Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis

2017 ◽  
Vol 27 (7) ◽  
pp. 1446-1454 ◽  
Author(s):  
Ozan Cem Guler ◽  
Sezin Yuce Sari ◽  
Sumerya Duru Birgi ◽  
Melis Gultekin ◽  
Ferah Yildiz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Local Control ◽  
External Beam Radiation ◽  
Significant Prognostic Factor ◽  
Definitive Chemoradiotherapy ◽  
Beam Radiation ◽  
Significant Difference

ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.

Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

2020 ◽  
pp. 1-10
Author(s):  
Dhiego C. A. Bastos ◽  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Amol J. Ghia ◽  
Jing Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Thoracic Spine ◽  
Adjuvant Radiotherapy ◽  
Neurological Complications ◽  
Thermal Therapy ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Laser Interstitial Thermal Therapy ◽  
Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

Disparities in the Use of Adjuvant External Beam Radiation Therapy in Node-positive Cervical Cancer Patients Following Hysterectomy

2020 ◽  
Vol 43 (1) ◽  
pp. 43-46
Author(s):  
Dimitrios Nasioudis ◽  
Kelsey Musselman ◽  
Sushmita Gordhandas ◽  
Eloise Chapman-Davis ◽  
Melissa K. Frey ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Node Positive

scholarly journals Effects of HIV status on non-metastatic cervical cancer progression among patients in Lusaka, Zambia

2020 ◽  
Vol 30 (5) ◽  
pp. 613-618
Author(s):  
Mario Jesus Trejo ◽  
Kennedy Lishimpi ◽  
Mulele Kalima ◽  
Catherine K Mwaba ◽  
Lewis Banda ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Stage I ◽  
External Beam Radiation ◽  
Hiv Positive ◽  
External Beam ◽  
Hiv Status ◽  
Beam Radiation ◽  
Hiv Negative

IntroductionSub-Saharan Africa has the highest global incidence of cervical cancer. Cervical cancer is the most common cause of cancer morbidity and mortality among women in Zambia. HIV increases the risk for cervical cancer and with a national Zambian adult HIV prevalence of 16%, it is important to investigate the impact of HIV on the progression of cervical cancer. We measured differences in cervical cancer progression between HIV-positive and HIV-negative patients in Zambia.MethodsThis study included 577 stage I and II cervical cancer patients seen between January 2008 and December 2012 at the Cancer Diseases Hospital in Lusaka, Zambia. The inclusion criteria for records during the study period included known HIV status and FIGO stage I and II cervical cancer at initial date of registration in the Cancer Diseases Hospital. Medical records were abstracted for clinical and epidemiological data. Cancer databases were linked to the national HIV database to assess HIV status among cervical cancer patients. Logistic regression examined the association between HIV and progression, which was defined as metastatic or residual tumor after 3 months of initial treatment.ResultsA total of 2451 cervical cancer cases were identified, and after exclusion criteria were performed the final analysis population totaled 537 patients with stage I and II cervical cancer with known HIV status (224 HIV-positive and 313 HIV-negative). HIV-positive women were, on average, 10 years younger than HIV-negative women who had a median age of 42, ranging between 25 and 72. A total of 416 (77.5%) patients received external beam radiation, and only 249 (46.4%) patients received the recommended treatment of chemotherapy, external beam radiation, and brachytherapy. Most patients were stage II (85.7%) and had squamous cell carcinoma (74.7%). HIV-positive patients were more likely to receive lower doses of external beam radiation than HIV-negative patients (47% vs 37%; P<0.05, respectively). The median total dose of external beam radiation for HIV-positive and HIV-negative patients was 46 Gy and 50 Gy, respectively. HIV positivity did not lead to tumor progression (25.4% in HIV-positive vs 23.9% in HIV-negative, OR 1.04, 95% CI [0.57, 1.92]). However, among a subset of HIV-positive patients, longer duration of infection was associated with lower odds of progression.ConclusionThere was no significant impact on non-metastatic cervical cancer progression by HIV status among patients in Lusaka, Zambia. The high prevalence of HIV among cervical cancer patients suggest that HIV-positive patients should be a primary target group for HPV vaccinations, screening, and early detection.

scholarly journals Comparison of Response to the Concurrent Low Dose Daily Cisplatin Vs Weekly Cisplatin Vs Three Weekly Cisplatin with External Beam Radiotherapy in Carcinoma Cervix Patients of Stage IIB, IIIA & IIIB: A Prospective Study from Single Institution

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Amol Ubale ◽  
Shruti Chandra ◽  
S N Prasad ◽  
P K Singh
Keyword(s):  
Cervical Cancer ◽  
Low Dose ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Beam Radiation ◽  
Significant Difference ◽  
Weekly Cisplatin

