Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis

IntroductionData supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer.MethodsThe clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival.ResultsA total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9–95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0–16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities.ConclusionsPatients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.

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Effect of addition of bevacizumab to chemoradiotherapy in newly diagnosed stage IVB cervical cancer: a single institution experience in Korea

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001200 ◽

2020 ◽

Vol 30 (6) ◽

pp. 764-771 ◽

Cited By ~ 1

Author(s):

Sang Hee Youn ◽

Yeon-Joo Kim ◽

Sang-Soo Seo ◽

Sokbom Kang ◽

Myong Cheol Lim ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Survival Rates ◽

Progression Free Survival ◽

Response Rates ◽

Complete Response ◽

Free Survival ◽

Group A ◽

Stage Ivb ◽

Group B

ObjectiveThe aim of this study was to compare the clinical outcomes of chemoradiotherapy with or without bevacizumab in patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer.Methods41 patients with stage IVB cervical cancer who underwent chemoradiotherapy between August 2015 and December 2017 were retrospectively analyzed. This study included 11 patients who received bevacizumab before or after radiotherapy (group A) and 30 patients who received conventional chemoradiotherapy without bevacizumab (group B). We excluded the following patients: those with dual primary cancers; those whose pathologic diagnosis was neither squamous cell carcinoma nor adenocarcinoma; those who did not undergo radiotherapy; or those from whom follow-up data could not be collected. We analyzed the treatment responses, toxicities, progression-free survival, and overall survival rates.ResultsA total of 41 patients were included in the analysis. The median follow-up was 19 months (range 3–108). The response rates at 3 months after treatment were 90.9% in group A and 83.3% in group B (p=0.54). After completing all treatments, the complete response rates were 81.8% in group A and 47% in group B (p=0.04). Grade ≥3 gastrointestinal toxicities, including bleeding, fistula, perforation, and obstruction, were more frequent in group A (54.5%) than in group B (6.7%) (p=0.003). The 12 month progression-free survival and overall survival rates were similar in both arms (12 month progression-free survival: 45.5% vs 46.7%, respectively, p=0.22; 12 month overall survival: 81.8% vs 72.9%, respectively, p=0.57). Patients with node-only metastasis had better 12 month progression-free survival in group B than in group A (59.1% vs 42.9%, respectively, p=0.04). However, the responses to both treatments did not differ in patients with organ metastasis.ConclusionsBevacizumab for stage IVB cervical cancer is associated with higher complete response rates. However, patients treated with bevacizumab experienced more bowel toxicities. Bevacizumab did not improve progression-free survival among patients with node-only metastasis.

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Stage IVA cervical cancer: outcomes of disease related complications and treatment

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000386 ◽

2020 ◽

pp. ijgc-2019-000386

Author(s):

