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Servayge J, Olthof EP, Mom CH, van der Aa MA, Wenzel HHB, van der Velden J, Nout RA, Boere IA, van Doorn HC, van Beekhuizen HJ. Survival of Women with Advanced Stage Cervical Cancer: Neo-Adjuvant Chemotherapy Followed by Radiotherapy and Hyperthermia versus Chemoradiotherapy. Cancers (Basel) 2024; 16:635. [PMID: 38339386 PMCID: PMC10854526 DOI: 10.3390/cancers16030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
AIM To investigate and compare overall survival (OS), disease-free survival (DFS) and toxicity of women who underwent either chemoradiotherapy with or without prior lymph node debulking or upfront chemotherapy followed by radiotherapy and hyperthermia (triple therapy) for locally advanced cervical cancer (LACC) to identify a potential role for triple therapy. METHODS Women with histologically proven LACC and with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 and IIA2 to IVA were included. Cox regression analyses were used for calculating hazard ratios and to adjust for confounding variables. A multivariable logistic regression analysis was used to examine the influence of covariates on toxicity. RESULTS A total of 370 patients were included of whom 58% (n = 213) received chemoradiotherapy (CRT), 18% (n = 66) received node-debulking followed by chemoradiotherapy (LND-CRT) and 25% (n = 91) received triple therapy (TT). Five-year OS was comparable between the three treatment groups, with 53% (95% confidence interval 46-59%) in the CRT group, 45% (33-56%) in the LND-CRT group and 53% (40-64%) in the TT group (p = 0.472). In the adjusted analysis, 5-year OS and DFS were comparable between the three treatment groups. No chemotherapy-related differences in toxicity were observed. CONCLUSION This study suggests that the toxicity and survival of TT is similar to CRT or LND-CRT.
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Affiliation(s)
- Jonathan Servayge
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Ester P. Olthof
- Department of Gynecologic Oncology, Amsterdam University Medical Centre, Centre for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
| | - Constantijne H. Mom
- Department of Gynecologic Oncology, Amsterdam University Medical Centre, Centre for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
| | - Maaike A. van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
| | - Hans H. B. Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecologic Oncology, Amsterdam University Medical Centre, Centre for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
| | - Remi A. Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Helena C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Heleen J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands
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Gao XS, Boere IA, van Beekhuizen HJ, Franckena M, Nout R, Kruip MJHA, Kulawska MD, van Doorn HC. Acute and long-term toxicity in patients undergoing induction chemotherapy followed by thermoradiotherapy for advanced cervical cancer. Int J Hyperthermia 2022; 39:1440-1448. [DOI: 10.1080/02656736.2022.2146213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- X. S. Gao
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - I. A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H. J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - R. Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. J. H. A. Kruip
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. D. Kulawska
- Department of Radiology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H. C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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Pattyn A, Kratkiewicz K, Alijabbari N, Carson PL, Littrup P, Fowlkes JB, Duric N, Mehrmohammadi M. Feasibility of ultrasound tomography-guided localized mild hyperthermia using a ring transducer: Ex vivo and in silico studies. Med Phys 2022; 49:6120-6136. [PMID: 35759729 DOI: 10.1002/mp.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As of 2022, breast cancer continues to be the most diagnosed cancer worldwide. This problem persists within the United States as well, as the American Cancer Society has reported that ∼12.5% of women will be diagnosed with invasive breast cancer over the course of their lifetime. Therefore, a clinical need continues to exist to address this disease from a treatment and therapeutic perspective. Current treatments for breast cancer and cancers more broadly include surgery, radiation, and chemotherapy. Adjuncts to these methods have been developed to improve the clinical outcomes for patients. One such adjunctive treatment is mild hyperthermia therapy (MHTh), which has been shown to be successful in the treatment of cancers by increasing effectiveness and reduced dosage requirements for radiation and chemotherapies. MHTh-assisted treatments can be performed with invasive thermal devices, noninvasive microwave induction, heating and recirculation of extracted patient blood, or whole-body hyperthermia with hot blankets. PURPOSE One common method for inducing MHTh is by using microwave for heat induction and magnetic resonance imaging for temperature monitoring. However, this leads to