scholarly journals Comparison of therapeutic effects of chemo-radiotherapy with neoadjuvant chemotherapy before radical surgery in patients with bulky cervical carcinoma (stage IB3 & IIA2)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Setareh Akhavan ◽  
Abbas Alibakhshi ◽  
Mahdieh Parsapoor ◽  
Abbas Alipour ◽  
Elahe Rezayof
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Medical Records ◽  
Primary Outcome ◽  
Disease Free Survival ◽  
Therapeutic Effects ◽  
Cancer Stage ◽  
Free Survival ◽  
Disease Free ◽  
Timely Treatment

Abstract Background Cervical cancer is one of the most common malignancies among women. Appropriate and timely treatment of these patients can reduce the complications and increase their survival. The objective of this study was to compare neoadjuvant chemotherapy plus radical hysterectomy (NACTRH) and chemo-radiotherapy (CRT) in patients with bulky cervical cancer (stage IB3 & IIA2). Material and methods The medical records of patients with bulky cervical cancer (stage IB3 & IIA2) that received NACTRH or CRT between 2007 and 2017 were evaluated for therapeutic effects. Demographic characteristics, complications of chemo-radiotherapy and neoadjuvant chemotherapy, were collected in a researcher-made questionnaire. Our primary outcome was comparison of overall survival (OS), and disease-free survival (DFS) between two groups receiving NACTRH and CRT modalities. Results One-hundred and twenty three patients were enrolled in the study. The median age and the proportion of patients with stage IIA2 were higher in the CRT group compared to the NACTRH group (p < 0.05). The medians (95% CI) OS were 3.64 (3.95–6.45) and 3.9 (3.53–4.27) years in the NACTRH and CRT groups, respectively (P = 0.003). There were 16 (34.8%) and 22 (43.1%) recurrences in the NACTRH and CRT group, respectively (P = 0.4). The median (95% CI) DFS was 4.5 (3.88–5.12) years in the NACTRH group and 3.6 (2.85–4.35) years in the CRT group (P = 0.004). The 3-year OS rate in NACTRH and CRT groups were 97 and 90% respectively. The 3-year DFS rate in NACTRH and CRT groups were 88 and 66% respectively. Conclusions NACTRH is associated with a higher OS and DFS compared to CRT.

Is Neoadjuvant Chemotherapy Followed by Radical Surgery More Effective Than Radiation Therapy for Stage IIB Cervical Cancer?

2013 ◽  
Vol 23 (7) ◽  
pp. 1303-1310 ◽  
Author(s):  
Dae Woo Lee ◽  
Keun Ho Lee ◽  
Jung Won Lee ◽  
Sung Taek Park ◽  
Jong Sup Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Patient Survival ◽  
Radical Surgery ◽  
Therapy Group ◽  
Disease Free Survival ◽  
Free Survival ◽  
Disease Free

ObjectiveThe primary objective of the study was to compare the survival rate of patients who had received neoadjuvant chemotherapy with that of patients who had received radiation therapy for stage IIB cervical cancer. The secondary objective was to analyze the effect of neoadjuvant chemotherapy on pathological prognostic factors.Materials and MethodsWe retrospectively reviewed the medical records of patients who had received therapy for stage IIB cervical cancer. Based on the primary therapy, 192 patients were divided into 2 groups; patients in the neoadjuvant chemotherapy group (n =103) underwent a type III radical hysterectomy after completion of the neoadjuvant chemotherapy. Patients in the other group (n = 89) were treated with radiation alone or a combination of chemotherapy and radiotherapy.ResultsAfter neoadjuvant chemotherapy, the level of squamous cell carcinoma antigen, tumor size, lymph node involvement, and parametrium involvement were significantly decreased. However, 90.3% of the patients who had received neoadjuvant chemotherapy needed to have adjuvant therapy after radical surgery because of poor pathological prognostic factors. The rate of disease-free survival did not differ significantly between the 2 groups. However, the overall survival rate was significantly lower in the neoadjuvant chemotherapy group for patients who were 60 years or older (P = 0.03). The rates of disease-free survival and overall survival for patients who had a good (complete or partial) response to the neoadjuvant chemotherapy were not significantly higher than the rates for patients in the radiation therapy group.ConclusionsAlthough neoadjuvant chemotherapy improved pathological prognostic factors in patients with stage IIB cervical cancer, it was not sufficiently effective to decrease adjuvant therapy. Neoadjuvant chemotherapy also did not improve the rate of patient survival compared to the rate of patient survival in the radiation therapy group.

