scholarly journals Comparison of Definitive Cervical Cancer Management With Chemotherapy and Radiation Between Two Centers With Variable Resources and Opportunities for Improved Treatment

2020 ◽  
pp. 1510-1518
Author(s):  
Francis Adumata Asamoah ◽  
Joel Yarney ◽  
Aba Scott ◽  
Verna Vanderpuye ◽  
Zhigang Yuan ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Treatment Duration ◽  
Multivariable Analysis ◽  
Stage Iii ◽  
High Dose ◽  
Early Stage Disease ◽  
Cancer Management ◽  
Comparative Review ◽  
Significant Difference

PURPOSE Cervical cancer remains a major health challenge in low- to middle-income countries. We present the experiences of two centers practicing in variable resource environments to determine predictors of improved radiochemotherapy treatment. METHODS AND MATERIALS This comparative review describes cervical cancer presentation and treatment with concurrent chemoradiotherapy with high-dose-rate brachytherapy between 2014 and 2017 at the National Radiotherapy Oncology and Nuclear Medicine Center (NRONMC) in Korle-Bu Teaching Hospital, Accra, Ghana, and Moffitt Cancer Center (MCC), Tampa, FL. RESULTS Median follow-up for this study was 16.9 months. NRONMC patients presented with predominantly stage III disease (42% v 16%; P = .002). MCC patients received para-aortic node irradiation (16%) and interstitial brachytherapy implants (19%). Median treatment duration was longer for NRONMC patients compared with MCC patients (59 v 52 days; P < .0001), and treatment duration ≥ 55 days predicted worse survival on multivariable analysis (MVA; P = .02). Stage ≥ III disease predicted poorer local control on MVA. There was a difference in local control among patients with stage III disease (58% v 91%; P = .03) but not in survival between MCC and NRONMC. No significant difference in local control was observed for stage IB, IIA, and IIB disease. CONCLUSION Although there were significant differences in disease presentation between the two centers, treatment outcomes were similar for patients with early-stage disease. Longer treatment duration and stage ≥ III disease predicted poor outcomes.

Comparison of definitive cervical cancer management with concurrent chemotherapy and radiation between two centers with variable resources and opportunities for improved treatment delivery.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5534-5534
Author(s):  
Francis Adumata Asamoah ◽  
Pearl Aba Anoa Scott ◽  
Zhigang Yuan ◽  
Daniel Celestino Fernandez ◽  
Samuel Anoa Boateng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
Treatment Duration ◽  
Multivariable Analysis ◽  
Concurrent Chemotherapy ◽  
Cancer Center ◽  
Financial Barriers ◽  
Screening Programs ◽  
Cancer Management

5534 Background: Cervical cancer remains a global health challenge particularly in low to middle income countries with under resourced healthcare systems. We present the experiences of two centers practicing in variable resource environments to determine predictors of improved radiochemotherapy outcomes. Methods: This retrospective review describes baseline demographic and clinicopathologic characteristics of cervical cancer patients treated with concurrent chemotherapy and radiation between 2014 and 2017 at the National Radiotherapy Oncology and Nuclear Medicine Center (NRONMC) in Korle Bu Teaching Hospital, Accra, Ghana and Moffitt Cancer Center, Tampa, Florida, USA. Results: Ghanaian patients presented at an older median age (56 vs. 49 years, p < 0.001), with predominantly stage IIIB disease (43% vs. 16%, p < 0.001) and squamous cell histology (89% vs. 79%, p < 0.001). Median treatment duration was longer for Ghanaian patients (58 vs. 52 days, p < 0.001). Ghanaian patients were less likely to receive concurrent chemotherapy (68% vs. 100%, p < 0.001) and interstitial brachytherapy implants (0 vs 19%, p < 0.001). No Ghanaian patients received a radiation boost to pelvic or paraortic lymph nodes (p < 0.001). Ghanaian patients had lower local control (64% vs. 93%, p < 0.001) and overall survival (82% vs. 95%, p = 0.02) at 24 months, respectively. For stages IB, IIA, IIB, IIIB, 24 month local control rates for NRONMC vs. Moffitt patients were (60% vs. 93%; p = 0.05), (89% vs. 100%; p = 0.35), (91% vs. 91%; p = 0.89), (53% vs. 91%; p = 0.02) and 24 month OS rates were (85% vs. 100%; p = 0.06), (100% vs. 100%; p = 0.48), (85% vs. 96%; p = 0.2), (73% vs. 91%; p = 0.24), respectively. Treatment duration > 55 days predicted poorer overall survival on multivariable analysis (MVA). Stage ≥III disease predicted poorer local control on MVA. Conclusions: Significant differences were noted in treatment and disease characteristics between the two centers. Feasible improvements for patients treated at NRONMC include removing financial barriers to chemotherapy access, improving radiotherapy delivery capacity to reduce treatment delays, and screening programs to reduce advanced disease presentation.

