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da Silva IF, da Silva IF, Saraceni V, Koifman RJ. Delays in treatment initiation and conclusion in women with stage IA to IIIB cervical cancer: A survival study in a hospital-based cohort from a developing country. Cancer Epidemiol 2023; 86:102450. [PMID: 37678095 DOI: 10.1016/j.canep.2023.102450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
AIM To evaluate the effect of delays in stage IA to IIIB cervical cancer treatment initiation and conclusion on hospital-based survival among Brazilian women. METHODS A retrospective follow-up study was conducted in a stage IA to IIIB cervical cancer cohort treated from 2012 and 2014 and followed until December 31, 2017 in Rio de Janeiro. Delay in treatment initiation definition was defined based on the Brazilian law of 60 days for treatment initiation after diagnosis. Delay in treatment conclusion was defined based on the literature and sample distributions: < 120/121-200/> 200 days. The endpoint was death(from all causes or cervical cancer). Death causes and dates were obtained by a record linkage procedure between the hospital cancer registry and the Mortality Information System. Global 36-month survival and HRs were estimated by the KaplanMeier method and proportional Cox regression models, respectively. RESULTS From 865 patients, 269(31.1%) died over the median follow-up time of 27 months. Delay on treatment initiation(>60-days) was 92.8%, while the delay in treatment conclusion(>120 days) was 87.5%. Overall survival was 61.3% (<60-days:62.6%; 61-90 days:63.5%). Among stage IIB-IIIB, women treated < 60-days presented 40.1% survival, while 61-90-days had 52.5%, and > 90-days had 53.3%. Delays in treatment conclusion significantly reduced survival[72.2%(<120-days) to 60.7%(>200-days)]. Multivariate analysis showed that delays in treatment initiation did not affect 36-month death risk. Compared to women concluding treatment in < 120-days, those taking 121-200-days or > 200-days showed increases in death risk of 89%(95%CI:1.10-3.24) and 111%(95%CI:1.31-3.39), respectively, regardless of age, stage, treatment protocol, and time to treatment initiation. CONCLUSION Delays in cervical cancer treatment conclusion (but not treatment initiation) affected 36-month survival and death risk among Brazilians.
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Affiliation(s)
- Ilce Ferreira da Silva
- Department of Epidemiology and Quantitative Methods in Health, National School of public Health, Oswaldo Cruz Foundation, Brazil; Graduate Program of Environmental Public Health, Nation al School of public Health, Oswaldo Cruz Foundation, Brazil.
| | - Ileia Ferreira da Silva
- Graduate Program of Environmental Public Health, Nation al School of public Health, Oswaldo Cruz Foundation, Brazil
| | - Valéria Saraceni
- Superintendence of Health Surveillance, Municipal Health Secretariat of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosalina Jorge Koifman
- Department of Epidemiology and Quantitative Methods in Health, National School of public Health, Oswaldo Cruz Foundation, Brazil; Graduate Program of Environmental Public Health, Nation al School of public Health, Oswaldo Cruz Foundation, Brazil
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Shimels T, Gashaw B, Gedif T. Association between delayed initiation of treatment indications and survival in patients with cervical cancer: A systematic review and meta-analysis protocol. PLoS One 2022; 17:e0271604. [PMID: 35857786 PMCID: PMC9299293 DOI: 10.1371/journal.pone.0271604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Cervical cancer is a growing public health problem globally. Despite the availability of management options, the progression of the disease as a function of waiting time may challenge the effort to attain a desired outcome. There is a conflicting report on the role of waiting time to initiate an appropriate treatment in improving patients’ survival.
Objective
This review aims to evaluate the association between delayed time to initiate any treatment indication with survival in patients with cervical cancer.
Methods
An internet-based literature search will be performed using text words, MESH terms and truncated words in databases, namely MEDLINE, Cochrane CENTRAL, EMBASE, Web of Science and Scopus. Grey literature searches in Google Scholar, Networked Digital Library of Theses and Dissertations (NDLTD) and Dissertations and Theses Global will be made. All articles published until 30th of December 2021 on human subjects will be searched without a language restriction. Studies which fulfil the inclusion criteria will be screened in full reading, selected, appraised and assessed for methodological quality by two independent reviewers. Data on participants, study methods, interventions, and outcomes will be abstracted. Included studies will be pooled for meta-analysis. Microsoft-Excel and R packages will be employed to carry out the statistical analysis. Heterogeneity will be assessed using Cochrane Q statistic, Tau2, and I2. Results will be reported as a function of 4-week delay in treatment initiation and the corresponding hazard ratio (HR) at 95% confidence interval. Statistical significance will be considered at P<0.05.
