOI: 10.1177/0284185115579077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 02/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tumor volumetry with magnetic resonance imaging (MRI) is very common; however, the accuracy of such measures remains unclear, especially after treatment. PURPOSE To determine the accuracy of preoperative volume measurements of uterine cervical carcinomas resected with and without neoadjuvant chemotherapy (NAC) on T2-weighted (T2W) and diffusion-weighted (DWI) MRI. MATERIAL AND METHODS Twenty-nine consecutive patients with surgically confirmed uterine cervical carcinoma were included in this study. MRI scans were performed before preoperative treatment in 17 patients and after two courses of NAC in 12 patients. In all patients, T2W images and DWI were obtained to measure the tumor diameters. The maximum diameter of the surgical specimens was macroscopically measured. The correlation coefficients between the measured tumor size using T2W imaging and DWI and the size measured on the surgical specimens were calculated for all specimens. RESULTS The correlation coefficient of the three-dimensional (3D) tumor volume measurement using T2W imaging and DWI was 0.97 in the primary surgery group and was 0.96 in the NAC group. The 3D tumor volume measurement using MRI and the measurement of the actual surgical specimen was 0.55 for T2WI and 0.48 for DWI in the primary surgery group and 0.88 for T2WI and 0.95 for DWI in the NAC group. CONCLUSION T2WI and DWI can provide accurate 3D tumor volume measurements of uterine cervical carcinomas in patients with and without preoperative chemotherapy, suggesting that tumor volumetry using 3 T MRI after uterus-preserving treatment is feasible.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Okada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tsukasa Saida
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Cai J, Yang L, Dong W, Wang H, Xiong Z, Wang Z. Retrospective comparison of laparoscopic versus open radical hysterectomy after neoadjuvant chemotherapy for locally advanced cervical cancer. Int J Gynaecol Obstet 2015; 132:29-33. [DOI: 10.1016/j.ijgo.2015.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/27/2015] [Accepted: 09/10/2015] [Indexed: 01/05/2023]
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Lapresa M, Parma G, Portuesi R, Colombo N. Neoadjuvant chemotherapy in cervical cancer: an update. Expert Rev Anticancer Ther 2015; 15:1171-81. [DOI: 10.1586/14737140.2015.1079777] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Osman M. The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review. Oncol Rev 2014; 8:250. [PMID: 25992238 PMCID: PMC4419645 DOI: 10.4081/oncol.2014.250] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 01/11/2023] Open
Abstract
Cervical cancer is the second most common cancer in women. Neoadjuvant chemotherapy for patients with locally advanced cervix cancer has comparable benefits to concurrent chemoradiotherapy (CCRT), but with fewer side effects. This systematic review aims to provide a comprehensive summary of the benefits of neoadjuvant chemotherapy for the management of locally advanced cervix cancer from stage IB2 (tumor >4.0 cm) to IIIB (tumor extending to the pelvic wall and/or hydronephrosis). Our primary objective was to assess benefits in terms of survival. The data source included the USA national library of medicine, Medline search, and the National Cancer Institute PDQ Clinical Protocols. Inclusion criteria for consideration in the current systematic review included studies published between January 1997 and December 2012. In terms of histology, they had to be focused on squamous cell carcinoma, adenosquamous carcinoma, and/or adenocarcinoma. Patients should be either chemotherapy naïve or cervix cancer chemotherapy naïve, and have a performance status ≤2. The search in the above-mentioned scientific websites led to identify 49 publications, 19 of which were excluded, as they did not meet the inclusion criteria of this systematic review. Therefore only 30 studies were deemed eligible. Data was collected from 1760 patients enrolled in the current systematic review study. The mean age was 45.2 years. The mean tumor size was 4.7 cm. The most commonly used chemotherapies were cisplatin doublets. Paclitaxel was the most commonly used chemotherapeutic agent in the doublets. The mean chemotherapy cycles were 2.7. After chemotherapy, patients underwent surgery after a mean time of 2.5 weeks. The standard operation was radical hysterectomy with pelvic lymphadenectomy. Chemotherapy achieved an objective response rate of 84%. The 5-year progression-free survival and overall survival were 61.9% and 72.8% respectively. The treatment protocol was associated with a mild early toxicity profile. Leucopenia and neutropenia were the most common side effects. Late toxicity was also generally mild and mainly associated with bladder dysfunction and vaginal dehiscence. The quality of the studies was assessed using the Newcastle-Ottawa quality assessment scale. Neoadjuvant chemotherapy achieved comparable survival results to CCRT, and was associated with less toxicity.