Significance of microvascular density (MVD) in cervical cancer recurrence

2003 ◽  
Vol 13 (6) ◽  
pp. 856-862 ◽  
Author(s):  
D. Cantu De León ◽  
C. Lopez-Graniel ◽  
M. Frias Mendivil ◽  
G. Chanona Vilchis ◽  
C. Gomez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Squamous Cell ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
Cancer Stage ◽  
Disease Free Interval ◽  
Free Survival ◽  
Free Interval ◽  
Global Survival ◽  
Disease Free

The purpose of this retrospective study of 118 patients with squamous cell cervical cancer from January 1990 to December 1993 was to evaluate angiogenesis as predictive factor of recurrence in cervical cancer stages II–III treated with standard radiotherapy. Microvessel density (MVD) was evaluated and correlated with other prognostic factors. MVD was greater than 20 in 67.8% of patients with recurrence (P = 0.002) in comparison to 39% of patients without. Disease-free survival was shorter in stage IIA and MVD >20 (P = 0.0193) as well as for stage IIB (P < 0.05), but not for IIIB (P = 0.1613). Global survival was significantly shorter when MVD was >20 (P = 0.0316). For stage IIA and MVD >20 survival was shorter (P = 0.0008) for stage IIB (P < 0.05) but not for IIIB (P = 0.14). Patients younger than 40 years and MVD >20 had poorer disease-free interval and survival (P = 0.0029). MVD in patients with squamous cell cervical cancer stage II and age younger than 40 may play a role in predicting recurrence and survival.

scholarly journals Neoadjuvant Chemotherapy with Taxane and Platinum Followed by Radical Hysterectomy for Stage IB2-IIB Cervical Cancer: Impact of Histology Type on Survival

2019 ◽  
Vol 8 (2) ◽  
pp. 156 ◽  
Author(s):  
Koji Matsuo ◽  
Muneaki Shimada ◽  
Satoshi Yamaguchi ◽  
Junzo Kigawa ◽  
Hideki Tokunaga ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Platinum Chemotherapy ◽  
Disease Free ◽  
Cause Specific Survival

The current study examined the histology-specific impact of neoadjuvant chemotherapy (NACT) with a taxane/platinum regimen on survival in women with locally-advanced cervical cancer who underwent radical hysterectomy. This nation-wide retrospective cohort study examined women with clinical stage IB2-IIB cervical cancer who received NACT prior to radical hysterectomy from 2004–2008 (n = 684). NACT type (taxane/platinum versus others) was correlated with survival based on histology: 511 squamous versus 173 non-squamous. Taxane/platinum chemotherapy use was more common in non-squamous compared to squamous tumors (53.8% versus 20.7%, P < 0.001). In both histology types, the taxane/platinum regimen was more frequently utilized over time (both, P < 0.01). Among squamous tumors, women who received taxane/platinum chemotherapy had survival comparable to those who received other regimens: 5-year rates for disease-free survival, 69.0% versus 70.1%, P = 0.98; and cause-specific survival, 80.0% versus 81.0%, P = 0.93. Similarly, in non-squamous tumors, disease-free survival (5-year rates: 60.4% versus 59.0%, P = 0.86) and cause-specific survival (74.7% versus 76.3%, P = 0.70) were similar. In conclusion, use of taxane/platinum regimens for NACT significantly increased during the study period. Irrespective of histology type, in women with clinical stage IB2-IIB cervical cancer who underwent NACT prior to radical hysterectomy, taxane/platinum regimens had a similar effect on survival compared to non-taxane/platinum regimens.

scholarly journals Comparison of outcomes and side effects for neoadjuvant chemotherapy with weekly cisplatin and paclitaxel followed by chemoradiation vs. chemoradiation alone in stage IIB–IVA cervical cancer: study protocol for a randomized controlled trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Jing Li ◽  
Hua Liu ◽  
Ya Li ◽  
Jian Li ◽  
Lifei Shen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Advanced Cervical Cancer ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Disease Free