Beman Roy Khulpateea ◽

Annette Paulson ◽

Matthew Carlson ◽

David Scott Miller ◽

Jayanthi Lea

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Cell Carcinoma ◽

Progression Free Survival ◽

Percutaneous Nephrostomy ◽

Emergency Department Visits ◽

Term Survival ◽

Histologic Subtype ◽

Free Survival ◽

Gynecology And Obstetrics

IntroductionStage IVA cervical cancer is an uncommon diagnosis. The course of the disease and the complications of treatment are not well characterized. The goal of this study was to report treatment outcomes of patients with stage IVA cervical cancer.MethodsA single institution retrospective review was carried out of all patients treated for stage IVA cervical cancer from January 2008 to July 2017. Patients were clinically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging criteria for cervical cancer. Inclusion criteria were patients with stage IVA cervical cancer of any histologic subtype, including patients with evidence of para-aortic lymph node involvement, treated at the institution during this time period. Overall survival and progression free survival were calculated using the Kaplan–Meyer method. Comparisons between survival were done using the Cox proportional hazards regression model and the log rank test.ResultsWe identified 25 patients with stage IVA cervical cancer. Mean age at diagnosis was 54 years (range 27–77). Squamous cell carcinoma was the histologic diagnosis in 24 of 25 patients (96%), with 1 case of small cell carcinoma (4%). 21 patients completed a full course of radiation. The median overall survival for patients who completed their treatment was 60 months (range 3–136), with a 2 year overall survival of 63%. The median progression free survival was 27 months (range 0–125), with a 2 year progression free survival of 40%. 11 of 25 patients (44%) developed fistulas during the course of their disease, and 55% of these were complex fistulas. 19 of 25 (76%) patients had a percutaneous nephrostomy for either hydronephrosis or diversion of vesicovaginal fistula. 111 unplanned admissions occurred among the 25 patients, and infections of the urinary tract was implicated in 46 (41%) of these. The cohort had a total of 92 emergency department visits, with pain control (36%) and medication refills (15%) being the most common presentations.DiscussionPatients with stage IVA cervical cancer may have substantial long term survival, although the sequelae of disease and treatment is associated with significant morbidity. Symptoms of fistula, percutaneous nephrostomy complications, and chronic pain present unique issues that require extensive supportive care.

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Moderate versus aggressive chemotherapy of nodular lymphocytic poorly differentiated lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.6.769 ◽

1985 ◽

Vol 3 (6) ◽

pp. 769-775 ◽

Cited By ~ 74

Author(s):

E Z Ezdinli ◽

J R Anderson ◽

F Melvin ◽

J H Glick ◽

T E Davis ◽

...

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Eastern Cooperative Oncology Group ◽

Progression Free Survival ◽

Complete Response ◽

Entire Group ◽

Free Survival ◽

Prior Therapy ◽

Poorly Differentiated ◽

Disease Free

One hundred twenty-eight patients with purely nodular lymphocytic poorly differentiated lymphoma (NLPDL) without any prior therapy, entered on Eastern Cooperative Oncology Group protocol EST 2474, were analyzed for response, progression-free and overall survival. The restaged complete response rates with cyclophosphamide-prednisone (CP) (moderate regimen) of 54% compared favorably with those of the more intensive regimens; cyclophosphamide, vincristine, procarbazine and prednisone (COPP) (56%) and BCNU, cyclophosphamide, vincristine, and prednisone (BCVP) (53%). The toxicity of the regimens decreased from BCVP to COPP to CP. The median survival rate for the entire group was 7.8 years. Estimated progression-free survival at five years by regimen was COPP, 57%; BCVP, 26%; CP, 22% (P = .02). No other prognostic parameter significantly affected progression-free survival. In spite of the better progression-free survival of COPP-treated patients, the overall survival rates with the different induction regimens were similar. Maintenance therapy for patients in complete response at the end of induction therapy with periodic BCVP reinduction did not significantly affect the disease-free or overall survival. Cyclophosphamide-prednisone is a minimally toxic regimen effective in the treatment of NLPDL, but COPP, in view of its acceptable toxicity in this patient population and apparent superiority in providing a longer disease-free state, deserves further testing.

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Phase III Trial of Observation Versus Six Courses of Paclitaxel in Patients With Advanced Epithelial Ovarian Cancer in Complete Response After Six Courses of Paclitaxel/Platinum-Based Chemotherapy: Final Results of the After-6 Protocol 1

Journal of Clinical Oncology ◽

10.1200/jco.2009.21.9691 ◽

2009 ◽

Vol 27 (28) ◽

pp. 4642-4648 ◽

Cited By ~ 73

Author(s):

Sergio Pecorelli ◽

Giuseppe Favalli ◽

Angiolo Gadducci ◽

Dionyssios Katsaros ◽

Pierluigi Benedetti Panici ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Survival Rates ◽