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Affiliation(s)
- Mohammed Osman
- Oncology Consultant, General Organization of Teaching Hospitals and Institutes , Cairo, Egypt
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Platinum-based neoadjuvant chemotherapy followed by radical surgery for cervical carcinoma international federation of gynecology and obstetrics stage IB2-IIB. Int J Gynecol Cancer 2014; 23:1647-54. [PMID: 24100590 DOI: 10.1097/igc.0b013e3182a616d2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the response rate to chemotherapy, as well as the progression-free survival (PFS), the overall survival (OS), and the main prognostic factors in patients treated at the European Institute of Oncology in Milan, Italy. METHODS Retrospective data were collected on patients with uterine cervical carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB, who underwent platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy. RESULTS A total of 121 patients were studied. The median (range) age was 45 years old (23-69 years). The distribution of patients by International Federation of Gynecology and Obstetrics stage was as follows: n = 88 (73%) with stage IB2, n = 7 (6%) with stage IIA, and n = 26 (21%) with stage IIB. The median (range) tumor size was 50 mm (20-90 mm). Neoadjuvant chemotherapy involved a combination of cisplatin, paclitaxel, and ifosfamide in 80 patients (65%). Using this treatment, 112 patients (93%) received 3 cycles of NACT, whereas 6 (5%) received 4 cycles. Complete and partial pathology response was observed in 9 patients (7%) and 79 patients (66%), respectively. Adjuvant radiotherapy was not necessary in 65% of patients. A 5-year PFS and OS of 58% and 71%, respectively, were observed. Independent prognostic factors for PFS and OS were identified, including response to NACT, persistent lymph node metastases, and parametrial involvement. CONCLUSIONS Neoadjuvant chemotherapy in this group of tumors is a promising treatment strategy and should be discussed with patients. Although these results are comparable to those obtained by standard chemoradiation treatment, one strategy should not be recommended over the other until the results of the ongoing phase 3 trial for NACT are released.
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Undurraga M, Loubeyre P, Dubuisson JB, Schneider D, Petignat P. Early-stage cervical cancer: is surgery better than radiotherapy? Expert Rev Anticancer Ther 2014; 10:451-60. [DOI: 10.1586/era.09.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dongol S, Tai Y, Shao Y, Jiang J, Kong B. A retrospective clinicopathological analysis of small-cell carcinoma of the uterine cervix. Mol Clin Oncol 2013; 2:71-75. [PMID: 24649310 DOI: 10.3892/mco.2013.193] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/28/2013] [Indexed: 11/06/2022] Open
Abstract
Cervical cancer encompasses several histological types, including neuroendocrine tumors (NETs). Small-cell carcinoma of the uterine cervix (SCCC) is the most common and aggressive subtype of cervical NET. The objective of this case report was to investigate SCCC using a retrospective clinicopathological approach. Four cases of large (≥4 cm) SCCCs are presented in this case study. The patients were diagnosed with SCCC through a sequential hierarchy of physical examinations, laboratory reports, radiological reports, immunohistochemical and pathological tests. The diagnosis for each case was made at various stages (Ib1, Ib2, IIa2 and IIb, according to the FIGO staging system, 2000) and each of the patients received different multimodality therapeutic regimens. All the patients underwent radical hysterectomy and pelvic lymphadenectomy, followed by adjuvant chemotherapy. Neoadjuvant chemotherapy was administered prior to surgery in two of the patients. The clinical and pathological analyses were assessed using a retrospective measure, maintaining timely follow-ups. SCCC is a rare but serious gynecological malignancy. This condition has a poor prognosis due to its high aggressiveness, high rate of metastases and mortality. Furthermore, the rarity of this disease represents a hindrance to adequate research and development of novel, efficient therapeutic regimens.
