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van den Heerik ASVM, Aiyer KTS, Stelloo E, Jürgenliemk-Schulz IM, Lutgens LCHW, Jobsen JJ, Mens JWM, van der Steen-Banasik EM, Creutzberg CL, Smit VTHBM, Horeweg N, Bosse T. Microcystic elongated and fragmented (MELF) pattern of invasion: Molecular features and prognostic significance in the PORTEC-1 and -2 trials. Gynecol Oncol 2022; 166:530-537. [PMID: 35840357 DOI: 10.1016/j.ygyno.2022.06.027] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Microcystic, elongated fragmented (MELF) pattern of myometrial invasion is a distinct histologic feature occasionally seen in low-grade endometrial carcinomas (EC). The prognostic relevance of MELF invasion was uncertain due to conflicting data, and it had not yet appropriately been studied in the context of the molecular EC classification. We aimed to determine the relation of MELF invasion with clinicopathological and molecular characteristics, and define its prognostic relevance in early-stage low/intermediate risk EC. METHODS Single whole tumor slides of 979 (85.8%) out of 1141 (high)intermediate-risk EC of women who participated in the PORTEC-1/-2 trials were available for review. Clinicopathological and molecular features were compared between MELF invasion positive and negative cases. Time-to-event analyses were done by Kaplan-Meier method, log-rank tests and Cox' proportional hazards models. RESULTS MELF invasion was found in 128 (13.1%) cases, and associated with grade 1-2 histology, deep myometrial invasion and substantial lymph-vascular space invasion (LVSI). 85.6% of MELF invasion positive tumors were no-specific-molecular-profile (NSMP) EC. NSMP EC with MELF invasion were CTNNB1 wild type in 92.2% and KRAS mutated in 24.4% of cases. Risk of recurrence was lower for MELF invasion positive as compared to MELF invasion negative cases (4.9% vs. 12.7%, p = 0.026). However, MELF invasion had no independent impact on risk of recurrence (HR 0.65, p = 0.30) after correction for clinicopathological and molecular factors. CONCLUSIONS MELF invasion has no independent impact on risk of recurrence in early-stage EC, and is frequently observed in low-grade NSMP tumors. Routine assessment of MELF invasion has no clinical implications and is not recommended.
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Affiliation(s)
- A S V M van den Heerik
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - K T S Aiyer
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L C H W Lutgens
- Department of Radiation Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - J J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J W M Mens
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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Wortman BG, Astreinidou E, Laman MS, van der Steen-Banasik EM, Lutgens LCHW, Westerveld H, Koppe F, Slot A, van den Berg HA, Nowee ME, Bijmolt S, Stam TC, Zwanenburg AG, Mens JWM, Jürgenliemk-Schulz IM, Snyers A, Gillham CM, Weidner N, Kommoss S, Vandecasteele K, Tomancova V, Creutzberg CL, Nout RA. Brachytherapy quality assurance in the PORTEC-4a trial for molecular-integrated risk profile guided adjuvant treatment of endometrial cancer. Radiother Oncol 2020; 155:160-166. [PMID: 33159971 DOI: 10.1016/j.radonc.2020.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/06/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The PORTEC-4a trial investigates molecular-integrated risk profile guided adjuvant treatment for endometrial cancer. The quality assurance programme included a dummy run for vaginal brachytherapy prior to site activation, and annual quality assurance to verify protocol adherence. Aims of this study were to evaluate vaginal brachytherapy quality and protocol adherence. METHODS For the dummy run, institutes were invited to create a brachytherapy plan on a provided CT-scan with the applicator in situ. For annual quality assurance, institutes provided data of one randomly selected brachytherapy case. A brachytherapy panel reviewed and scored the brachytherapy plans according to a checklist. RESULTS At the dummy run, 15 out of 21 (71.4%) institutes needed adjustments of delineation or planning. After adjustments, the mean dose at the vaginal apex (protocol: 100%; 7 Gy) decreased from 100.7% to 99.9% and range and standard deviation (SD) narrowed from 83.6-135.1 to 96.4-101.4 and 8.8 to 1.1, respectively. At annual quality assurance, 22 out of 27 (81.5%) cases had no or minor and 5 out of 27 (18.5%) major deviations. Most deviations were related to delineation, mean dose at the vaginal apex (98.0%, 74.7-114.2, SD 7.6) or reference volume length. CONCLUSIONS Most feedback during the brachytherapy quality assurance procedure of the PORTEC-4a trial was related to delineation, dose at the vaginal apex and the reference volume length. Annual quality assurance is essential to promote protocol compliance, ensuring high quality vaginal brachytherapy in all participating institutes.