Trial registration
PROSPERO registration number: CRD42022299689.
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Affiliation(s)
- Tariku Shimels
- Research Directorate, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Biruck Gashaw
- Gynecologist and Obstetrician, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teferi Gedif
- Social and Administrative Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Dreyer G. Surgery for Cervical Cancer: Perspectives from Low- and Middle-Income Countries. Indian J Gynecol Oncolog 2019. [DOI: 10.1007/s40944-019-0341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gajjar SR, Mellon EA, Castaneda SA, Zoghbi SR, Llorente R, DeGennaro V, Grover S, Ventura NC. Assessment of the Radiation Therapy Model in the Dominican Republic and Its Impact on the Caribbean Islands. Int J Radiat Oncol Biol Phys 2018; 101:503-509. [DOI: 10.1016/j.ijrobp.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
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Abstract
INTRODUCTION The treatment of some early-stage and most locally advanced disease cervical cancer patients consists of concurrent chemoradiation, while almost all with advanced disease require palliative chemotherapy. AREAS COVERED This review is aimed to analyze the safety issues emerging from trials of chemoradiation for early-stage high-risk disease and locally advanced stages, as well as safety issues of trials of palliative chemotherapy for advanced disease. Safety issues on fertility preservation are also discussed. EXPERT OPINION Cisplatin chemoradiation produces higher toxicity as compared to radiation alone, yet it is well-tolerated. Further advances would require (i) the development of more effective and tolerated combination chemoradiation regimens, (ii) demonstration of the efficacy and tolerability of adjuvant chemotherapy after cisplatin chemoradiation, and (iii) incorporation of targeted therapies into radiosensitizing regimens. A major problem continues to be the population of patients with advanced disease. The recent incorporation of bevacizumab into chemotherapy regimens represents a step forward; however, toxicity as well as economic issues may impede its wide acceptance worldwide. Preserving fertility in young women with cervical cancer is an issue that must be fully addressed. In this setting, neoadjuvant chemotherapy seems to increase fertlity rate without compromising oncological outcomes.
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Affiliation(s)
- Alfonso Dueñas-González
- a Unit of Biomedical Research on Cancer , Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología , Mexico City , Mexico.,b Centro Oncológico Estatal , ISSEMyM , Toluca , Mexico
| | - Lucely Cetina
- c Division of Clinical Research , Instituto Nacional de Cancerología , Mexico City , Mexico
| | - Jaime Coronel
- c Division of Clinical Research , Instituto Nacional de Cancerología , Mexico City , Mexico
| | - Aurora González-Fierro
- c Division of Clinical Research , Instituto Nacional de Cancerología , Mexico City , Mexico.,d Division of Basic Research , Instituto Nacional de Cancerología , Mexico City , Mexico
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Grover S, Xu MJ, Yeager A, Rosman L, Groen RS, Chackungal S, Rodin D, Mangaali M, Nurkic S, Fernandes A, Lin LL, Thomas G, Tergas AI. A systematic review of radiotherapy capacity in low- and middle-income countries. Front Oncol 2015; 4:380. [PMID: 25657930 PMCID: PMC4302829 DOI: 10.3389/fonc.2014.00380] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC. Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health, and the Latin American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013. Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases). The main concern with the review of RT resources in Eastern Europe was the lack of data. Conclusion: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the countries’ economic status. The challenges to delivering radiation in the discussed regions are multidimensional and include lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing RT and affordability of care remains a large problem.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Melody J Xu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Alyssa Yeager
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lori Rosman
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Smita Chackungal
- Department of Surgery, University of Western Ontario , London, ON , Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Margaret Mangaali
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Sommer Nurkic
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Annemarie Fernandes
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lilie L Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Gillian Thomas
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons , New York, NY , USA
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Sarraf Z, Hamedi B, Hooshmand S, Mosalaie A, Robati M, Momtahan M, Farhadi P. The Effect of Extrafascial Hysterectomy After Completion of External Beam Radiotherapy for Treatment of Locally Advanced Stages (IIB-III) of Cervical Cancer. Iran Red Crescent Med J 2013; 15:e10758. [PMID: 24693381 PMCID: PMC3955496 DOI: 10.5812/ircmj.10758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022]
Abstract
Background: Worldwide, cervical cancer is one of the most challenging gynecologic cancers in treatment. Objectives: This study was designed with the aim of comparing patients treated with External Beam Radiotherapy (EBRT) and Interactivity Brachytherapy (ICBT) with EBRT and extrafascial hysterectomy in locally advanced stages of cervical cancer (IIB-III). Patients and Methods: The present study was designed as a case-control which was performed on the patients with cervical cancer in locally advanced stages (IIB-III) admitted to Namazi and Faghihi hospitals (university hospitals in Shiraz) between 2008-2011. 51 patients were included in two distinct groups: 25 patients were treated with EBRT and Interactivity Brachytherapy (group A). 26 patients were treated with EBRT and extrafascial hysterectomy group B. Results: In group A, the number of patients with FIGO stage IIb and III were 16 and 9, respectively, and 17 and 9 in group B. The median duration of follow-up was 24 months. There were no significant differences between two groups in metastasis and recurrence rate (P > 0.05). 5-years overall survival rate was 54.8% [95% CI: 39-70.9] in group A and in group B was 50.9% [95% CI: 41.5-60] and The LOG-rank test which controls the effect of treatment modalities on overall survival rate, did not show any significant difference between two groups (P = 0.407). Conclusion: The results of our study showed that the trend of treatment using EBRT along with intracavity brachytherapy may have the same outcome as the method of using EBRT and extrafascial hysterectomy. Overall, it seems that external beam radiation followed by extrafascial hysterectomy could be a proper substitute for brachytherapy.