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Affiliation(s)
- Samina Dongol
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Yanhong Tai
- Jinan Military Area General Hospital, Jinan, Shandong, P.R. China
| | - Yi Shao
- Shandong University School of Medicine, Jinan, Shandong, P.R. China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
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McCormack M, Kadalayil L, Hackshaw A, Hall-Craggs MA, Symonds RP, Warwick V, Simonds H, Fernando I, Hammond M, James L, Feeney A, Ledermann JA. A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer. Br J Cancer 2013; 108:2464-9. [PMID: 23695016 PMCID: PMC3694233 DOI: 10.1038/bjc.2013.230] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: We investigated the feasibility of dose-dense neoadjuvant chemotherapy (NACT) with paclitaxel and carboplatin before radical chemoradiation (CRT) and assessed the response rate to such a regimen. Methods: CxII is a single-arm phase II trial of 46 patients, with locally advanced cervical cancer (stage Ib2-IVa). Patients received dose-dense carboplatin (AUC2) and paclitaxel (80 mg m−2) weekly for six cycles followed by CRT (40 mg m−2 of weekly cisplatin, 50.4 Gy, 28 fractions plus brachytherapy). The primary end point was response rate 12 weeks post-CRT. Results: Baseline characteristics were: median age at diagnosis 43 years; 72% squamous, 22% adenocarcinoma and 7% adenosquamous histologies; FIGO stage IB2 (11%), II (50%), III (33%), IV (7%). Complete or partial response rate was 70% (95% CI: 54–82) post-NACT and 85% (95% CI: 71–94) post-CRT. The median follow-up was 39.1 months. Overall and progression-free survivals at 3 years were 67% (95% CI: 51–79) and 68% (95% CI: 51–79), respectively. Grade 3/4 toxicities were 20% during NACT (11% haematological, 9% non-haematological) and 52% during CRT (haematological: 41%, non-haematological: 22%). Conclusion: A good response rate is achieved by dose-dense weekly NACT with carboplatin and paclitaxel followed by radical CRT. This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy (98%).
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Affiliation(s)
- M McCormack
- University College London Hospitals, 250 Euston Road, London NW1 2PG, UK.
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Yamaguchi S, Nishimura R, Yaegashi N, Kiguchi K, Sugiyama T, Kita T, Kubushiro K, Kokawa K, Hiura M, Mizutani K, Yamamoto K, Takizawa K. Phase II study of neoadjuvant chemotherapy with irinotecan hydrochloride and nedaplatin followed by radical hysterectomy for bulky stage Ib2 to IIb, cervical squamous cell carcinoma: Japanese Gynecologic Oncology Group study (JGOG 1065). Oncol Rep 2012; 28:487-93. [PMID: 22614251 DOI: 10.3892/or.2012.1814] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/03/2012] [Indexed: 11/05/2022] Open
Abstract
The efficacy and adverse events of neoadjuvant chemotherapy with irinotecan hydrochloride and nedaplatin were evaluated in patients with bulky stage Ib2 to IIb cervical squamous cell carcinoma. Eligibility included patients who received irinotecan (60 mg/m2) on days 1 and 8 and nedaplatin (80 mg/m2) on day 1 of a 21-day cycle. After 1-3 courses of chemotherapy, radical hysterectomy was performed. Sixty-eight patients were enrolled. Sixty-six were included in the full analysis set. Their median age was 47 years (range 22-71), the FIGO stage was Ib2 in 18 patients, IIa in 10, and IIb in 38. Radical hysterectomy was performed after NAC in 63 patients (95.5%). The number of administered courses of NAC was 1 in 13 patients, 2 in 43, and 3 in 10. The response rate, the primary endpoint of this study, was 75.8% (CR in 2 patients, PR in 48, SD in 12, PD in 0, and NE in 4). The mean number of treatment courses required for a response was 1.42 (1 course in 30 patients, 2 courses in 19, and 3 courses in 1). The incidences of grade 3 or 4 hematological toxicities were: neutropenia 72.2%, leukopenia 16.7%, anemia 13.6%, thrombocytopenia 7.6%, febrile neutropenia 1.5%, and elevations of alanine aminotransferase and aspartate aminotransferase 1.5%. Grade 3 or 4 non-hematologic toxicities were as follows: diarrhea 6.1%, nausea 3%, anorexia 1.5%, vomiting 1.5%, fever 1.5%, allergic reactions 1.5%, ileus 1.5% and vesicovaginal fistula 1.5%. Neoadjuvant chemotherapy with irinotecan and nedaplatin was an effective and well-tolerated treatment for patients with bulky stage Ib2 to IIb squamous cell carcinoma of the uterine cervix.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan.