Abstract Background Currently, the standard treatment for locally advanced cervical cancer is concurrent chemoradiation (CCRT). The effect of neoadjuvant chemotherapy in advanced cervical cancer is controversial. Studies have shown that the addition of a weekly regimen of neoadjuvant chemotherapy (NACT) followed by CCRT may be superior to a thrice-weekly regimen of NACT and CCRT. Among patients who had not received prior cisplatin, a cisplatin and paclitaxel (TP) regimen resulted in longer overall survival than other regimens. This study aims to investigate the feasibility, safety, and efficacy of NACT with weekly TP followed by CCRT. Methods This is a prospective, randomized, open-labeled, multicentered phase III study. Based on a 65% of 2-year disease-free survival (DFS) rate in the CCRT group and 80% of that in NACT followed by CCRT group, and on prerequisite conditions including an 8% loss to follow-up, a two-sided 5% of type I error probability, and an 80% of power, a total of 300 cases were required for enrollment. Patients with IIB–IVA cervical cancer will be randomly allocated in a 1:1 ratio to one of two intervention arms. In the study arm, patients will receive dose-dense cisplatin (40 mg/m2) and paclitaxel (60 mg/m2) weekly for 4 cycles followed by CCRT (45 Gy in 5 weeks concurrent with cisplatin 40 mg/m2 weekly) plus image-guided adaptive brachytherapy (IGBRT). In the control arm, patients will undergo CCRT treatment. The primary endpoint of the study is 2-year disease-free survival (DFS); the secondary endpoints are 5-year overall survival (OS) and disease-free survival (DFS), the response rate 3 months after treatment completion, grade III/IV adverse effects, and quality of life, and potential biomarkers for predicting treatment response will also be studied. Discussion The data gathered from the study will be used to determine whether NACT with weekly TP followed by CCRT may become an optimized treatment for locally advanced cervical cancer. Trial registration Chinese Clinical Trial Registry ChiCTR1900025327. Registered on 24 August 2019. medresman.org.cn ChiCTR1900025326

Neoadjuvant chemotherapy in early-stage cervical cancer (<2 cm) before conization for fertility preservation: is there any advantage over upfront conization?

2021 ◽  
Vol 31 (3) ◽  
pp. 379-386
Author(s):  
Florencia Noll ◽  
Ana Tatiana Palacios Torres ◽  
Pablo Pecci ◽  
Sergio Martin Lucchini ◽  
Fernando Heredia
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Fertility Preservation ◽  
Disease Free Survival ◽  
Free Survival ◽  
Fertility Sparing ◽  
Preservation Rate ◽  
Disease Free ◽  
Cervical Conization

BackgroundNeoadjuvant chemotherapy before fertility-sparing surgery is an accepted option for patients with cervical tumors between 2 cm and 4 cm. There is a paucity of data regarding its role in patients with tumors <2 cm. Our objective was to compare the oncological and obstetrical outcomes between patients who underwent neoadjuvant chemotherapy before cervical conization versus upfront cervical conization in patients with cervical cancer with tumors <2 cm.MethodsWe conducted a systematic literature review and searched MEDLINE, EMBASE, and CINAHL (from 1995 to March 2020) using the terms: uterine cervix neoplasms, cervical cancer, fertility-sparing surgery, fertility preservation, conization, cone biopsy, and neoadjuvant chemotherapy. We included manuscripts with information on patients with tumor size <2 cm, lymph node status, follow-up, oncological and obstetrical outcome, and toxicity related to neoadjuvant chemotherapy. We excluded review articles or articles with duplicated patient information.ResultsWe identified 12 articles, including 579 patients. For final analysis, 261 patients met inclusion criteria. The most common histology was non-squamous cell carcinoma (62%). Median follow-up time was 63.5 (range 7–122) months for the neoadjuvant chemotherapy group and 48 (range 12–184) months for the upfront cervical conization group. There was no difference in either overall survival (neoadjuvant chemotherapy group 100% vs upfront cervical conization 99.7%, p=0.79) or disease-free survival (neoadjuvant chemotherapy 100% vs upfront cervical conization 98.9%, p=0.59) between the groups. Fertility preservation rate was 81.4% versus 99.1% (p<0.001) favoring upfront cervical conization. No statistically significant differences were seen in live birth rate or pregnancy loss. Also, we found that all neoadjuvant chemotherapy patients reported chemotherapy-related toxicity (30.7% grade 3 and 69.2% grade 1–2).ConclusionsThere was no difference in disease-free survival or overall survival between patients who underwent neoadjuvant chemotherapy followed by conization and upfront cervical conization. Patients who underwent upfront cervical conization had a higher fertility preservation rate.

scholarly journals STAGE IB2–IIIB CERVICAL CANCER: NEOADJUVANT CHEMOTHERAPY, RADICAL SURGERY AND PATIENT SURVIVAL

2021 ◽  
Vol 20 (3) ◽  
pp. 82-89
Author(s):  
D. L. Ovodenko ◽  
G. N. Khabas ◽  
Yu. M. Kreinina ◽  
A. A. Seregin ◽  
O. I. Aleshikova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Survival Rate ◽  
Neoadjuvant Chemotherapy ◽  
Radical Surgery ◽  
Disease Free Survival ◽  
Cytostatic Drugs ◽  
Free Survival ◽  
Long Term Treatment ◽  
Disease Free

