Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer

PurposeWe identified the predictive factors for locoregional failure after definitive chemoradiation in patients with locally advanced cervical cancer.MethodsAltogether, 397 patients with locally advanced cervical cancer (stage IB2–IVA) were treated with definitive chemoradiation between June 2001 and February 2010. Platinum-based concurrent chemotherapy was given to all patients with median radiation dose of external beam radiotherapy 50.4 Gy in 28 fractions and intracavitary radiotherapy 30 Gy in 6 fractions. Competing risk regression analysis was used to reveal the predictive factors for locoregional failure.ResultsDuring the median follow-up of 7.2 years, locoregional failure occurred in 51 (12.9%) patients. The estimated 3-year rate of locoregional control was 89%, whereas the overall survival rate was 82%. After univariate and multivariate analyses, large tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage (III–IV) were identified as risk factors for locoregional failure (P = 0.003, P = 0.075, P = 0.005, P = 0.055, and P < 0.001, respectively). After risk grouping according to the coefficients from the multivariate model, we identified a high-risk group for locoregional failure after treatment with definitive chemoradiation as follows: (1) tumor size larger than 5 cm, and at least 1 other risk factor or (2) tumor size 5 cm or less, and at least 3 other risk factors. The cumulated estimated 3-year rate of locoregional failure of the high-risk group was 26%, which was significantly higher than that of the low-risk group (7%, P < 0.001). The 3-year overall survival rates of the 2 groups were also significantly different (57% vs 86%, P < 0.001).ConclusionsLarge tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage are all risk factors for locoregional failure after definitive platinum-based chemoradiation in patients with locally advanced cervical cancer. In the high-risk group, further clinical trials are warranted to improve the locoregional control rate.

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Plasma HPV DNA as a Biomarker of Response in Patients with Locally Advanced Cervical Cancer Treated With Definitive Chemoradiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.06.062 ◽

2017 ◽

Vol 99 (2) ◽

pp. S21

Author(s):

K. Han ◽

E.W. Leung ◽

S.V. Bratman

Keyword(s):

Cervical Cancer ◽

Locally Advanced ◽

Chemoradiation Therapy ◽

Advanced Cervical Cancer ◽

Hpv Dna ◽

Locally Advanced Cervical Cancer ◽

Definitive Chemoradiation

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Impact of pretreatment P53 gene mutation in locally advanced cervical cancer patients treated with definitive chemoradiation on treatment outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e16506 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e16506-e16506

Author(s):

Prarthana Dalal ◽

Tamer Refaat ◽

Eric Donald Donnelly ◽

Sean Sachdev ◽

Vamsi Parimi ◽

...

Keyword(s):

Cervical Cancer ◽

Treatment Outcomes ◽

Cancer Patients ◽

Gene Mutation ◽

Locally Advanced ◽

P53 Gene ◽

Advanced Cervical Cancer ◽

P53 Gene Mutation ◽

Locally Advanced Cervical Cancer ◽

Definitive Chemoradiation

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Impact of exposure to tobacco smoke, arsenic, and phthalates on locally advanced cervical cancer treatment—preliminary results

PeerJ ◽

10.7717/peerj.2448 ◽

2016 ◽

Vol 4 ◽

pp. e2448 ◽

Cited By ~ 2

Author(s):

Iulia A. Neamtiu ◽

Michael S. Bloom ◽

Irina Dumitrascu ◽

Carmen A. Roba ◽

Cristian Pop ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Treatment ◽

Tobacco Smoke ◽

Tumor Size ◽

Locally Advanced ◽

Absorption Spectrometry ◽

Response To Treatment ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

The Impact

BackgroundCancer research is a national and international priority, with the efficiency and effectiveness of current anti-tumor therapies being one of the major challenges with which physicians are faced.ObjectiveTo assess the impact of exposure to tobacco smoke, arsenic, and phthalates on cervical cancer treatment.MethodsWe investigated 37 patients with locally advanced cervical carcinoma who underwent chemotherapy and radiotherapy. We determined cotinine and five phthalate metabolites in urine samples collected prior to cancer treatment, by gas chromatography coupled to mass spectrometry, and urinary total arsenic by atomic absorption spectrometry with hydride generation. We used linear regression to evaluate the effects of cotinine, arsenic, and phthalates on the change in tumor size after treatment, adjusted for confounding variables.ResultsWe detected no significant associations between urinary cotinine, arsenic, or phthalate monoesters on change in tumor size after treatment, adjusted for urine creatinine, age, baseline tumor size, and cotinine (for arsenic and phthalates). However, higher %mono-ethylhexyl phthalate (%MEHP), a putative indicator of phthalate diester metabolism, was associated with a larger change in tumor size (β= 0.015, 95% CI [0.003–0.03],P= 0.019).ConclusionWe found no statistically significant association between the urinary levels of arsenic, cotinine, and phthalates metabolites and the response to cervical cancer treatment as measured by the change in tumor size. Still, our results suggested that phthalates metabolism may be associated with response to treatment for locally advanced cervical cancer. However, these observations are preliminary and will require confirmation in a larger, more definitive investigation.