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Affiliation(s)
- B G Wortman
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands.
| | - E Astreinidou
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | - M S Laman
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | | | | | - H Westerveld
- Department of Radiation Oncology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - F Koppe
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - A Slot
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - H A van den Berg
- Department of Radiation Oncology, Catharina Hospital Eindhoven, The Netherlands
| | - M E Nowee
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Bijmolt
- Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands
| | - T C Stam
- Department of Radiation Oncology, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - A G Zwanenburg
- Department of Radiation Oncology, Zwolle, The Netherlands
| | - J W M Mens
- Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | | | - A Snyers
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C M Gillham
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin 6, Ireland
| | - N Weidner
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Germany
| | - S Kommoss
- Department of Women's Health, Tübingen University Hospital, Germany
| | - K Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - V Tomancova
- Department of Clinical Oncology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
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3
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Wortman BG, Creutzberg CL, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MCS, van Triest B, Nijman HW, Stelloo E, Bosse T, de Boer SM, van Putten WLJ, Smit VTHBM, Nout RA. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018; 119:1067-1074. [PMID: 30356126 PMCID: PMC6219495 DOI: 10.1038/s41416-018-0310-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [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: 04/12/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/16/2023] Open
Abstract
Background PORTEC-2 was a randomised trial for women with high-intermediate risk (HIR) endometrial cancer, comparing pelvic external beam radiotherapy (EBRT) with vaginal brachytherapy (VBT). We evaluated long-term outcomes combined with the results of pathology review and molecular analysis. Methods 427 women with HIR endometrial cancer were randomised between 2002–2006 to VBT or EBRT. Primary endpoint was vaginal recurrence (VR). Pathology review was done in 97.4%, combined with molecular analysis. Results Median follow-up was 116 months; 10-year VR was 3.4% versus 2.4% for VBT vs. EBRT (p = 0.55). Ten-year pelvic recurrence (PR) was more frequent in the VBT group (6.3% vs. 0.9%, p = 0.004), mostly combined with distant metastases (DM). Ten-year isolated PR was 2.5% vs. 0.5%, p = 0.10, and DM 10.4 vs. 8.9% (p = 0.45). Overall survival for VBT vs. EBRT was 69.5% vs. 67.6% at 10 years (p = 0.72). L1CAM and p53-mutant expression and substantial lymph-vascular space invasion were risk factors for PR and DM. EBRT reduced PR in cases with these risk factors. Conclusion Long-term results of the PORTEC-2 trial confirm VBT as standard adjuvant treatment for HIR endometrial cancer. Molecular risk assessment has the potential to guide adjuvant therapy. EBRT provided better pelvic control in patients with unfavourable risk factors.