Progression Free Survival ◽

Complete Response ◽

First Line ◽

Free Survival ◽

Consolidation Treatment ◽

Platinum Based Chemotherapy ◽

Advanced Epithelial Ovarian Cancer

Purpose To assess whether six courses of paclitaxel are effective as consolidation treatment in patients with advanced epithelial ovarian cancer who are in complete response after first-line paclitaxel/platinum–based chemotherapy. Patients and Methods Patients with stages IIb to IV disease in clinical or pathologic complete response after six courses of paclitaxel/platinum–based chemotherapy were randomly allocated to either observation (ie, control) or six courses of paclitaxel 175 mg/m2 every 3 weeks (ie, maintenance). Results Two hundred patients were randomly assigned from March 1999 to July 2006. Because of the low accrual rate, an unplanned interim analysis of futility according to the Bayesian approach was performed. Grade 2 or greater motor neurotoxicity and sensory neurotoxicity were reported in 11.3% and 28.0% of the paclitaxel-arm patients, respectively. After a median follow-up of 43.5 months, 107 patients (53%) had experienced relapse, and 48 patients (24%) had died. Two-year progression-free survival rates were 54% (95% CI, 43% to 64%) and 59% (95% CI, 49% to 69%; P = not significant) in the control and maintenance arms, respectively. Corresponding 2-year overall survival rates were 90% (95% CI, 84% to 97%) and 87% (95% CI, 80% to 94%; P = not significant), respectively. The Cox model showed that residual disease after initial surgery (macroscopic v no macroscopic residuum; hazard ratio [HR], 1.91; 95%CI, 1.21 to 3.03) and stage (IIIc to IV v others; HR, 3.10; 95% CI, 1.13 to 8.48) were independent prognostic factors for progression-free survival, whereas the treatment arm (maintenance v control) had no prognostic relevance. Conclusion A consolidation treatment with six cycles of paclitaxel does not prolong progression-free survival or overall survival in patients in complete response after first-line paclitaxel/platinum–based regimens.

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Long-Term Survival Results of a Randomized Trial Comparing Gemcitabine Plus Cisplatin, With Methotrexate, Vinblastine, Doxorubicin, Plus Cisplatin in Patients With Bladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.07.757 ◽

2005 ◽

Vol 23 (21) ◽

pp. 4602-4608 ◽

Cited By ~ 1004

Author(s):

Hans von der Maase ◽

Lisa Sengelov ◽

James T. Roberts ◽

Sergio Ricci ◽

Luigi Dogliotti ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Locally Advanced ◽

Survival Rates ◽

Progression Free Survival ◽

Term Survival ◽

Free Survival ◽

Visceral Metastases ◽

Overall Survival Rates

Purpose To compare long-term survival in patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium treated with gemcitabine/cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC). Patients and Methods Efficacy data from a large randomized phase III study of GC versus MVAC were updated. Time-to-event analyses were performed on the observed distributions of overall and progression-free survival. Results A total of 405 patients were randomly assigned: 203 to the GC arm and 202 to the MVAC arm. At the time of analysis, 347 patients had died (GC arm, 176 patients; MVAC arm, 171 patients). Overall survival was similar in both arms (hazard ratio [HR], 1.09; 95% CI, 0.88 to 1.34; P = .66) with a median survival of 14.0 months for GC and 15.2 months for MVAC. The 5-year overall survival rates were 13.0% and 15.3%, respectively (P = .53). The median progression-free survival was 7.7 months for GC and 8.3 months for MVAC, with an HR of 1.09. The 5-year progression-free survival rates were 9.8% and 11.3%, respectively (P = .63). Significant prognostic factors favoring overall survival included performance score (> 70), TNM staging (M0 v M1), low/normal alkaline phosphatase level, number of disease sites (≤ three), and the absence of visceral metastases. By adjusting for these prognostic factors, the HR was 0.99 for overall survival and 1.01 for progression-free survival. The 5-year overall survival rates for patients with and without visceral metastases were 6.8% and 20.9%, respectively. Conclusion Long-term overall and progression-free survival after treatment with GC or MVAC are similar. These results strengthen the role of GC as a standard of care in patients with locally advanced or metastatic TCC.

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RONC-32. LOCAL CONTROL FOLLOWING PROTON THERAPY FOR PEDIATRIC CHORDOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.798 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii461-iii461

Author(s):

Daniel Indelicato ◽

Ronny Rotondo ◽

Raymond Vega ◽

Adam Holtzman ◽

Wen Shen Looi ◽

...