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Affiliation(s)
- Zahra Sarraf
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Bahareh Hamedi
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Bahareh Hamedi, Obstetrics and Gynecology Department Office, Shahid Faghihi Hospital, Zand Avenue, Shiraz, IR Iran, Tel: +98-7112332365, Fax: +98-7112332365, E-mail:
| | - Soodabeh Hooshmand
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ahmad Mosalaie
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Minoo Robati
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mozhdeh Momtahan
- Gynecologic Oncology Ward, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Pouya Farhadi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Bialas B, Kellas-Sleczka S, Fijalkowski M, Raczek-Zwierzycka K. Tolerance and efficacy of preoperative intracavitary HDR brachytherapy in IB and IIA cervical cancer. J Contemp Brachytherapy 2009; 1:38-44. [PMID: 27799952 PMCID: PMC5080393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 03/09/2009] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this work is to analyze the efficacy and tolerance of preoperative intracavitary HDR brachytherapy (HDR-BT) in patients with IB and IIA cervical cancer. MATERIAL AND METHODS 139 patients with cervical cancer IB-IIA with preoperative HDR-BT, out of which 60 patients with cervical cancer IB (43.2%) and 79 with IIA (56.8%) were treated since 1996 to 2002. In preoperative BT total dose to point A ranged from 30-45 Gy in 6-9 fractions twice a week. The fraction dose was 4-5 Gy at point A. Six weeks after BT all patients underwent radical Wertheim-Meigs hysterectomy. Patients with disadvantageous risk factors or with positive specimen histology had a complementary therapy: external-beam radiotherapy (EBRT) given to the whole pelvic volume in daily fractions of 2 Gy up to total dose of 36-52 Gy (20 patients) or EBRT with cisplatin-based chemotherapy with the dose of 30-40 mg/m2 in 5-7 fractions given weekly (7 patients) or chemotherapy (6 patients). Acute and late radiation toxicity was evaluated according to EORTC/RTOG. RESULTS In postoperative specimen histopathology the number of 114 women (82%) had tumor-free specimen within brachytherapy target (in cervix and cavity), 96 women (60.1%) had tumor-free specimen both in and outside brachytherapy target (lymph nodes, parametra, adnexis). The 5-year and 10-year DFS were 93.8% and 88% for IB and 89.7% and 64.7% for IIA respectively. 7.9% of patients developed acute toxicity both in rectum and bladder (only in I and II grade of EORTC/RTOG). Late severe complication occurred in rectum in 2.2% of patients and in bladder 1.4%. CONCLUSIONS 1. Preoperative HDR-BT in patients with IB and IIA cervical cancer is an effective and well tolerated therapy with acceptable rate of side effects. 2. Preoperative HDR-BT followed by surgery in a group without risk factors is a sufficient treatment option with no additional adjuvant therapy requirement.
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Cetina L, Garcia-Arias A, Candelaria M, Cantú D, Rivera L, Coronel J, Bazan-Perkins B, Flores V, Gonzalez A, Dueñas-González A. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients. World J Surg Oncol 2009; 7:19. [PMID: 19220882 PMCID: PMC2649933 DOI: 10.1186/1477-7819-7-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 02/16/2009] [Indexed: 11/10/2022] Open
Abstract
Background A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. Methods In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. Results A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31) and 22 (3–27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. Conclusion The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.
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Affiliation(s)
- Lucely Cetina
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/INCan, Mexico City, México.
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