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Affiliation(s)
- B G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Jobsen
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - L C H W Lutgens
- Maastricht Radiation Oncology Clinic, Maastricht, The Netherlands
| | | | - J W M Mens
- Department of Radiation Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands
| | - A Slot
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | | | - B van Triest
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - E Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - S M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - W L J van Putten
- Department of Biostatistics, ErasmusMC Cancer Institute, Rotterdam, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Wortman BG, Bosse T, Nout RA, Lutgens LCHW, van der Steen-Banasik EM, Westerveld H, van den Berg H, Slot A, De Winter KAJ, Verhoeven-Adema KW, Smit VTHBM, Creutzberg CL. Molecular-integrated risk profile to determine adjuvant radiotherapy in endometrial cancer: Evaluation of the pilot phase of the PORTEC-4a trial. Gynecol Oncol 2018; 151:69-75. [PMID: 30078506 DOI: 10.1016/j.ygyno.2018.07.020] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [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: 05/01/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-4a trial is a randomized trial for women with high-intermediate risk endometrial cancer (EC), comparing individualized adjuvant treatment based on a molecular-integrated risk profile to standard adjuvant treatment; vaginal brachytherapy. To evaluate patient acceptability and pathology logistics of determining the risk profile, a pilot phase was included in the study. METHODS PORTEC-4a is ongoing and the first 50 patients enrolled were included in the pilot phase. Primary endpoints of the pilot phase were patient acceptance, evaluated by analyzing the screening logs of the participating centers, and logistical feasibility of determination of the risk profile within 2 weeks, evaluated by analyzing the pathology database. RESULTS In the first year, 145 eligible women were informed about the trial at 13 centers, of whom 50 (35%) provided informed consent. Patient accrual ranged from 0 to 57% per center. Most common reasons for not participating were: not willing to participate in any trial (43.2%) and not willing to risk receiving no adjuvant treatment (32.6%). Analysis of the pathology database showed an average time between randomization and determination of the molecular-integrated risk profile of 10.2 days (1-23 days). In 5 of the 32 patients (15.6%), pathology review took >2 weeks. CONCLUSIONS The PORTEC-4a trial design was proven feasible with a satisfactory patient acceptance rate and an optimized workflow of the determination of the molecular-integrated risk profile. PORTEC-4a is the first randomized trial to investigate use of a molecular-integrated risk profile to determine adjuvant treatment in EC.
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Affiliation(s)
- B G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - L C H W Lutgens
- Maastricht Radiation Oncology Clinic, Maastricht, the Netherlands
| | | | - H Westerveld
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - H van den Berg
- Department of Radiotherapy, Catharina Hospital Eindhoven, the Netherlands
| | - A Slot
- Radiotherapy Institute Friesland, Leeuwarden, the Netherlands
| | - K A J De Winter
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands
| | | | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
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5
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Nout RA, Smit VTHBM, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MCS, van Bunningen BNFM, Ansink AC, van Putten WLJ, Creutzberg CL. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 2010; 375:816-23. [PMID: 20206777 DOI: 10.1016/s0140-6736(09)62163-2] [Citation(s) in RCA: 774] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND After surgery for intermediate-risk endometrial carcinoma, the vagina is the most frequent site of recurrence. This study established whether vaginal brachytherapy (VBT) is as effective as pelvic external beam radiotherapy (EBRT) in prevention of vaginal recurrence, with fewer adverse effects and improved quality of life. METHODS In this open-label, non-inferiority, randomised trial undertaken in 19 Dutch radiation oncology centres, 427 patients with stage I or IIA endometrial carcinoma with features of high-intermediate risk were randomly assigned by a computer-generated, biased coin minimisation procedure to pelvic EBRT (46 Gy in 23 fractions; n=214) or VBT (21 Gy high-dose rate in three fractions, or 30 Gy low-dose rate; n=213). All investigators were masked to the assignment of treatment group. The primary endpoint was vaginal recurrence. The predefined non-inferiority margin was an absolute difference of 6% in vaginal recurrence. Analysis was by intention to treat, with competing risk methods. The study is registered, number ISRCTN16228756. FINDINGS At median follow-up of 45 months (range 18-78), three vaginal recurrences had been diagnosed after VBT and four after EBRT. Estimated 5-year rates of vaginal recurrence were 1.8% (95% CI 0.6-5.9) for VBT and 1.6% (0.5-4.9) for EBRT (hazard ratio [HR] 0.78, 95% CI 0.17-3.49; p=0.74). 5-year rates of locoregional relapse (vaginal or pelvic recurrence, or both) were 5.1% (2.8-9.6) for VBT and 2.1% (0.8-5.8) for EBRT (HR 2.08, 0.71-6.09; p=0.17). 1.5% (0.5-4.5) versus 0.5% (0.1-3.4) of patients presented with isolated pelvic recurrence (HR 3.10, 0.32-29.9; p=0.30), and rates of distant metastases were similar (8.3% [5.1-13.4] vs 5.7% [3.3-9.9]; HR 1.32, 0.63-2.74; p=0.46). We recorded no differences in overall (84.8% [95% CI 79.3-90.3] vs 79.6% [71.2-88.0]; HR 1.17, 0.69-1.98; p=0.57) or disease-free survival (82.7% [76.9-88.6] vs 78.1% [69.7-86.5]; HR 1.09, 0.66-1.78; p=0.74). Rates of acute grade 1-2 gastrointestinal toxicity were significantly lower in the VBT group than in the EBRT group at completion of radiotherapy (12.6% [27/215] vs 53.8% [112/208]). INTERPRETATION VBT is effective in ensuring vaginal control, with fewer gastrointestinal toxic effects than with EBRT. VBT should be the adjuvant treatment of choice for patients with endometrial carcinoma of high-intermediate risk. FUNDING Dutch Cancer Society.