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Paclitaxel Plus Platinum Neoadjuvant Chemotherapy Followed by Surgery Versus Primary Surgery in Locally Advanced Cervical Cancer—A Propensity Score Matching Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.604308 ◽

2020 ◽

Vol 10 ◽

Author(s):

Yanan Zhang ◽

Bin Li ◽

Yating Wang ◽

Shuanghuan Liu ◽

Haibo Wang

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Adjuvant Radiotherapy ◽

Locally Advanced ◽

Tumor Diameter ◽

Intermediate Risk ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Primary Surgery

ObjectiveTo compare the efficacy and safety of neoadjuvant chemotherapy followed by surgery (NACTS) and primary surgery (PS) in locally advanced cervical cancer (LACC).MethodsLACC (stage IB2/IIA2, FIGO 2009) patients who accepted NACTS or PS in the Cancer Hospital of the Chinese Academy of Medical Sciences from 2007 to 2017 were enrolled, and a database was established. A 1:1 ratio propensity score matching (PSM) was performed for the NACTS group and PS group according to pretreatment characteristics. After PSM, the clinicopathological features and prognosis between the matched groups were compared.ResultsOf 802 cases in the database, 639 met the inclusion criteria, with 428 received paclitaxel plus platinum NACTS, and 211 received PS. After PSM, the two groups had comparable pretreatment characteristics, with 190 cases in each group. In the NACTS group, the operation parameters were similar to the PS group except for the longer operation time (median 255 min vs. 239 min, P = 0.007); pathological intermediate-risk factors including tumor diameter (P < 0.001) and LVSI(+) (P < 0.001) were significantly decreased; fewer patients were with ≥2 intermediate-risk factors (10.5 vs. 53.2%, P < 0.001) so that the rate of adjuvant radiotherapy was reduced (54.2 vs. 70.0%, P = 0.002). DFS and OS were similar between the NACTS group and PS group (P > 0.05). However, for patients with tumor diameter ≥5 cm or SCC ≥5 ng/ml, DFS of the NACTS group was significantly prolonged (P = 0.016, P = 0.007).ConclusionPaclitaxel plus platinum neoadjuvant chemotherapy can reduce adjuvant radiotherapy by decreasing pathological risk factors. Patients with tumor diameter ≥5 cm or SCC ≥5 ng/ml may obtain survival benefits.

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Impact of Tumor Size, Shape and Patterns of Response to Chemoradiation in Locally Advanced Cervical Cancer Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.1733 ◽

2018 ◽

Vol 102 (3) ◽

pp. e635

Author(s):

A. Schernberg ◽

S. Bockel ◽

I. Fumagalli ◽

P. Annede ◽

A. Escande ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Tumor Size ◽

Locally Advanced ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer

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A new marker based on risk stratification of human papillomavirus DNA and tumor size to predict survival of locally advanced cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000095 ◽

2019 ◽

Vol 29 (3) ◽

pp. 459-465 ◽

Cited By ~ 2

Author(s):

Yecai Huang ◽

Qiao He ◽

Ke Xu ◽

Jie Zhou ◽

Jun Yin ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Risk Stratification ◽

Tumor Size ◽

Locally Advanced ◽

Figo Stage ◽

Advanced Cervical Cancer ◽

Hpv Dna ◽

Locally Advanced Cervical Cancer ◽

Advanced Cervical Carcinoma

ObjectiveTo assess the prognostic value of human papillomavirus (HPV) viral load in locally advanced cervical carcinoma treated with radical concurrent chemoradiotherapy.MethodsFrom January 2012 to October 2013, a total of 246 locally advanced cervical carcinoma patients were included in this retrospective study. HPV DNA status was tested by Hybrid Capture 2 assay. Tumor size was measured on T2WI. All the patients in the study received concurrent cisplatin-based chemoradiotherapy with intensity-modulated radiotherapy and three-dimensional brachytherapy. Survival rate was calculated by the Kaplan-Meier method, and a log-rank test was used to compare the survival. Multivariate analysis employed the Cox regression model.ResultsThe median follow-up time was 52 months. The median value of HPV DNA was 163.13 relative light unit/cut-off (RLU/CO) (range 1.65–2162.62 RLU/CO). The 5-year overall survival, distant metastasis-free survival of patients in the low HPV DNA group (HPV DNA ≤ 163.13 RLU/CO) and the high HPV DNA group (HPV DNA > 163.13 RLU/CO) were 46.3 % vs 58.5 % (p = 0.009) and 65.9 % vs 75.6% (p = 0.003), respectively. Multivariate analysis showed that the HPV DNA, tumor size, and International Federation of Gynecology and Obstetrics (FIGO) stage were independent prognostic factors for overall survival and distant metastasis-free survival. We choose the tumor size and HPV DNA as the risk stratification factors to build a new prediction marker which can better predict overall survival for locally advanced cervical cancer than can the FIGO stage.ConclusionsHPV DNA may be a useful biomarker for locally advanced cervical cancer. Low HPV load predicts a worse survival. The new marker based on risk stratification by combining HPV DNA and tumor size is better associated with overall survival of locally advanced cervical cancer treated with concurrent chemoradiotherapy.

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