The influence of overall treatment time to the efficiency of chemo-radiotherapy for locally advanced cervical cancer

2017 ◽  
Vol 17 (1) ◽  
pp. 124-130
Author(s):  
Ekkasit Tharavichitkul ◽  
Panupat Rugpong ◽  
Nisa Chawapun ◽  
Razvan M. Galalae
Keyword(s):  
Cervical Cancer ◽  
Treatment Time ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Intracavitary Brachytherapy ◽  
Treatment Results ◽  
Overall Treatment Time ◽  
Free Survival ◽  
Significant Difference ◽  
The Mean

AbstractPurposeThis study aims to clarify the influence of overall treatment time (OTT) on the efficiency of combined chemo-radiotherapy in cervical cancer.Material and methodsThis retrospective study enrolled 122 cervical cancer patients who had squamous cell carcinoma and had undergone definitive chemo-radiotherapy from 2009 to 2013. All patients received whole pelvic radiotherapy (WPRT) with the dose of 50 Gy in 25 fractions (with central shielding after 44 Gy) plus intracavitary brachytherapy with the dose of 28 Gy in four fractions. During WPRT, all patients received concurrent chemotherapy with weekly platinum-based regimen. The data of patient characteristics, OTT, treatment results and toxicities were collected and evaluated.ResultsThe mean follow-up time was 36 months. The mean age of patients was 52 years old; 68% of patients were stage IIB related to International Federation of Gynaecology and Obstetrics staging. Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates did not differ significantly in the data-derived cut points of 55·8 and 53 days. No statistically significant difference in treatment results between the two groups of OTT<49 and OTT≥62 days was observed.ConclusionsIn our data-derived cut point, OTT did not influence to PC, DMFS, DFS and OS. The influence of OTT on treatment results may be found in longer periods.

scholarly journals Comparative study to evaluate dosimetric differences in patients of locally advanced carcinoma cervix undergoing intracavitary brachytherapy under two different anaesthesia techniques: an audit from a tertiary cancer centre in India

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Divyesh Kumar ◽  
G. Y. Srinivasa ◽  
Ankita Gupta ◽  
Bhavana Rai ◽  
Arun S. Oinam ◽  
...  
Keyword(s):  
Day Care ◽  
Treatment Time ◽  
Locally Advanced ◽  
Effective Alternative ◽  
External Beam Radiation ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Carcinoma Cervix ◽  
Beam Radiation ◽  
Significant Difference

Abstract Background Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. In this audit, we tried to retrospectively analyse the dosimetric difference, if any, in patients who underwent ICBT at our centre, under either GA in OT or PS in day care. Results Thirty five patients were analysed 16/35 (45.71%) patients underwent HDR-ICBT under GA while 19/35 (54.28%) patients under PS. In both groups, a statistically significant difference was observed between the dose received by 0.1 cc as well as 2 cc of rectum (p < 0.05), while the bladder and sigmoid colon had comparable dosages. Conclusion Though our dosimetric analysis highlighted better rectal sparing in patients undergoing HDR-ICBT under GA when compared to patients under PS, PS can still be considered an effective alternative, especially in centres dealing with significant patient load. Further studies are required for firm conclusion.

scholarly journals Postoperative adjuvant chemotherapy combined with intracavitary brachytherapy achieved the equivalent survival compared with concurrent chemoradiotherapy in cervical cancer patients with intermediate-risk

2019 ◽  
Vol 49 (8) ◽  
pp. 714-718
Author(s):  
Hao Yu ◽  
Linlin Zhang ◽  
Dapeng Li ◽  
Naifu Liu ◽  
Yueju Yin ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Disease Free Survival ◽  
Intracavitary Brachytherapy ◽  
Intermediate Risk ◽  
Postoperative Adjuvant Chemotherapy ◽  
Significant Difference ◽  
Grade Iii

Abstract Objectives The current study was aimed to evaluate the efficacy and toxicity of postoperative adjuvant chemotherapy (CT) combined with intracavitary brachytherapy (ICRT) in cervical cancer patients with intermediate-risk. Methods We analyzed the medical records of 558 patients who were submitted to radical surgery for Stage IB-IIA cervical cancer. A total of 172 of those 558 patients were considered intermediate-risk according to the GOG criteria. Among those 172 patients, 102 were subjected to CT combined with ICRT (CT+ICRT) and the remaining 70 patients were treated with concurrent chemoradiation (CCRT). The 3-year disease free survival (DFS), overall survival (OS), and complications of each group were evaluated and analyzed. Results No significant difference was observed in 3-year DFS or OS of the patients submitted to CT+ICRT and CCRT. Importantly, the frequencies of grade III to IV acute complications were significantly higher in patients submitted to CCRT than in those treated with CT+ICRT (Hematologic, P = 0.016; Gastrointestinal, P = 0.041; Genitourinary, P = 0.019). Moreover, the frequencies of grade III–IV late complications in patients treated with CCRT were significantly higher compared with CT+ICRT-treated patients (Gastrointestinal, P = 0.026; Genitourinary, P = 0.026; Lower extremity edema, P = 0.008). Conclusions Postoperative adjuvant CT+ICRT treatment achieved equivalent 3-year DFS and OS but low complication rate compared to CCRT treatment in early stage cervical cancer patients with intermediate-risk.