a complex, expensive, and inaccessible therapy platform. Therefore, in this work we aim to show the feasibility of a novel all-acoustic MHTh system that uses focused ultrasound (US) to induce heating while also using US tomography (UST) to provide temperature estimates. Changes in sound speed (SS) have been shown to be strongly correlated with temperature changes and can therefore be used to indirectly monitor heating throughout the therapy. Additionally, these SS estimates allow for heterogeneous SS-corrected phase delays when heating complex and heterogeneous tissue structures. METHODS Feasibility to induce localized heat in tissue was investigated in silico with a simulated breast model, including an embedded tumor using continuous wave US. Here, both heterogenous acoustic and thermal properties were modeled in addition to blood perfusion. We further demonstrate, with ex vivo tissue phantoms, the feasibility of using ring-based UST to monitor temperature by tracking changes in SS. Two phantoms (lamb tissue and human abdominal fat) with latex tubes containing varied temperature flowing water were imaged. The measured SS of the water at each temperature were compared against values that are reported in literature. RESULTS Results from ex vivo tissue studies indicate successful tracking of temperature under various phantom configurations and ranges of water temperature. The results of in silico studies show that the proposed system can heat an acoustically and thermally heterogenous breast model to the clinically relevant temperature of 42°C while accounting for a reasonable time needed to image the current cross section (200 ms). Further, we have performed an initial in silico study demonstrating the feasibility of adjusting the transmit waveform frequency to modify the effective heating height at the focused region. Lastly, we have shown in a simpler 2D breast model that MHTh level temperatures can be maintained by adjusting the transmit pressure intensity of the US ring. CONCLUSIONS This work has demonstrated the feasibility of using a 256-element ring array transducer for temperature monitoring; however, future work will investigate minimizing the difference between measured SS and the values shown in literature. A hypothesis attributes this bias to potential volumetric average artifacts from the ray-based SS inversion algorithm that was used, and that moving to a waveform-based SS inversion algorithm will greatly improve the SS estimates. Additionally, we have shown that an all-acoustic MHTh system is feasible via in silico studies. These studies have indicated that the proposed system can heat a tumor within a heterogenous breast model to 42°C within a narrow time frame. This holds great promise for increasing the accessibility and reducing the complexity of a future all-acoustic MHTh system.
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Affiliation(s)
- Alexander Pattyn
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Karl Kratkiewicz
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Naser Alijabbari
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Paul L Carson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Littrup
- Delphinus Medical Technologies, Novi, Michigan, USA.,Ascension Providence Rochester Radiology, Rochester, Michigan, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Nebojsa Duric
- Delphinus Medical Technologies, Novi, Michigan, USA.,Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Electrical and Computer Engineering, Wayne State University, Detroit, Michigan, USA.,Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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Fiorentini G, Sarti D, Gadaleta CD, Ballerini M, Fiorentini C, Garfagno T, Ranieri G, Guadagni S. A Narrative Review of Regional Hyperthermia: Updates From 2010 to 2019. Integr Cancer Ther 2021; 19:1534735420932648. [PMID: 33054425 PMCID: PMC7570290 DOI: 10.1177/1534735420932648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of hyperthermia (HT) in cancer therapy and palliative care has been discussed for years in the literature. There are plenty of articles that show good feasibility of HT and its efficacy in terms of tumor response and survival improvements. Nevertheless, HT has never gained enough interest among oncologists to become a standard therapy in clinical practice. The main advantage of HT is the enhancement of chemotherapy (CHT), radiotherapy (RT), chemoradiotherapy (CRT), and immunotherapy benefits. This effect has been confirmed in several types of tumors: esophageal, gastrointestinal, pancreas, breast, cervix, head and neck, and bladder cancers, and soft tissue sarcoma. HT effects include oxygenation and perfusion changes, DNA repair inhibition and immune system activation as a consequence of new antigen exposure. The literature shows a wide variety of randomized, nonrandomized, and observational studies and both prospective and retrospective data to confirm the advantage of HT association to CHT and RT. There are still many ongoing trials on this subject. This article summarizes the available literature on HT in order to update the current knowledge on HT use in association with RT and/or CHT from 2010 up to 2019.
