A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

Abstract The purpose of this study was to reveal treatment outcomes and toxicity after pelvic intensity-modulated radiotherapy (IMRT) for postoperative uterine cervical cancer of Japanese patients. Consecutive patients who were treated with pelvic IMRT for postoperative cervical cancer in our institute were retrospectively analyzed. Relapse-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier estimator, and log-rank tests were used to compare differences. From the database, 62 patients were identified. The pathology was squamous cell carcinoma in 44 patients and other pathology in 18 patients. Of the 62 patients, 35 had high-risk prognostic factors and 27 patients had intermediate-risk prognostic factors. The prescribed radiation doses were 50 Gy in 25 fractions for 58 patients and 50.4 Gy in 28 fractions for 4 patients. One patient received a vaginal cuff boost. Chemotherapy was administered in 36 patients. During the median follow-up period of 50.9 months, there was no locoregional failure. Six patients in the high-risk group relapsed, but none of the patients in the intermediate-risk group relapsed (P = 0.02). The 3-year OS and RFS rates were 98.2% and 90.9%, respectively. Significant factors related to RFS were squamous cell carcinoma pathology (P = 0.02), pathological T stage (P = 0.04), surgical margin status (P < 0.01) and multiple lymph nodes metastases (P < 0.01). Grade 3 or more toxicity occurred in 6 patients. Four patients had obstruction of the intestine, and 2 patients had stenosis of the urinary tract. In clinical practice, the use of pelvic IMRT for postoperative cervical cancer of Japanese patients showed a low rate of toxicity without decreasing the efficacy.

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Long-term results of early adjuvant concurrent chemoradiotherapy for high-risk, early stage uterine cervical cancer patients after radical hysterectomy

BMC Cancer ◽

10.1186/s12885-017-3299-0 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Sang-Won Kim ◽

Mison Chun ◽

Hee-Sug Ryu ◽

Suk-Joon Chang ◽

Tae Wook Kong ◽

...

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Cancer Patients ◽

Radical Hysterectomy ◽

Concurrent Chemoradiotherapy ◽

Early Stage ◽

Uterine Cervical Cancer ◽

Long Term Results

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The value of prognostic factors for uterine cervical cancer patients treated with irradiation alone

BMC Cancer ◽

10.1186/1471-2407-7-234 ◽

2007 ◽

Vol 7 (1) ◽

Cited By ~ 19

Author(s):

Rūta Grigienė ◽

Konstantinas P Valuckas ◽

Eduardas Aleknavičius ◽

Juozas Kurtinaitis ◽

Simona R Letautienė

Keyword(s):

Cervical Cancer ◽

Prognostic Factors ◽

Cancer Patients ◽

Uterine Cervical Cancer

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Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors: A 13-Year Experience

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31828703fd ◽

2013 ◽

Vol 23 (3) ◽

pp. 567-575 ◽

Cited By ~ 30

Author(s):

Mika Okazawa ◽

Seiji Mabuchi ◽

Fumiaki Isohashi ◽

Osamu Suzuki ◽

Yasuo Yoshioka ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Prognostic Factors ◽

High Risk ◽

Cancer Patients ◽

Risk Group ◽

Figo Stage ◽

High Risk Group ◽

Intermediate Risk ◽

Stromal Invasion

ObjectivesTo identify groups of patients who derive clinical benefit from postoperative adjuvant concurrent chemoradiotherapy (CCRT), we retrospectively investigated the survival outcomes of surgically treated early-stage cervical cancer patients.MethodsWe reviewed the medical records of 316 patients with FIGO stage IB1-IIB cervical cancer who had been treated with adjuvant radiotherapy (RT) (n = 124, RT group) or adjuvant CCRT (n = 192, CCRT group) after radical hysterectomy between January 1996 and December 2009. Of these, 187 patients displayed high-risk prognostic factors (high-risk group), and 129 displayed intermediate-risk prognostic factors (intermediate-risk group). Sixty patients with 1 intermediate-risk prognostic factor who received no adjuvant therapy were also identified and used as controls (NFT group). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.ResultsIn the high-risk group, adjuvant CCRT was significantly superior to RT alone with regard to recurrence rate, progression-free survival (PFS), and overall survival. In the intermediate-risk group, CCRT was superior to RT with regard to recurrence rate and PFS in patents with 2 or more risk factors. Among the patients with only 1 intermediate-risk factor, although no survival benefit of CCRT over RT was observed, addition of adjuvant treatment resulted in significantly improved PFS compared with the NFT group in patients with deep stromal invasion (log-rank, P = 0.012).ConclusionsPostoperative CCRT improved the prognosis of FIGO stage IB1-IIB cervical cancer patients in the high-risk group and patients who displayed 2 or more intermediate-risk factors. Patients who displayed deep stromal invasion alone also derived clinical benefit from adjuvant treatment.

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Distribution of genetic alterations in high-risk early-stage cervical cancer patients treated with postoperative radiation therapy

Scientific Reports ◽

10.1038/s41598-021-90139-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Naoya Murakami ◽

Yuka Asami ◽

Hiroshi Yoshida ◽

Daisuke Takayanagi ◽

Sou Hirose ◽

...

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

High Risk ◽

Cancer Patients ◽

Early Stage ◽

Survival Rates ◽

Genetic Alterations ◽

Uterine Cervical Cancer ◽

Risk Category ◽

Postoperative Radiation Therapy

AbstractSomatic genetic alteration analysis was performed for post-hysterectomy high-risk early-stage uterine cervical cancer patients who underwent post-operative radiation therapy. Post-operative radiation therapy was performed for patients with pathological features of pelvic lymph node metastasis, parametrium invasion, or positive vaginal margin, which corresponded to the post-operative high-risk category. DNA was extracted from paraffin-embedded surgical specimens, and 50 somatic hotspot genetic alternations were detected using Ion AmpliSeq Cancer Hotspot Panel. The existence of actionable mutation was assessed based on OncoKB evidence level > 3A. Between January 2008 and November 2019, 89 patients who underwent abdominal radical hysterectomy followed by post-operative radiation therapy were identified. The follow-up period for living patients was 82.3 months (range 9.3–153.9), and the 5-year relapse-free survival and overall survival rates were 72.6% and 85.9%, respectively. The most frequently detected somatic mutation was PIK3CA (26 [29.2%] patients); however, no prognostic somatic genetic alterations were identified. Actionable mutations were detected in 30 (33.7%) patients. Actionable mutations were detected in approximately one-third of patients, suggesting that precision medicine can be offered to patients with post-operative high-risk uterine cervical cancer in the near future.

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