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Shen Y, Yang L, Wang Z. Treatment of early bulky cervical cancer with neoadjuvant paclitaxel, carboplatin and cisplatin prior to laparoscopical radical hysterectomy and pelvic lymphadenectomy. Oncol Lett 2011; 3:641-645. [PMID: 22740967 DOI: 10.3892/ol.2011.529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/29/2011] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. A total of 19 patients who had bulky cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib2 to IIb2 (lesion diameter >4 cm) received NAC with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. The tumor diameter, the response rate, the resection rate and the lymph node metastasis rate after chemotherapy, as well as the toxicity were evaluated. All patients successfully received NAC, with the exception of 1 patient with FIGO Stage Ib2 and 7 cm tumor diameter, who rejected complete therapy. The tumor diameter was reduced from 4.93±0.81cm before NAC to 2.57±1.90 cm after treatment (P<0.01), and the overall response rate [complete remission (CR) + partial remission (PR)] was 78.9% (15/19). Two patients received radiotherapy after NAC, 1 patient was found to have cystic metastasis during the surgery and the operative rate was 83.3% (15/18). Pelvic lymph node metastasis was found in 2 of the 18 patients (11.1%) without parametrial and vaginal margin involvement. Hematological toxicity was the most common side effect and the 3-4 toxicity level was only 11.1% (2/18). In conclusion, NAC with paclitaxel, combined with carboplatin and cisplatin, followed by laparoscopic radical hysterectomy and pelvic lymphadenectomy was found to be effective and safe. Thus, NAC is the ideal treatment for patients with early bulky cervical cancer.
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Affiliation(s)
- Yi Shen
- Department of Gynaecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
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Fernandez-Pineda I, Spunt SL, Parida L, Krasin MJ, Davidoff AM, Rao BN. Vaginal tumors in childhood: the experience of St. Jude Children's Research Hospital. J Pediatr Surg 2011; 46:2071-5. [PMID: 22075335 PMCID: PMC3476720 DOI: 10.1016/j.jpedsurg.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to retrospectively analyze the clinical presentation, histology, treatment, and outcomes of children with vaginal tumors who were treated at a single institution. METHODS A retrospective review of medical records and pathologic materials of all children with vaginal tumors treated at St Jude Children's Research Hospital between 1970 and 2009 was conducted. RESULTS Eighteen patients (median age, 3.7 years; range, 0.1-15 years) were identified. Three different histologies were found: rhabdomyosarcoma (RMS; n = 13), germ cell tumor (n = 3), and clear cell adenocarcinoma (n = 2). Bleeding or blood-tinged discharge was the most common clinical presentation (66%), followed by a protruding mass (39%). Vaginal and uterine salvage was 44.4% (8 of 18 patients). Thirteen patients (72.2%) remain disease-free, with a median follow-up of 23.2 years (range, 2-39 years). Four patients (22.2%) died of disease progression (1 RMS, 2 germ cell tumor, and 1 clear cell adenocarcinoma), and 1 patient with RMS died of colon cancer 12 years after the primary diagnosis had been made. CONCLUSIONS Vaginal tumors are extremely rare in the pediatric population. Early recognition of symptoms like bleeding and a protruding vaginal mass may prevent morbidity and mortality. Our findings confirm the good prognosis of vaginal RMS.