scholarly journals PD-L1 protein expression and copy number gains in HIV-positive locally advanced cervical cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592096300
Author(s):  
Kongsak Loharamtaweethong ◽  
Napaporn Puripat ◽  
Niphon Praditphol ◽  
Jidapa Thammasiri ◽  
Siriwan Tangitgamol
Keyword(s):  
Cervical Cancer ◽  
Copy Number ◽  
Locally Advanced ◽  
Hiv Positive ◽  
Hiv Status ◽  
Free Survival ◽  
Parametrial Invasion ◽  
Programmed Death ◽  
Significant Difference ◽  
Hiv Negative

Background: The programmed death-1/programmed death-ligand-1 (PD-1/PD-L1) axis may represent a target for cervical cancer; however, it is poorly understood in human immunodeficiency virus (HIV)-infected patients. Methods: We evaluated HIV-positive ( n = 42) and HIV-negative ( n = 110) women with locally advanced cervical cancer regarding their PD-L1 expression, determined by combined positive score (CPS) ⩾ 1 and tumor proportion score (TPS) ⩾ 25%, and PD-L1 copy number alterations, assessed by fluorescence in situ hybridization. Results: Regardless of HIV status, 84.9% and 44.8% of cases were PD-L1-positive according to CPS ⩾ 1 and TPS ⩾ 25%. Per CPS ⩾ 1, PD-L1 positive rate was similar between HIV-positive and HIV-negative women, whereas a significant difference was seen per TPS ⩾ 25%. Tumor size and parametrial invasion were correlated with PD-L1 positivity in HIV-negative women, whereas anti-retroviral therapy (ART) was correlated with TPS < 25%. Low CD4-positive cell counts were associated with CPS < 1 in HIV-positive women. No significant difference was observed in PD-L1 copy number status between HIV-positive and HIV-negative women. PD-L1 amplification and polysomy were independently associated with TPS ⩾ 25%, whereas the presence of parametrial invasion was independently associated with CPS ⩾ 1. Cancer stage and PD-L1 amplification were identified as independent predictors of recurrence-free survival [hazard ratio (HR) = 2.40 (1.32–4.36) and HR = 5.33 (1.94–14.61)] and cancer-specific survival [HR = 13.62 (5.1–36.38) and HR = 3.53 (1.43–8.69)]. PD-L1 polysomy was an independent predictor of locoregional recurrence-free survival [HR = 3.27 (1.27–8.41)]. HIV status and PD-L1 expression (CPS ⩾ 1 or TPS ⩾ 25%) were not associated with poor patient outcomes. Conclusion: PD-L1 amplification and polysomy are the strongest drivers of PD-L1 expression in cervical cancer, and could represent prognostic biomarkers for anti-PD-1/PD-L1 therapy. Cervical cancer biology may be modulated by HIV infection, CD4-positive cells, and HIV treatments.

Pelvic Irradiation With Concurrent Chemotherapy Versus Pelvic and Para-Aortic Irradiation for High-Risk Cervical Cancer: An Update of Radiation Therapy Oncology Group Trial (RTOG) 90-01

2004 ◽  
Vol 22 (5) ◽  
pp. 872-880 ◽  
Author(s):  
Patricia J. Eifel ◽  
Kathryn Winter ◽  
Mitchell Morris ◽  
Charles Levenback ◽  
Perry W. Grigsby ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Disease Stage ◽  
Tumor Diameter ◽  
Free Survival ◽  
Stage Ib ◽  
Disease Free

Purpose To report mature results of a randomized trial that compared extended-field radiotherapy (EFRT) versus pelvic radiotherapy with concomitant fluorouracil and cisplatin (CTRT) in women with locoregionally advanced carcinomas of the uterine cervix. Patients and Methods Four hundred three women with cervical cancer were randomly assigned to receive either EFRT or CTRT. Patients were eligible if they had stage IIB to IVA disease, stage IB to IIA disease with a tumor diameter ≥ 5 cm, or positive pelvic lymph nodes. Patients were stratified by stage and by method of lymph node evaluation. Results The median follow-up time for 228 surviving patients was 6.6 years. The overall survival rate for patients treated with CTRT was significantly greater than that for patients treated with EFRT (67% v 41% at 8 years; P < .0001). There was an overall reduction in the risk of disease recurrence of 51% (95% CI, 36% to 66%) for patients who received CTRT. Patients with stage IB to IIB disease who received CTRT had better overall and disease-free survival than those treated with EFRT (P < .0001); 116 patients with stage III to IVA disease had better disease-free survival (P = .05) and a trend toward better overall survival (P = .07) if they were randomly assigned to CTRT. The rate of serious late complications of treatment was similar for the two treatment arms. Conclusion Mature analysis confirms that the addition of fluorouracil and cisplatin to radiotherapy significantly improved the survival rate of women with locally advanced cervical cancer without increasing the rate of late treatment-related side effects.