Introduction: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. External beam radiation therapy along with intra cavitary insertion has long been the treatment of choice for locally advanced (IIB-IVA) cervical cancer, but long-term successes are limited in terms of pelvic recurrence or distant metastasis. Outcome of low dose daily versus weekly versus three weekly Cisplatin concurrent with External beam radiotherapy in locally advanced cervical carcinoma was compared in this study. Methods: A prospective cross sectional study was carried out in J K cancer institute, Kanpur. Total 60 patients of cervical cancer were randomized into 3 arms. Arm I, Arm II and Arm III received External beam radiotherapy concurrent with either daily (8mg/m2), weekly (40 mg/m2) or three weekly (100 mg/m2) Cisplatin respectively. External beam radiotherapy was given with a dose of 50 Gy / 25 # / 5 week / 2 field or 4 field. Patients were evaluated weekly during treatment and afterwards up to 1year. Results: Most of the patients were from fourth and fifth decade, low socioeconomic strata and illiterate. Majority of the cases belong to squamous cell carcinoma (96.6%) and stage III B (55%). Objective response in arm I was 80.0%, in arm II was 75.0% and in arm III was 60.0% respectively. Statistically significant difference was noted between arm III and Arm I (80%Vs60% p<0.05). Results were better in arm I as compare to arm II but not statistically significant. (80%Vs75% P>0.05) Conclusions: This study showed that response was better in ARM I as compared to ARM III and best results was seen with Cisplatin concurrent daily with radiation. Keywords: Cisplatin, concurrent chemotherapy, daily, weekly, three weekly, carcinoma cervix

scholarly journals Changes in the cervical microbiota of cervical cancer patients after primary radio-chemotherapy

2020 ◽  
Vol 30 (9) ◽  
pp. 1326-1330
Author(s):  
Anastasia Tsakmaklis ◽  
Maria Vehreschild ◽  
Fedja Farowski ◽  
Maike Trommer ◽  
Christhardt Kohler ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Beta Diversity ◽  
Radiation Treatment ◽  
Diversity Index ◽  
Locally Advanced ◽  
Post Treatment ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Significant Difference ◽  
Pre Treatment

ObjectiveSeveral recent studies have identified a potential interaction between the vaginal microbiota and gynecological cancers, but little is known about the cervical microbiota and its changes during cancer treatment. Therefore, the aim of the study was to evaluate the quantitative and qualitative changes of cervical microbiota in patients undergoing concurrent chemotherapy and radiation treatment for locally advanced cervical cancer.MethodsCervical cytobrush samples of 15 cervical patients undergoing chemoradiation treatment were collected 1 day before starting external beam radiation therapy and on the day of the last fraction of brachytherapy. After DNA extraction, 16S rRNA amplicon sequencing of the V3–V4 region was performed on the MiSeq platform, followed by data processing and statistical analyses concerning the alpha and beta diversity of 16 samples (7 samples were excluded because of incomplete sample sets).ResultsThe amount of amplicon yield after polymerase chain reaction analysis in post-radiation samples was significantly lower compared with the baseline samples (pre 31.49±24.07 ng/µl; post 1.33±1.94 ng/µl; p=0.007). A comparison of pre-treatment and post-treatment samples did not show significant differences regarding beta diversity (weighted UniFrac). There was no significant difference in alpha diversity, which is used to characterize species diversity within a particular community and takes into account both number and abundance (Shannon Diversity Index pre-treatment samples: 2.167±0.7504 (95% CI 1.54 to 2.79); post-treatment samples: 1.97±0.43 (95% CI 1.61 to 2.33); p=0.38). Interindividual differences in patients could partly explain some variation of the samples (permutational multivariate analysis of variance).ConclusionThere was a strong reduction in cervical bacterial loads after chemoradiation. Neither alpha nor beta diversity varied significantly when baseline samples were compared with post-treatment samples.

Association of LINC00858 with clinical outcome of patients with cervical cancer who received standard concurrent chemo-radiotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18002-e18002
Author(s):  
Shun Lu ◽  
Siyao Deng ◽  
Jiayu Zhang ◽  
Jin Yi Lang
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
External Beam Radiation ◽  
Relapse Free Survival ◽  
Beam Radiation ◽  
Free Survival ◽  
Local Recurrences