scholarly journals In-room computed tomography–based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study

2016 ◽  
Vol 58 (4) ◽  
pp. 543-551 ◽  
Author(s):  
Tatsuya Ohno ◽  
Shin-Ei Noda ◽  
Noriyuki Okonogi ◽  
Kazutoshi Murata ◽  
Kei Shibuya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
External Beam Radiotherapy ◽  
Clinical Stage ◽  
Stage Ii ◽  
High Dose ◽  
Significant Difference ◽  
Grade 3

Abstract Herein, we investigate the long-term clinical outcomes for cervical cancer patients treated with in-room computed tomography–based brachytherapy. Eighty patients with Stage IB1–IVA cervical cancer, who had undergone treatment with combined 3D high-dose rate brachytherapy and conformal radiotherapy between October 2008 and May 2011, were retrospectively analyzed. External beam radiotherapy (50 Gy) with central shielding after 20–40 Gy was performed for each patient. Cisplatin-based chemotherapy was administered concurrently to advanced-stage patients aged ≤75 years. Brachytherapy was delivered in four fractions of 6 Gy per week. In-room computed tomography imaging with applicator insertion was performed for treatment planning. Information from physical examinations at diagnosis, and brachytherapy and magnetic resonance imaging at diagnosis and just before the first brachytherapy session, were referred to for contouring of the high-risk clinical target volume. The median follow-up duration was 60 months. The 5-year local control, pelvic progression-free survival and overall survival rates were 94%, 90% and 86%, respectively. No significant differences in 5-year local control rates were observed between Stage I, Stage II and Stage III–IVA patients. Conversely, a significant difference in the 5-year overall survival rate was observed between Stage II and III–IVA patients (97% vs 72%; P = 0.006). One patient developed Grade 3 late bladder toxicity. No other Grade 3 or higher late toxicities were reported in the rectum or bladder. In conclusion, excellent local control rates were achieved with minimal late toxicities in the rectum or bladder, irrespective of clinical stage.

scholarly journals Analysis of Radiation Therapy for the Control of Merkel Cell Carcinoma of the Head and Neck Based on 36 Cases and a Literature Review

2008 ◽  
Vol 87 (11) ◽  
pp. 634-643 ◽  
Author(s):  
Brian D. Lawenda ◽  
Michelle G. Arnold ◽  
Valerie A. Tokarz ◽  
Joshua R. Silverstein ◽  
Paul M. Busse ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Local Control ◽  
Clinical Stage ◽  
Local Control Rate ◽  
Stage I ◽  
Stage Iii ◽  
Regional Control ◽  
Kaplan Meier ◽  
Significant Difference