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Affiliation(s)
| | - Sheri L Spunt
- Department of Oncology. St. Jude Children’s Research Hospital, Memphis, TN
| | - Lalit Parida
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Krasin
- Division of Radiation Oncology, Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
| | - Bhaskar N Rao
- Department of Surgery. St. Jude Children’s Research Hospital, Memphis, TN
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A prospective phase II study of topotecan (Hycamtin®) and cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer. Gynecol Oncol 2011; 122:285-90. [DOI: 10.1016/j.ygyno.2011.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/10/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
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Huang X, Lan C, Huang H, Zhang Y, Huang H, Cao X, Huang Y, Guo Y, Wan T, Liu J. Neoadjuvant docetaxel combined with cisplatin and followed by radical surgery for the treatment of locally advanced (stage IB2 - IIB) cervical cancer: preliminary results of a single-institution experience. Expert Opin Pharmacother 2011; 12:165-73. [PMID: 21226631 DOI: 10.1517/14656566.2011.530657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We aimed to determine the efficacy and toxicity of treating locally advanced cervical cancer (LACC) with a neoadjuvant chemotherapy (NAC) regimen combining docetaxel and cisplatin followed by radical surgery. METHODS We retrospectively reviewed the clinical records of patients with stage IB2 - IIB (tumor diameter ≥ 4 cm) disease admitted between January 2007 and July 2009 who, before radical hysterectomy and pelvic lymph node dissection, received two to three courses of an NAC regimen comprising docetaxel (75 mg/m²) and cisplatin (70 - 75 mg/m²). RESULTS Fifty-two patients with LACC received 109 cycles of NAC. The objective response rate was 86.5% (26.9% CR and 17.3% pathological CR). Stage IB2 disease had a more favorable response to NAC (95.7%, p = 0.019). Deep stromal invasion and lymph-vascular space metastasis rates were significantly lower in NAC responders (p = 0.033) than in nonresponders (p = 0.012). Most side effects of NAC were mild or moderate. Log-rank test showed the 2-year overall survival and progression-free survival rates were 100 and 90.3% for NAC responders, compared with only 57.1% (p = 0.000) and 68.6% for nonresponders (p = 0.012), respectively. CONCLUSION Neoadjuvant docetaxel combined with cisplatin yielded a high response rate with well tolerable toxicity for LACC and could decrease pathological risk factors in NAC responders.
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Affiliation(s)
- Xin Huang
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou, People's Republic of China
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Treatment of stage IB2, IIA bulky cervical cancer: a single-institution experience of neoadjuvant chemotherapy followed by radical hysterectomy and primary radical hysterectomy. Arch Gynecol Obstet 2010; 284:477-82. [PMID: 20878172 DOI: 10.1007/s00404-010-1685-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this study was to compare the efficacy and safety of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (NAC group) with primary radical hysterectomy (RH group). METHODS We reviewed all patients with bulky stage IB-IIA cervical cancer treated at Seoul National University Hospital from January 1, 2000 to December 31, 2006. Thirty-three patients were treated with NAC prior to radical hysterectomy, and 41 patients were treated with radical hysterectomy. RESULTS Clinical characteristics were not significantly different between the two groups. The response rate in the NAC group was 81.8%. Operation time, estimated blood loss, and complication rate were not significantly different between the two groups. Pathologic outcomes were improved in the NAC group. Adjuvant therapy was less frequently performed in the NAC group (51.6%) than in the RH group (82.9%) (P = 0.005). The 5-year progression-free survival was 90.7% in the NAC group and 81.3% in the RH group, but the difference was not statistically significant (P = 0.297). CONCLUSION The results of this study suggest that NAC may improve pathologic outcomes, decrease the need for adjuvant radiation therapy and have a comparable operation feasibility without affecting progression-free survival.
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Dueñas-González A, Cetina L, Coronel J, Martínez-Baños D. Pharmacotherapy options for locally advanced and advanced cervical cancer. Drugs 2010; 70:403-32. [PMID: 20205484 DOI: 10.2165/11534370-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cervical cancer continues to be a significant health burden worldwide. Globally, the majority of cancers are locally advanced at diagnosis; hence, radiation remains the most frequently used therapeutic modality. Currently, the value of adding cisplatin or cisplatin-based chemotherapy to radiation for the treatment of locally advanced cervical cancer is strongly supported by randomized studies and meta-analyses. Nevertheless, despite these significant achievements, therapeutic results are far from optimal; thus, novel therapies need to be investigated. A recent, randomized, phase III trial has shown for the first time that combination chemotherapy with cisplatin and gemcitabine concurrently with radiation improves parameters of survival over cisplatin alone and establishes a new standard for the management of locally advanced cervical cancer. On the other hand, advanced disease, presenting either as an International Federation of Gynecology and Obstetrics (FIGO) stage IVB or as persistent or recurrent to primary therapy without local curative options, remains a devastating group of diseases with no options other than palliative chemotherapy. Recent results from the GOG (Gynecologic and Oncologic Group)-204 study demonstrate that cisplatin-doublets with paclitaxel, vinorelbine, gemcitabine or topotecan only produce small improvements in survival, although with different toxicity patterns; hence, patient-related factors are important when choosing any one of these regimens. The role of targeted therapies both in locally advanced and advanced disease is promising, but still at an investigational stage.