e18002 Background: Cervical cancer is the second most common malignant tumour threatening women’s health and remains a vast challenge for many underdeveloped nations. Combination of concurrent chemotherapy with external beam radiation therapy (EBRT) followed by intracavitary brachytherapy (ICBT) boost achieved a favorable outcome for cervical cancer patients. However, the reduced sensitivity of cancer cells to radiotherapy is an important cause of re-currence and metastasis in some patients, it is necessary to constantly improve the radiotherapy technology and the treatment effect. Long noncoding RNAs (lncRNA) are noncoding RNA molecules greater than 200 nucleotides in size that are often critical regulators of gene expression, lncRNAs were implicated in stem cell pluripotency by examining the expression. Methods: Whole-exome sequencing and RNA sequencing were conducted in patients with locally advanced cervical cancer (LACC) to identify prognostic variants by using a two-stage case-control design. Patients developed local recurrences in 3 years after standard concurrent chemotherapy with EBRT followed by ICBT were divided in case group. While patients did not show local recurrences were regarded as a radio-sensitive group. In the first stage, DNA and RNA were extracted from formalin-fixed paraffin-embedded tumor tissues of 32 patients. In the second stage, to validate the significant association between LincRNA and Local control rate of patients found in first stage, RT-PCR was carried out in RNA samples from an independent 100 patients (with same criteria of selection). Cox regression models were used to analyze the association between genetic variants and time-to-event outcomes. Results: In the first stage, expression of 7 LincRNAs: RP11-335O4.(P = 0.01,HR = 10.86), CTD-2292M14.1(P = 0.01,HR = 9.47),RP11-94H6.1(P = 0.02,HR = 9.47), RP11-417L19.2(P = 0.0,HR = 9.36), RP4-683M8.2(P = 0.02,HR = 10.82), RP11-20B24.3(P = 0.02,HR = 8.90) and LINC00858(P = 0.03,HR = 6.41) were found to be markedly correlated with relapse-free survival in 32 patients. Among these LincRNAs, LINC00858 (P = 0.01, HR = 11.23) remained significant association with relapse-free survival in 100 independent patients. Conclusions: Our data suggest that LincRNA may be a useful predict marker for radiosencetivity of cervical cancer patients.

Predicting tumor recurrence in patients with cervical carcinoma treated with definitive chemoradiotherapy: value of quantitative histogram analysis on diffusion-weighted MR images

2016 ◽  
Vol 58 (4) ◽  
pp. 481-488 ◽  
Author(s):  
Gurcan Erbay ◽  
Cem Onal ◽  
Elif Karadeli ◽  
Ozan C Guler ◽  
Sami Arica ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Tumor Recurrence ◽  
Disease Recurrence ◽  
Definitive Chemoradiotherapy ◽  
Node Metastasis ◽  
The Mean

Background Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results The mean and median ADC values for the cohort were 1.043 ± 0.135 × 10−3 mm2/s and 1.018 × 10−3 mm2/s (range, 0.787–1.443 × 10−3 mm2/s). The mean ADC was significantly lower for patients with advanced stage (≥IIB) or lymph node metastasis compared with patients with stage <IIB or no lymph node metastasis. The mean ADC, 75th percentile ADC (ADC75), 90th percentile ADC (ADC90), and 95th percentile ADC (ADC95) were significantly lower in patients with tumor recurrence compared with patients without recurrence. In multivariate analysis, tumor size, ADC75 and ADC95 were independent prognostic factors for both overall survival and disease-free survival. Conclusion ADC histogram parameters could be markers for disease recurrence and for predicting survival outcomes. ADC75, ADC90, and ADC95 of the primary tumor were significant predictors of disease recurrence in cervical cancer patients treated with definitive CRT.

scholarly journals Analysis of local control rate and toxicity of radiotherapy dose of cervical cancer.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 136-136
Author(s):  
Hanyi Zhang ◽  
Shun Lu ◽  
Chang Sun ◽  
Jin Yi Lang
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Univariate Analysis ◽  
Local Control Rate ◽  
External Beam Radiation ◽  
Youden Index ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Beam Radiation ◽  
Radiotherapy Dose

136 Background: The standard of care for treatment of advanced cervical cancer is the combination of external beam radiation therapy (EBRT) and intracavitary brachytherapy with cisplatin based concurrent chemotherapy. Radiotherapy plays a crucial role in treatment of cervical cancer. Recent GEC-ESTRO guidelines recommend that the dose to 90% (D90) of the high-risk clinical target volume (HRCTV) in cervical cancer be at least 85Gy with higher doses for poor response to radiotherapy. This study was aim to analyze our institution’s patients with locally advanced cervical cancer in regards to whether higher brachytherapy dose delivery lead to a better outcome, and to investigate the proper dose to balance the local control rate and toxicity. Methods: A total of 262 patients with local advanced cervical cancer treated at a single institution were retrospectively analyzed for the association between dosimetry and outcomes. Youden index was used to identify the optimal cut-off point of continuous tumor parameters and divide patients into subgroups. Significance of radiotherapy dose parameters on OS, PFS, LRFS and DMFS and toxicity was evaluated. Results: In the univariate analysis, for both HR-CTV and LR-CTV, the high dose group (EQD2 D90 >75Gy, LR-CTV>68Gy, respectively) have a better LRFS than low-dose groups (P<0.05). LR-CTV remains significance after adjusted for age and FIGO stage. Moreover, in the high-dose LR-CTV group, there is no association between dose of LR-CTV and LRFS was found, however, higher dose of HR-CTV significant associated with higher ratio of side effect was found. In addition, no association of dose of HR-CTV or LR-CTV and OS were found for all patients. Conclusions: Our results showed that dose of LR-CTV may be a useful prognostic factor of LRFS of patients with cervical cancer. Moreover, after D90 of LR-CTV reaches 68Gy, increasing dose did not show a better LRFS but lead to higher ratio of toxicity, supporting that LR-CTV at 68Gy might be a safety and efficacy dose of radiotherapy to the patients with cervical cancer. However, further improved in dose had no significant benefit on local control rate, and it might increase the risks of toxicity.

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