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Affiliation(s)
- Giammaria Fiorentini
- Azienda Ospedaliera "Ospedali Riuniti Marche Nord," Pesaro, Italy.,Private Clinic Ravenna33, Ravenna, Italy
| | - Donatella Sarti
- Azienda Ospedaliera "Ospedali Riuniti Marche Nord," Pesaro, Italy
| | - Cosmo Damiano Gadaleta
- Department of Interventional and Integrated Medical Oncology, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | | | | | - Girolamo Ranieri
- Department of Interventional and Integrated Medical Oncology, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Effect of Scalp Cooling on the Pharmacokinetics of Paclitaxel. Cancers (Basel) 2021; 13:cancers13153915. [PMID: 34359815 PMCID: PMC8345584 DOI: 10.3390/cancers13153915] [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: 07/03/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary This study investigated the correlation between scalp cooling used to prevent chemotherapy-induced alopecia and the pharmacokinetics of paclitaxel in female cancer patients with a solid tumor. In a prospective cohort study, 14 patients who were treated with weekly paclitaxel and scalp cooling were able to undergo pharmacokinetic sampling of paclitaxel during one cycle of treatment. In comparison to a control cohort of 24 patients treated with weekly paclitaxel without scalp cooling, our data showed that scalp cooling used concomitantly with one course of paclitaxel did not reduce or increase the clearance of paclitaxel. Therefore, it is unlikely that scalp cooling influences paclitaxel efficacy or toxicity. Finally, despite scalp cooling, half of the patients in our study developed a form of hair loss. Importantly, neither an association with difference in paclitaxel clearance nor change in hair loss was found. Abstract Chemotherapy-induced alopecia (CIA), a side effect with high impact, can be prevented by cooling the scalp during the administration of some cytotoxic drugs. However, the effects of this prolonged scalp cooling on the pharmacokinetics of chemotherapy have never been investigated. In this study, we compared the pharmacokinetics of the widely used chemotherapeutic agent paclitaxel (weekly dose of 80–100 mg/m2) in female patients with solid tumors using concomitant scalp cooling (n = 14) or not (n = 24). Blood samples were collected in all patients for pharmacokinetic analyses up to 6 h after one course of paclitaxel administration. The primary endpoint was the clearance (L/h) of paclitaxel. Paclitaxel clearance—expressed as relative difference in geometric means—was 6.8% (90% CI: −16.7% to 4.4%) lower when paclitaxel was administered with concomitant scalp cooling versus paclitaxel infusions without scalp cooling. Within the subgroup of patients using scalp cooling, paclitaxel clearance was not statistically significantly different between patients with CIA (alopecia grade 1 or 2) and those without CIA. Hence, scalp cooling did not negatively influence the clearance of paclitaxel treatment.
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Kroesen M, Mulder HT, van Holthe JML, Aangeenbrug AA, Mens JWM, van Doorn HC, Paulides MM, Oomen-de Hoop E, Vernhout RM, Lutgens LC, van Rhoon GC, Franckena M. Confirmation of thermal dose as a predictor of local control in cervical carcinoma patients treated with state-of-the-art radiation therapy and hyperthermia. Radiother Oncol 2019; 140:150-158. [PMID: 31302345 DOI: 10.1016/j.radonc.2019.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Addition of deep hyperthermia results in improved local control (LC) and overall survival (OS) compared to radiotherapy alone in patients with cervical carcinoma. Previously, we showed that the thermal dose of hyperthermia significantly correlates with LC and disease specific survival (DSS). Over the last decade, new radiation techniques were introduced resulting in improved LC. AIM To validate the effect of thermal dose in a more recent cohort of patients treated with modern radiotherapy techniques, including image guided brachytherapy (IGBT). METHODS We analyzed primary cervical carcinoma patients treated with a combination of radiotherapy and deep hyperthermia between 2005 and 2016 at our institute. Data on patient, tumor and treatment were collected including the thermal dose parameters TRISE and CEM43T90. Follow-up data on LC, disease free survival, DSS, OS as well as late toxicity data were collected. Data were analyzed using the Cox proportional hazard and Kaplan-Meier analyses. RESULTS 227 patients were included. In multivariate analysis, histology, FIGO stage, lymphadenopathy, TRISE, CEM43T90 and IGBT had a significant effect on LC. In the patients treated with IGBT, the thermal dose parameter TRISE remained to have a significant effect on LC in univariate analysis. CONCLUSIONS The positive association between thermal dose and clinical outcome is replicated in an independent, recent cohort of cervical carcinoma patients. Importantly, in patients receiving IGBT, the effect of thermal dose on clinical outcome is still observed.
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Affiliation(s)
- Michiel Kroesen
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Hendrik T Mulder
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jeanette M L van Holthe
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Aleida A Aangeenbrug
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jan Willem M Mens
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Helena C van Doorn
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynaecology, The Netherlands
| | - Margarethus M Paulides
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands; Eindhoven University of Technology, Department of Electrical Engineering, The Netherlands
| | - Esther Oomen-de Hoop
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Rene M Vernhout
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Ludy C Lutgens
- University Medical Centre Maastricht, Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands
| | - Gerard C van Rhoon
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Martine Franckena
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands.