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Affiliation(s)
- Alfonso Dueñas-González
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología/Instituto de Investigaciones Biomédicas (INCan/IIBM), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
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Mori T, Hosokawa K, Sawada M, Kuroboshi H, Tatsumi H, Koshiba H, Okubo T, Kitawaki J. Neoadjuvant Weekly Carboplatin and Paclitaxel Followed by Radical Hysterectomy for Locally Advanced Cervical Cancer. Int J Gynecol Cancer 2010; 20:611-6. [DOI: 10.1111/igc.0b013e3181d80aa9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mahajan NN. Neoadjuvant chemotherapy for locally advanced cervical carcinoma. Int J Gynecol Cancer 2009; 19:1671. [PMID: 19955958 DOI: 10.1111/igc.0b013e3181a812ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kumar JV, Doval DC, Rao R, Rawal S. A retrospective study of patients with locally advanced cancer of the cervix treated with neoadjuvant chemotherapy followed by radical surgery. Int J Gynecol Cancer 2009; 19:417-22. [PMID: 19407570 DOI: 10.1111/igc.0b013e3181a1c6df] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
New concept of downstaging locally advanced cancer of the cervix (LACC) with neoadjuvant chemotherapy (NACT), to make it resectable, is of great interest and needs to be explored. This is a retrospective study of 56 LACC patients. Efficacy of NACT was measured in terms of optimal pathological response (OR). Percentage of patients who needed adjuvant radiotherapy and disease-free interval at 2 years was evaluated. Clinically, 49 patients (87.5%) responded well to NACT with TIP regimen (paclitaxel, ifosfamide, and cisplatin) and underwent radical surgery. Adjuvant radiation was given for adverse factors in histopathology. Recurrences were noted; 46.4% of patients were in stage 2b, followed by 25% in stage IIIb; 92.8% of patients had squamous cell carcinoma. Optimal pathological response was seen in 15 patients (30.6%) with complete response in 8 patients (16.3%). Four patients (8.2%) had deposits in the parametrium, and 11 (22.4%) had positive nodes. On gross examination, 48.9% of patients had complete disappearance of cervical growth, and there was no microscopic evidence of cervical malignancy in 16.3%. In 20.4% of patients, cervical cancer was reduced to cervical intraepithelial neoplasia or microinvasion. Thirty-four patients (69.4%) needed full adjuvant radiotherapy. Overall, 14 patients (25.92%) had recurrence, with 11 (22.44%) being in NACT and radical surgery group. At 2 years, disease-free interval for 49 patients who underwent radical surgery was 69%. This study suggests that LACC patients who respond to NACT are surgically resectable with pathological cure in some cases, who are then spared from adjuvant radiation, which is given when recurrence occurs. However, with advancing stage, the percentage of OR decreases, and the need of adjuvant radiation increases.
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Affiliation(s)
- Jaggi Vinita Kumar
- Department of Uro-Gynae, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Cho YH, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer. J Gynecol Oncol 2009; 20:22-7. [PMID: 19471665 DOI: 10.3802/jgo.2009.20.1.22] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer. METHODS From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone. RESULTS There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival. CONCLUSION As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.
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Affiliation(s)
- Yun-Hyun Cho
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Mahajan NN. Neoadjuvant chemotherapy for locally advanced cervical carcinoma. Int J Gynecol Cancer 2009; 19:174. [PMID: 19258963 DOI: 10.1111/igc.0b013e318197f9bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Petsuksiri J, Chansilpa Y, Therasakvichya S, Suntornpong N, Thephamongkhol K, Dankulchai P, Mahasitthiwat P, Ieumwananonthachai N, Veerasarn V, Sangruchi S, Pattaranutaporn P. Treatment options in bulky stage IB cervical carcinoma. Int J Gynecol Cancer 2008; 18:1153-62. [DOI: 10.1111/j.1525-1438.2008.01195.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Cervical cancer is the most common female cancer in the developing countries. Treatments of bulky stage IB cervical cancer have been challenged as the local control is relatively poor compared to smaller stage I disease, whether treated by radical surgery or irradiation. The treatment options are definitive concurrent chemoradiation therapy or radical surgery with or without neoadjuvant or adjuvant therapy. The treatment decision is based on the patients' status and preferences, tumor characteristics, and experiences of clinician. This study will review and compare the treatment modalities and rationales of a combination of treatment including surgery, radiation therapy, and chemotherapy for bulky stage IB cervical carcinoma.