Keyword(s):

Overall Survival ◽

Local Control ◽

Proton Therapy ◽

Survival Rates ◽

Progression Free Survival ◽

Lumbosacral Spine ◽

High Dose ◽

Free Survival ◽

Well Differentiated ◽

Overall Survival Rates

Abstract BACKGROUND Due to the location and high dose required for disease control, pediatric chordomas are theoretically well-suited for treatment with proton therapy, but their low incidence limits the clinical outcome data available in the literature. METHODS AND MATERIALS: Between 2008 and 2019, 29 patients with a median age of 14.8 years (range, 3.8–21.8) received proton therapy for non-metastatic chordoma at a single institution. Twenty-four tumors arose in the clivus/cervical spine region and 5 in the lumbosacral spine. Twenty-six tumors demonstrated well-differentiated histology and 3 were dedifferentiated or not otherwise specified (NOS). Approximately half of the tumors underwent specialized testing: 14 were brachyury-positive and 10 retained INI-1. Seventeen patients had gross disease at the time of radiation. The median radiation dose was 73.8 GyRBE. RESULTS With a median follow-up of 4.3 years (range, 1.0–10.7), the 5-year estimates of local control, progression-free survival, and overall survival rates were 85%, 82%, and 86%, respectively. Excluding 3 patients with dedifferentiated/NOS chordoma, the 5-year local control, progression-free survival, and overall survival rates were 92%, 92%, and 91%, respectively. Serious toxicities included 3 patients with hardware failure or related infection requiring revision surgery, 2 patients with hormone deficiency, and 2 patients with Eustachian tube dysfunction causing chronic otitis media. CONCLUSION In pediatric patients with chordoma, proton therapy is associated with a low risk of serious toxicity and high efficacy, particularly in well-differentiated tumors. Complete resection may be unnecessary for local control and destabilizing operations requiring instrumentation may result in additional complications following therapy.

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Comparative Survival Assessment of Two-Dimension (2D) versus Three-Dimension (3D) Brachytherapy Treatment in Locally Advanced Cervical Cancer: A Retrospective Case Control Study

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.06.12361 ◽

2021 ◽

Vol 104 (6) ◽

pp. 934-942

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Local Control ◽

Progression Free Survival ◽

P Value ◽

Three Dimension ◽

Retrospective Case ◽

Ct Guided ◽

Free Survival ◽

Grade 3

Objective: To assess the efficacy as seen as overall survival, local control, progression free survival (PFS) and toxicities, between two-dimension (2D) and three-dimension (3D) computed tomography (CT) guided brachytherapy (BT) without using interstitial needles among patients with cervical cancer. Materials and Methods: A retrospective case control study was performed among patients with FIGO stage IB-IVA cervical cancer treated between March 1990 and August 2018. Concurrent chemoradiation using external beam radiotherapy followed by BT was the treatment method used in all patients. Patients were divided in two groups based on imaging type during BT to compare between 2D and 3D BT techniques. Clinical endpoints were overall survival, local control, progression free survival, acute toxicities, and late toxicities. Results: One hundred two patients with cervical cancer were included, which 52 patients had been treated with 2D and 50 patients with 3D using CT scan BT without interstitial needles. Baseline characteristics were similar between the groups. External beam was used among all patients during the concurrent chemoradiation period before BT. All patients completed the treatment. Similar 3-year overall survival and local control were reported between 2D and 3D techniques. Overall, the 3-year survival rate was 95.7% in 2D and 91.8% in 3D BT (p=0.188). Local control at the 3-year follow-up was 88.6% for 2D and 93.3% for 3D treatment (p-value=0.571). Progression free survival was better in the 2-D rather than the 3D group with 86.13% in 2D versus 27.4% in the 3D group (p-value=0.006). No grade 3 or 4 toxicity regarding the 3D technique was observed whereas 1.9% of grade 3 presented acute gastrointestinal toxicity (p-value=1), and grade 3 late gastrointestinal and genitourinary toxicities in the 2D technique group at 7.7 and 5.8%, respectively (p=1, both). The 3D BT significantly reduced acute grade 1 to 2 gastrointestinal side effect as 23% in the 2D versus 4% in 3D group (p-value=0.003), and grade 1 to 2 late genitourinary side effect as 50% in the 2D versus 16% in the 3D group (p-value=0.001). Conclusion: Using CT guided 3D BT to treat cervical cancer showed similar outcomes in survival and local control but reduced toxicity compared with the 2D technique. Disease progression including metastasis was better in the 2D BT technique group. CT guided BT helped reduce dose to organs at risk and long-term follow-up for survival outcome and toxicities was needed. Keywords: Cervical cancer; Brachytherapy technique; Brachytherapy; 3D brachytherapy; 2D brachytherapy