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Kroesen M, Mulder HT, van Holthe JML, Aangeenbrug AA, Mens JWM, van Doorn HC, Paulides MM, Oomen-de Hoop E, Vernhout RM, Lutgens LC, van Rhoon GC, Franckena M. The Effect of the Time Interval Between Radiation and Hyperthermia on Clinical Outcome in 400 Locally Advanced Cervical Carcinoma Patients. Front Oncol 2019; 9:134. [PMID: 30906734 PMCID: PMC6418024 DOI: 10.3389/fonc.2019.00134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/14/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Addition of deep hyperthermia to radiotherapy results in improved local control (LC) and overall survival compared to radiotherapy alone in cervical carcinoma patients. Based on preclinical data, the time interval between radiotherapy, and hyperthermia is expected to influence treatment outcome. Clinical studies addressing the effect of time interval are sparse. The repercussions for clinical applications are substantial, as the time between radiotherapy and hyperthermia should be kept as short as possible. In this study, we therefore investigated the effect of the time interval between radiotherapy and hyperthermia on treatment outcome. Methods: We analyzed all primary cervical carcinoma patients treated between 1996 and 2016 with thermoradiotherapy at our institute. Data on patients, tumors and treatments were collected, including the thermal dose parameters TRISE and CEM43T90. Follow-up data on tumor status and survival as well as late toxicity were collected. Data was analyzed using Cox proportional hazards analysis and Kaplan Meier analysis. Results: 400 patients were included. Kaplan Meier and univariate Cox analysis showed no effect of the time interval (range 30-230 min) on any clinical outcome measure. Besides known prognostic factors, thermal dose parameters TRISE and CEM43T90 had a significant effect on LC. In multivariate analysis, the thermal dose parameter TRISE (HR 0.649; 95% CI 0.501-0.840) and the use of image guided brachytherapy (HR 0.432; 95% CI 0.214-0.972), but not the time interval, were significant predictors of LC and disease specific survival. Conclusions: The time interval between radiotherapy and hyperthermia, up to 4 h, has no effect on clinical outcome. These results are re-ensuring for our current practice of delivering hyperthermia within maximal 4 h after radiotherapy.
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Affiliation(s)
- M Kroesen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H T Mulder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - J M L van Holthe
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - A A Aangeenbrug
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - J W M Mens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H C van Doorn
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - M M Paulides
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - E Oomen-de Hoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - R M Vernhout
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - L C Lutgens
- Department of Radiation oncology, University Medical Centre Maastricht (MAASTRO), Maastricht, Netherlands
| | - G C van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - M Franckena
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Interobserver Variability of the International Federation of Gynecology and Obstetrics Staging in Cervical Cancer. Int J Gynecol Cancer 2013; 23:890-4. [DOI: 10.1097/igc.0b013e318292da65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
ObjectiveThe objective of this study was to assess the interobserver variability of pelvic examination under anesthesia (EUA) in cervical cancer.MethodsSubsequent patients undergoing a staging procedure under anesthesia for primary cervical cancer were enrolled in the study. All clinicians assessed “blinded” tumor size, and the involvement of vagina, parametria, sacrouterine ligaments, pelvic sidewalls, bladder, and/or rectum. Items were scored varying from 1 (“certainly no involvement”), 2 (“not sure about involvement”), to 3 (”involvement”). Each individual decided on the International Federation of Gynecology and Obstetrics (FIGO) stage; also, the urge for imaging and treatment proposal were accounted for. Final FIGO staging was obtained by consensus of the team. Investigators were classified as experienced after more than 50 EUAs. All others were classified less experienced. The free-marginal κ values between experienced and less experienced investigators were calculated for all previously mentioned items.ResultsBetween February 2009 and December 2010, a total of 86 patients were enrolled. Among experienced investigators, a moderate interobserver agreement was found with regard to FIGO stage (free-marginal κ value of 0.49) and an excellent interobserver agreement on their proposed therapy (free-marginal κ value of 0.84). A lower level of agreement was found when comparing experienced with less experienced investigators: only a slight level of agreement on FIGO stage and a substantial agreement on their therapy proposal (free-marginal κ values of 0.03 and 0.66).ConclusionsWe describe only a moderate interobserver agreement on clinical staging of patients with cervical cancer. The interobserver agreement increases in the group of experienced doctors, indicating that EUA can be learned.
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