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Chen H, Liang C, Zhang L, Huang S, Wu X. Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: A randomized study. Gynecol Oncol 2008; 110:308-15. [DOI: 10.1016/j.ygyno.2008.05.026] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 05/26/2008] [Accepted: 05/28/2008] [Indexed: 11/24/2022]
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González-Martín A, González-Cortijo L, Carballo N, Garcia JF, Lapuente F, Rojo A, Chiva LM. The current role of neoadjuvant chemotherapy in the management of cervical carcinoma. Gynecol Oncol 2008; 110:S36-40. [DOI: 10.1016/j.ygyno.2008.05.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 05/19/2008] [Indexed: 11/16/2022]
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Carcopino X, Houvenaeghel G, Buttarelli M, Esterni B, Tallet A, Goncalves A, Jacquemier J. Equivalent survival in patients with advanced stage IB–II and III–IVA cervical cancer treated by adjuvant surgery following chemoradiotherapy. Eur J Surg Oncol 2008; 34:569-75. [PMID: 17531428 DOI: 10.1016/j.ejso.2007.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 04/12/2007] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate survival in patients with advanced cervical cancer who underwent surgery after concurrent chemoradiotherapy. METHODS One hundred and forty-four patients with biopsy-proven stage IB-IVA cervical cancer underwent adjuvant surgery after concurrent chemoradiotherapy. Surgical resection was classified as curative (no evidence of remaining disease after surgery) or palliative (remaining disease after surgery). Endpoints were pelvic control, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included tumour FIGO stage, type of surgery (curative versus palliative), pelvic control, response to chemoradiotherapy and lymphatic status. RESULTS Tumour FIGO stages were IB-II in 91 cases and III-IVA in 53 cases. Surgery was curative in 127 cases. Pelvic control was achieved in 114 patients and was equivalent in stage IB-II and III-IVA patients. So far, 60 patients have died. The 5-year OS and DFS rates were, respectively, 57.6% [95% CI: 49.1-67.5] and 65% [95% CI: 56.2-75]. OS was significantly affected by the type of surgery (p<2.10(-16)), the presence of tumoural residue (p=0.002) and the pelvic lymphatic status (p<0.001). DFS was affected by the pelvic (p=0.02) and para-aortic lymphatic status (p=0.009). No significant difference was observed between OS and DFS in stage IB-II and III-IVA patients, whereas a macroscopic tumoural residue was observed in, respectively, 30.9 and 52.2% of cases (p=0.022). CONCLUSION Survival rates were equivalent between patients with IB-II and III-IVA cervical cancer, suggesting that adjuvant surgery following chemoradiotherapy may improve local control.
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Affiliation(s)
- X Carcopino
- Department of Surgery, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France.
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Mori T, Hosokawa K, Kinoshita Y, Watanabe A, Honjo H. Neoadjuvant chemotherapy with weekly carboplatin and paclitaxel for locally advanced cervical carcinoma. Int J Gynecol Cancer 2008; 18:85-9. [PMID: 17587314 DOI: 10.1111/j.1525-1438.2007.00963.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The efficacy and toxicity of neoadjuvant carboplatin and paclitaxel administered on a weekly schedule for locally advanced cervical carcinoma were evaluated. Thirty patients staged as IB2-IVA according to the FIGO were treated with carboplatin (AUC 2; an area under the time-concentration of 2 mg*min/ml based on creatinine clearance) and paclitaxel (60 mg/m(2)) intravenously, every week for six cycles. A type III radical hysterectomy was then undertaken. Thirty patients were enrolled in this study. An objective response was recorded in 26 patients (87%, 95% CI 70-95%). Progressive disease was not observed. Grade 3 neutropenia was observed in only two patients (7%), and grade 1 or 2 neuropathy was seen in six patients (20%). The combination of carboplatin and paclitaxel given in weekly schedule for advanced cervical carcinoma was highly active, permitting a high rate of subsequent surgical resectability. It was well tolerated. This regimen may provide improved outcomes with minimal toxicity.