Merkel cell carcinoma (MCC) is a rare and aggressive epidermal cancer. We conducted a retrospective study and literature review to investigate the impact that radiation therapy has on local, regional, and distant control as part of the oncologic management of MCC of the head and neck and to further elucidate the role of radiation therapy with regard to regional control for the clinically uninvolved neck. We reviewed all registered cases of head and neck MCC that had occurred at four institutions from January 1988 through December 2005. Treatment and outcomes data were collected on patients with American Joint Committee on Cancer stage I, II, and III tumors. Local, regional, and distant control rates were calculated by comparing variables with the Fisher exact test; Kaplan-Meier analysis was used to report actuarial control data. Stage I to III head and neck MCC was identified in 36 patients— 22 men and 14 women, aged 43 to 97 years (mean: 71.6) at diagnosis. Patients with stage I and II tumors were combined into one group, and their data were compared with those of patients with stage III tumors. Twenty-sixpatients(72%) had clinical stage I/II disease and 10 patients (28%) had clinical stage III disease. Median follow-up was 41 months for the stage I/II group and 19 months for the stage III group. Based on examination at final follow-up visits, local recurrence was seen in 7 of the 36 patients (19%), for a local control rate of 81 %. The 2-year actuarial local control rate for all stages of MCC was 83%; by treatment subgroup, the rates were 95% for those who had undergone radiation therapy to the primary site and 69%) for those who had not— a statistically significant difference(p = 0.020). Based on information obtained at final follow-ups, 10 of the 36 patients (28%) experienced a regional recurrence, for a regional control rate of 72%. The 2-year actuarial regional control rate among all patients was 70%; by subgroup, rates were 82%) for patients who had undergone regional node radiation therapy and 60% for those who had not— not a statistically significant difference (p = 0.225). Nine patients (25%) overall developed a distant metastasis, for a distant control rate of 75%. Salvage therapies included chemotherapy and/or radiation therapy to the metastatic site, but neither had any significant effect on survival. Regardless of treatment, the Kaplan-Meier survival curves leveled off at 30 months with 82% survival for the stage I/II group and at 19 months with 60% survival for the stage III group. We conclude that radiation therapy to the primary tumor site (either following resection or definitively) results in a local control rate of more than 90% in patients with head and neck MCC. We also found a trend toward improved regional control of the clinically negative neck with the addition of radiation therapy.

Prognostic significance of rate of tumor marker (TM) decline during high-dose chemotherapy (HDCT) for relapsed germ cell tumors (rGCT).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 403-403
Author(s):  
Nabil Adra ◽  
Sandra K. Althouse ◽  
Rafat Abonour ◽  
Mohammad Issam Abu Zaid ◽  
Hao Liu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Germ Cell Tumors ◽  
High Dose Chemotherapy ◽  
Rank Test ◽  
High Dose ◽  
Cell Transplant ◽  
Background Rate ◽  
Significant Difference

403 Background: Rate of serum TM decline is prognostic in patients (pts) with GCT receiving first-line chemotherapy. We investigated the prognostic value of TM decline in rGCT treated with HDCT+peripheral-blood stem-cell transplant (PBSCT). Methods: 462 consecutive pts with rGCT treated with HDCT+PBSCT at Indiana University between 1/2004-1/2019. All pts were planned for 2 consecutive HDCT courses with carboplatin+etoposide per protocol (N Engl J Med 2007;357:340-8). Pts with elevated AFP and/or hCG were included (N=347). Slope and half-life (T1/2) were calculated for weekly AFP+hCG during HDCT starting with peak value at days 1-7 to avoid interference from lysis. T1/2 AFP≤7 days and hCG≤3 days were categorized satisfactory (SAT). Progression-free (PFS) and overall survival (OS) were compared for SAT vs unsatisfactory (UNSAT) using log-rank test and analyzed using Kaplan-Meier. Uni- and multivariable analysis using Cox regression model was performed. Results: 347 pts had elevated TM: 312 had non-seminoma and 35 had seminoma. Median age was 31 (range, 17-58). Primary site: testis (292), mediastinum (26), retroperitoneum/other (29). Metastatic sites included retroperitoneum (277), lung (233), liver (83), brain (77), and bone (21). At initiation of HDCT, 77 pts had elevated AFP, 222 elevated hCG, and 48 elevated both AFP+hCG. Median AFP 9 (1-21,347) and hCG 113 (1-178,140). 314 pts (91%) completed 2 planned cycles of HDCT. Overall, 46/347 pts had SAT decline (13 for AFP; 30 for hCG; 3 for both). Pts with SAT TM decline had superior outcomes compared to UNSAT: 2-yr PFS 69% vs 45% (p=0.006) and 2-yr OS 75% vs 51% (p=0.006). When evaluating each TM separately, SAT decline in hCG had superior outcomes vs UNSAT: 2-yr PFS 74% vs 47% (p=0.002). There was statistically non-significant difference for AFP: 2-yr PFS 48% vs 42% (p=0.65). In univariable analysis, UNSAT decline of hCG, but not AFP, was an adverse prognostic factor for PFS: HR=2.51 (95% CI, 1.40-4.51); p=0.002. Multivariable analysis will be presented. Conclusions: SAT rate of TM decline, particularly in hCG, predicts superior outcomes in rGCT undergoing HDCT+PBSCT. Pts with UNSAT TM decline are at higher risk for relapse and death.

scholarly journals Toxicity Outcome Using Bladder-Rectum Spacer Balloon Versus Vaginal Gauze Packing in Brachytherapy in Cervical Cancer.