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The effectiveness of proton beam therapy for liver metastatic recurrence in gastric cancer patients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa052 ◽

2020 ◽

Vol 50 (8) ◽

pp. 903-908

Author(s):

Hisashi Yamaguchi ◽

Michitaka Honda ◽

Koichi Hamada ◽

Hiroshi Kobayashi ◽

Yukitoshi Todate ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Proton Beam ◽

Local Control ◽

Survival Rates ◽

Progression Free Survival ◽

Proton Beam Therapy ◽

Free Survival ◽

Metastatic Recurrence ◽

Gastric Cancer Patients

Abstract Objective The purpose of this cross-sectional study was to evaluate the efficacy and safety of proton beam therapy for liver metastatic recurrence in gastric cancer patients. Methods Consecutive patients who underwent proton beam therapy from 2010 to 2015 were isolated from our institutional database. Patients with extrahepatic metastatic lesions were excluded. Seven patients were enrolled. The median diameter of target lesions was 31 mm (13–68 mm). The most frequent dosage was 72.6 Gy equivalent in 22 fractions. The effectiveness was assessed based on the local control, overall survival and progression-free survival rates. The local control, overall survival and progression-free survival rates were calculated using the Kaplan–Meier method. Adverse events were described according to the patients’ medical records. Results The median follow-up period was 41.7 months (20.7–66.3 months). The 3-year local control, overall survival and progression-free survival rates were 85.7, 68.6 and 43%, respectively. All patients completed proton beam therapy without interruption. No grade ≥3 adverse events were observed. Conclusions Proton beam therapy might be a treatment option for patients with liver metastasis of gastric cancer.

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ABVD Versus Modified Stanford V Versus MOPPEBVCAD With Optional and Limited Radiotherapy in Intermediate- and Advanced-Stage Hodgkin's Lymphoma: Final Results of a Multicenter Randomized Trial by the Intergruppo Italiano Linfomi

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.907 ◽

2005 ◽

Vol 23 (36) ◽

pp. 9198-9207 ◽

Cited By ~ 133

Author(s):

Paolo G. Gobbi ◽

Alessandro Levis ◽

Teodoro Chisesi ◽

Chiara Broglia ◽

Umberto Vitolo ◽

...

Keyword(s):

Adjuvant Radiotherapy ◽

Hodgkin’S Lymphoma ◽

Response Rate ◽

Survival Rates ◽

Progression Free Survival ◽

Complete Response ◽

Hodgkin's Lymphoma ◽

Free Survival ◽

Drug Doses ◽

Advanced Hodgkin’S Lymphoma

Purpose In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to ≤ two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program). Patients and Methods Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively. Results The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens). Corresponding 5-year overall survival rates were 90%, 82%, and 89% for ABVD, Stanford V, and MOPPEBVCAD, respectively. Stanford V was more myelotoxic than ABVD but less myelotoxic than MOPPEBVCAD, which had larger reductions in the prescribed drug doses. Conclusion When associated with conditioned and limited (not adjuvant) radiotherapy, ABVD and MOPPEBVCAD were superior to Stanford V chemotherapy in terms of response rate and FFS and progression-free survival. Patients were irradiated less often after MOPPEBVCAD, but this regimen was more toxic. ABVD is still the best choice when it is combined with optional, limited irradiation.

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