Completion Surgery After Intensity-Modulated Arc Therapy in the Treatment of Locally Advanced Cervical Cancer: Feasibility, Surgical Outcome, and Oncologic Results

2013 ◽  
Vol 23 (5) ◽  
pp. 877-883 ◽  
Author(s):  
Philippe Tummers ◽  
Amin Makar ◽  
Katrien Vandecasteele ◽  
Gert De Meerleer ◽  
Hannelore Denys ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Cervical Cancer ◽  
Bulky Disease ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Intensity Modulated ◽  
Arc Therapy ◽  
Disease Free

IntroductionSince the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity.AimThe objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity.MethodsThis was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery ± pelvic lymphadenectomy (on positron emission tomography–computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy.ResultsSince 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachytherapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63% and 74%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81% and 91%.ConclusionsCompleting surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.

scholarly journals Comparison of Chemoradiotherapy and Radical Radiotherapy in Patients With Cervical Cancer

2020 ◽  
pp. 15-20
Author(s):  
Ozlem Yetmen Dogan ◽  
Ismet Sahinler
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Treatment Failure ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
High Response Rate ◽  
Intracavitary Brachytherapy ◽  
Radical Radiotherapy

Introduction: The current study aimed at comparing the results of radical radiotherapy (RT) or chemoradiotherapy (CRT) in patients with cervical cancer and evaluating the prognostic factors. Methods: CRT is the standard of care for locally advanced cervical cancer with the five-year survival rate of 30%–80%. In 1978-2006, a total of 716 patients with cervical cancer stage IB2-IVB were retrospectively analyzed for RT and CRT. In intracavitary brachytherapy, the median dose was 24 Gy and follow-up was 78 months. CRT was treated with 45 Gy external radiotherapy with cisplatin 40 mg/m2 given once a week. Results: The five-year pelvic control rate was 56.2% in the radical RT arm and 75.8% in the combined arm (P=0.01); disease-free survival and overall survival rates were 47%-56.3% (P=0.09) and 44.9%-52.5% (P=0.03), respectively. Treatment failure was detected in 317(50.5%) of 627 patients in the RT arm and in 30 (33.7%) of 89 patients in the CRT arm (Chi-squared value=8.86, P<0.01). Treatment failure rate was high in the 1st two years. Distant metastases were detected in 116 patients in the RT and 17 patients in the CRT arms. Hematological side effect rates in the CRT arm -anemia, thrombopenia, and leukopenia- were 33.7%, 13.5%, and 28.1%, respectively. The prevalence of rectitis, cystitis, and skin and subcutaneous fibrosis in the RT arm was 9.4%, 4.8%, and 2.2%, and in the CRT arm was 12.4%, 11.2%, and 13.5%, respectively. Conclusions: CRT increased pelvic control and overall survival rate based on the findings; it can be the preferred treatment modality because of its high response rate and acceptable toxicity.

scholarly journals Postoperative Adjuvant Chemotherapy in Locally Advanced Cervical Cancer Patients with Optimal Response to Neoadjuvant Chemotherapy: A Retrospective Study

2020 ◽  
Author(s):  
Xiaojie Feng ◽  
Hongmin Chen ◽  
Lei Li ◽  
Ling Gao ◽  
Xupeng Bai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Optimal Number ◽  
Chinese Patients ◽  
Optimal Response ◽  
Increased Risk ◽  
Significant Difference

Abstract Background. Few studies investigated the effectiveness of adjuvant chemotherapy (CT) in patients with optimal response to neoadjuvant CT (NACT), and an optimal number of treatment cycles for these patients remains unknown. Methods. A total of 261 Chinese patients with FIGO stage Ib2–IIb cervical cancer who showed an optimal response to NACT were included after radical surgery (RS), and the disease-free survival (DFS) and overall survival (OS) of patients treated with different cycles of postoperative adjuvant CT were compared. Results. We found that patients treated with different cycles of postoperative adjuvant CT were significantly better than those without further therapy. The multivariate analysis showed that postoperative adjuvant CT was an independent prognostic factor for DFS. However, there was no significant difference in the DFS and OS between patients who had 3 cycles of adjuvant CT and those with 6 cycles. Further analysis revealed a significant association of 6 cycles of adjuvant CT with increased risk of leukopenia, nausea/vomiting, and rash. Conclusion. These data suggest that additional 3 cycles of adjuvant CT after NACT + RS may improve the clinical outcome of optimal responders in terms of DFS, OS, and drug toxicity.

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