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Affiliation(s)
- R A Nout
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands.
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Vanclée A, Lutgens LCHW, Oving EBH, Deutz NEP, Gijbels MJJ, Schouten HC, Bos GMJ. Keratinocyte growth factor ameliorates acute graft-versus-host disease in a novel nonmyeloablative haploidentical transplantation model. Bone Marrow Transplant 2005; 36:907-15. [PMID: 16151417 DOI: 10.1038/sj.bmt.1705157] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Allogeneic stem cell transplantations (SCT) are currently being used as a therapy for hematological malignancies, some solid tumors and nonmalignant bone marrow deficiencies. Nevertheless, clinical applicability is limited due to toxicity of conditioning regimens, graft-versus-host disease (GVHD) and the scarcity of HLA-identical family donors. New concepts are based on nonmyeloablative conditioning to reduce toxicity, prevention or amelioration of GVHD and the use of haploidentical donors to increase donor availability. To combine these requirements, we have developed a nonmyeloablative conditioning regimen, consisting of low-dose total body irradiation and cyclophosphamide-based chemotherapy. In a haploidentical F1 --> F1 mouse model, this nonmyeloablative transplantation protocol resulted in stable full donor chimerism, but also in the development of severe GVHD. Administration of keratinocyte growth factor (KGF) reduced GVHD, evident as reduced weight loss and a lesser degree of dermatitis, compared to saline-treated controls. KGF preserved plasma citrulline and tumor necrosis factor-alpha levels, both indicative for reduced injury to the gastrointestinal tract. This was confirmed by histological findings. At 6 months after transplantation, survival rates were significantly higher in KGF-treated animals as compared to phosphate buffered saline-treated controls. These results indicate that KGF preserves gut integrity and might therefore contribute substantially to reduction of lethal GVHD in (nonmyeloablative) haploidentical transplantation.
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Affiliation(s)
- A Vanclée
- Department of Internal Medicine, Division of Hematology and Oncology, University Hospital Maastricht, Maastricht, The Netherlands.
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Blijlevens NMA, Lutgens LCHW, Schattenberg AVMB, Donnelly JP. Citrulline: a potentially simple quantitative marker of intestinal epithelial damage following myeloablative therapy. Bone Marrow Transplant 2005; 34:193-6. [PMID: 15170165 DOI: 10.1038/sj.bmt.1704563] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We noted a significant decline in the serum concentrations of citrulline of 32 haematopoietic stem cell transplant recipients following intensive myeloablative therapy during the first 3 weeks after transplantation when patients have oral mucositis, a markedly disturbed gut integrity (L/R ratio) and are most at risk of infection and other severe complications. Closer inspection of the citrulline concentrations of 12 patients confirmed that the decline did indeed correspond to the onset of oral mucositis and altered gut integrity. Since serum citrulline is a reliable biochemical marker of small bowel enterocyte mass in humans with villous-atrophy-associated diseases, it may prove a useful marker for intestinal mucosal damage induced by chemotherapy, allowing the relationship between gut mucosal damage and post-transplant complications including infections to be explored more readily.