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Affiliation(s)
- T Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Eddy GL, Bundy BN, Creasman WT, Spirtos NM, Mannel RS, Hannigan E, O'Connor D. Treatment of (“bulky”) stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: A phase III trial of the gynecologic oncology group. Gynecol Oncol 2007; 106:362-9. [PMID: 17493669 DOI: 10.1016/j.ygyno.2007.04.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/02/2007] [Accepted: 04/06/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A randomized phase III trial was conducted to determine if neoadjuvant chemotherapy (NACT) prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy (RHPPL) could improve progression-free survival (PFS) and overall survival (OS), as well as operability, with acceptable levels of toxicity. Adjuvant radiation therapy was prescribed for specific surgical/pathological risk factors for both regimens. METHODS Eligible patients were required to have bulky FIGO Stage IB cervical cancer, tumor diameter > or =4 cm, adequate bone marrow, renal and hepatic function, and performance status < or =2. Prospective random allocation was to either NACT (vincristine-cisplatin chemotherapy every 10 days for 3 cycles) before exploratory laparotomy and planned RHPPL (NACT+RHPPL), or RHPPL only. RESULTS The study was closed prematurely, because of slow accrual, after 291 patients were enrolled, three were ineligible; thus 288 were eligible and randomly allocated to RHPPL (N=143) or NACT+RHPPL (N=145). There were no notable differences between regimens with regard to patient age, race, performance status, or tumor size. The median follow-up time is 62 months among living patients. The NACT+RHPPL group had very similar recurrence rates (relative risk: 0.998) and death rates (relative risk: 1.008) when compared to the RHPPL group. There were 79% that had surgery in the RHPPL group compared to 78% in the NACT RHPPL group. There were 52% who received post op RT in the RHPPL group compared to 45% in the NACT+RHPPL group (not statistically significant). CONCLUSION There is no evidence from this trial that NACT offered any additional objective benefit to patients undergoing RHPPL for suboptimal Stage IB cervical cancer.
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Affiliation(s)
- Gary L Eddy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mercer University School of Medicine, 840 Pine Street, Suite 760, Macon, GA 31201, USA.
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Candelaria M, Cetina L, Garcia-Arias A, Lopez-Graniel C, de la Garza J, Robles E, Duenas-Gonzalez A. Radiation-sparing managements for cervical cancer: a developing countries perspective. World J Surg Oncol 2006; 4:77. [PMID: 17101048 PMCID: PMC1660541 DOI: 10.1186/1477-7819-4-77] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 11/13/2006] [Indexed: 01/13/2023] Open
Abstract
Cervical cancer is the seventh most frequent cancer worldwide but more than 80% of cases occur in developing countries. Till date, radiation therapy with external beam and brachytherapy remains as the core treatment for most stages of cervical cancer. However, radiation treatment protocols and equipment modelled on the best developed countries can be seldom applied directly to developing countries owing to financial constraints and lack of qualified personnel, thus, a substantial proportion of patients do not have access to even palliative radiation therapy. Treatment options when the standard therapy is either not available or difficult to reproduce in particular settings is highly desirable with the potential to save lives that otherwise could be lost by the lack of adequate treatment. These options of treatment ideally had to have show, 1) that these are not inferior to the "standard" in terms of either survival or quality of life; 2) that these can be delivered in settings were the "standard" is not available or if available its quality is poor; and 3) that the treatment option be accepted by the population to be treated. Based on these considerations, it is obvious that cervical cancer patients, particularly those who live in countries with limited resources and therefore may not have sufficient radiation therapy resources are in need of newer therapeutical options. There is now a considerable amount of information emanating from clinical studies where surgery has a major role in treating this disease. These forms of "radiation-sparing" treatments include total mesometrial resection that could make unnecessary the use of adjuvant radiation; neoadjuvant chemotherapy that could avoid the use of adjuvant radiation in around 85% of patients and preoperative chemoradiation that could make brachytherapy dispensable. The feasibility and therapeutical value of these potential forms of management need to be prospectively evaluated.
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Affiliation(s)
- Myrna Candelaria
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Lucely Cetina
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Alicia Garcia-Arias
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Carlos Lopez-Graniel
- Department of Gynecology Oncology, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Jaime de la Garza
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Elizabeth Robles
- Division of Clinical Research, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Alfonso Duenas-Gonzalez
- Unidad de Investigación Biomédica en Cáncer. Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México. Instituto Nacional de Cancerología. Mexico City, Mexico
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