 The aim of the study was to evaluate the five-year survival rate in patients with stage ib2–iiib cervical cancer treated with neoadjuvant chemotherapy and radical surgery.Material and Methods. Long-term treatment outcomes were studied in 173 patients with histologically-verified stage ib2–iiib cervical squamous cell carcinoma. The patients underwent neoadjuvant chemotherapy using intravenous infusion of cytostatic drugs (n=106) and intra-arterial infusion of cytostatic drugs in combination with embolization of tumor-feeding arteries (n=67). Patients with resectable tumors underwent radical surgery. Disease-free survival was assessed.Results. The median follow-up time was 66 months, and the maximum follow-up period was 144 months. 160 (92.5 %) patients underwent radical surgery after chemotherapy. 55 (34.4 %) patients did not receive adjuvant radiation therapy. The five-year disease-free survival rate was 79.6 %.Conclusion. For the group of patients with locally advanced cervical cancer, who achieved respectability following neoadjuvant chemotherapy, radical surgery could be performed. Chemotherapy followed by radical surgery can improve disease-free survival rates in patients with stage ib2–iiib cervical cancer.

Survival impact of neoadjuvant treatment in cervical cancer stage IIB

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16559-e16559
Author(s):  
H. F. Oliveira ◽  
F. M. Peria ◽  
J. M. Andrade ◽  
H. R. Marana ◽  
A. C. Santos ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Complete Response ◽  
Free Survival ◽  
Alternative Approach ◽  
Disease Free

e16559 Background: A few previous studies demonstrated that neoadjuvant chemotherapy, followed by preoperative radiotherapy in diagnosed IIB cervical cancer patients, had similar therapeutic results as the standard protocol with concurrent chemoradiotherapy, considering complete response; overall survival; disease free survival and toxicity; requiring its evaluation as an alternative approach. Methods: One hundred sixteen women with IIB stage cervical cancer stages were submitted to a platinum combined based neoadjuvant chemotherapy followed by chemoradiotherapy with cisplatin. Those who had a good response, allowing a surgical approach, underwent the Wertheim-Meigs procedure. Those that could not be submitted to surgery remained in clinical follow-up. Results: The age of the patients were 22 to 75 years old (48.7±11.4 years). The average follow-up was about 48 months (1–120). The good response to the neoadjuvant treatment was found in 76 patients (65.5%), and surgery was possible in 86 (74%). The pathological complete response was found in 39 (33%), and the partial response in 40%. The global recurrence was diagnosed in 37 (32%) patients. In the operated group (n = 86), the overall-five years survival was 76%, and in the non-operated group (n = 30) was 17,5%. The five years-global survival was 79,2% in “good response” (GR) patients, and 27.4% in that with “no-good response” (NGR) to combined neoadjuvant treatment ( p < 0.01). The free-relapse survival was 79.4% in GR, and 32.5% in NGR group (p < 0.01). Conclusions: Amongst the studied prognostic factors, the most important one for interval of relapse and survival (global and free-relapse) was a good response to the neoadjuvant treatment, and that this treatment had an acceptable toxicity and could be considered in other trials as an option to standard treatment. No significant financial relationships to disclose.

scholarly journals 154 Disease-free survival in early-stage cervical cancer: comparison of laparoscopic versus open surgery in a tertiary centre

2020 ◽  
Author(s):  
Amanda Veiga-Fernández ◽  
María López-Altuna ◽  
Ignacio Romero-Martínez ◽  
Elsa Mendizábal Vicente ◽  
Patricia Rincon Olbes ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Open Surgery ◽  
Early Stage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Tertiary Centre ◽  
Early Stage Cervical Cancer ◽  
Disease Free

scholarly journals Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis

2021 ◽  
pp. ijgc-2020-002086
Author(s):  
Juliana Rodriguez ◽  
Jose Alejandro Rauh-Hain ◽  
James Saenz ◽  
David Ortiz Isla ◽  
Gabriel Jaime Rendon Pereira ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Laparoscopic Radical Hysterectomy ◽  
Oncological Outcomes ◽  
Early Stage Cervical Cancer ◽  
Laparotomy Group ◽  
Disease Free

IntroductionRecent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.MethodsWe performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.ResultsA total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8–201.2) in the laparoscopic group and 52.6 months (range, 0.4–166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09–2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05–4.37; P=0.03).ConclusionIn this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

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