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Affiliation(s)
- N M A Blijlevens
- Department of Haematology, University Medical Centre, St. Radboud, Nijmegen, The Netherlands.
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8
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de Rijke JM, van der Putten HWHM, Lutgens LCHW, Voogd AC, Kruitwagen RFPM, van Dijck JAAM, Schouten LJ. Age-specific differences in treatment and survival of patients with cervical cancer in the southeast of The Netherlands, 1986-1996. Eur J Cancer 2002; 38:2041-7. [PMID: 12376210 DOI: 10.1016/s0959-8049(02)00315-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Age at diagnosis has been proven to be an important determinant of the choice of initial treatment for several sites of cancer. Elderly patients are more likely to receive no treatment or less intensive treatment modalities. This study analysed the influence of age on treatment choice and survival in patients diagnosed with cervical cancer. This population-based study used data on 1176 new cases of invasive cervical cancer diagnosed in the period of 1986-1996 from three regional cancer registries in the Netherlands. All available information on treatment and survival (on 1 January 1998) was recorded. Relative survival rates were calculated according to the Hakulinen method. Relative risks (RR) for excess mortality due to the diagnosis of cervical cancer were calculated with a regression model for relative survival rates. Only 5% of the patients aged 70 years and older (n=224) were diagnosed with stage IA disease, compared with 11 and 30% of the patients aged 50-69 years and 49 years and younger, respectively. Almost 50% of the 70+ patients with stage IB-IIA were treated with radiotherapy as a single treatment modality, whereas 64% of the patients aged < or =49 years were treated with surgery alone. In all age groups, treatment for advanced stage disease (stage > or =IIB) was radiotherapy alone. No treatment was given to 10% of the patients aged 70 years and older, 5% of those aged 50-69 years and 1% of those aged 49 years and younger. Five-year relative survival was 69% (95% Confidence Interval (CI): 66-72%) and differed significantly (P=0.001) with age (70+ years: 49%; 50-69 years 58%; < or =49 years: 81%). Multivariate analyses on a subset of patients showed that age was not an independent prognostic factor, whereas stage and treatment modality were very important prognostic factors. Although elderly cancer patients were sometimes treated differently from younger patients, this was in accordance with the guidelines. Relative survival rates differed significantly by age. The multivariate analyses on the subset of patients also revealed that excess mortality increased with age. However, when adjustment was made for stage and treatment, this difference disappeared. The influence of treatment on survival is likely to be due to the selection of patients based on other characteristics, such as tumour volume, comorbidity and performance status.
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Affiliation(s)
- J M de Rijke
- Maastricht Cancer Registry, Comprehensive Cancer Centre Limburg, (IKL), PO Box 2208, The Netherlands.
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9
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van der Zee J, Koper PCM, Lutgens LCHW, Burger CW. Point-counterpoint: what is the optimal trial design to test hyperthermia for carcinoma of the cervix? Point: addition of hyperthermia or cisplatin to radiotherapy for patients with cervical cancer; two promising combinations--no definite conclusions. Int J Hyperthermia 2002; 18:19-24. [PMID: 11824390 DOI: 10.1080/02656730110083738] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Randomized trials have shown that results of radiotherapy in patients with cervical cancer can be improved by combining the treatment with either cisplatin based chemotherapy, or hyperthermia. The studies on both the combination of radiotherapy with chemotherapy, and the combination on radiotherapy with hyperthermia, leave several important questions unanswered. At present, no definite conclusions can be drawn with regard to which combination results in the best therapeutic ratio. Therefore, on both ethical and scientific grounds, the next logical step would be to compare the two types of combined treatment to each other, and each combination with a treatment including all three modalities, in a randomized fashion.
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Affiliation(s)
- J van der Zee
- University Hospital Rotterdam--Daniel den Hoed Cancer Center, Hyperthermia Unit
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