2021 ◽  
Author(s):  
Nagarjun Ballari ◽  
Sakshi Rana ◽  
Bhavana Rai ◽  
Srinivasa Gowda ◽  
Suja Bhargavan ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Randomized Study ◽  
High Dose Rate ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Clinical Trial Registry ◽  
Gauze Packing ◽  
Dosimetric Data ◽  
Significant Difference

Abstract BACKGROUNDTo compare the clinical impact in terms of toxicity outcomes with RayshieldTM bladder rectum spacer balloon (BRSB) versus vaginal gauze packing (VGP) in patients treated with high dose rate intracavitary brachytherapy for carcinoma cervix.RESULTSFollow-up and dosimetric data of patients in whom BRSB and VGP were used in a previously reported randomized study were retrieved, 8. Out of 80 patients analysed, late toxicities assessment (according to Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). was possible in 65 patients as 14 patients were lost to follow-up and one patient died. Grade 2 bladder toxicity was observed in 2 patients in each arm. Only 1 patient in VGP arm experienced grade 3 proctitis while none of the patient in BRSB arm had ³Grade 2 rectal toxicity. Vaginal toxicity was comparable in both the arms.CONCLUSION No significant difference was observed in bladder and rectal toxicities using the BRSB versus VGP. BRSB can be considered as an alternative to VGP in intracavitary brachytherapy for cervical cancer using tandem- ovoid applicatorsThe study was approved by the institute ethics committee and registered under Clinical Trial Registry of India (CTRI/2009/091/000840).

Retrospective Evaluation of the Bifractionated Scheme in Utero-Vaginal Brachytherapy in the Treatment of Cervical Cancer : Experience of the Radiotherapy Oncology Service at Marrakech University Hospital

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 2-2
Author(s):  
A Zayane ◽  
M Elanigri ◽  
H Abourrazek ◽  
Y Bouchabaka ◽  
I Lalya ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Treatment Time ◽  
Locally Advanced ◽  
Good Alternative ◽  
High Dose Rate ◽  
University Hospital ◽  
High Dose ◽  
Local Progression ◽  
Metastatic Relapse

Objective: To retrospectively report the results in terms of local control and toxicities, of the 2 x 9 Gy fractionation used in our service, in high dose rate brachytherapy, during the treatment of locally advanced cervical cancer, preceded by a concomitant chemotherapy radiotherapy association. Material and method: Report and analyze data from 106 patients treated in our center between 2015 and 2018, for cervical cancer stage IIB and IIIB according to the FIGO classification. Results: The median follow-up was 29 months. Among the 106 patients analyzed, 75.5% had good local control at 3 years against 7.5% who had local progression, while 9.5% had local relapse and 7.5% had metastatic relapse. The average time for the occurrence of an event (progression, local or remote relapse) was 8 months. Most patients (90.6%) did not have acute toxicity. As for chronic toxicities, 66% had good long-term tolerance, while 27.4% had synechiae or even vaginal stenosis. The other toxicities were in the minority. Conclusion: Despite the considerable advantage of 2 x 9 Gy fractionation in uterovaginal brachytherapy in terms of reduction in treatment time, it is not the ideal choice in terms of local control and toxicity and the 3 x 8 Gy scheme seems a good alternative.

Construction of immune scores to predict patient prognosis and response of anti-PD1 treatment in stage III-IV melanoma

2020 ◽  
Author(s):  
Wei Li ◽  
Haitao Xiao ◽  
Xuewen Xu ◽  
Yange Zhang
Keyword(s):  
Overall Survival ◽  
Targeted Therapy ◽  
Immune Cell ◽  
Comprehensive Evaluation ◽  
Multivariable Analysis ◽  
Therapy Response ◽  
The Cancer Genome Atlas ◽  
Stage Iii ◽  
Lasso Regression ◽  
Significant Difference

Abstract Background: Tumor-infiltrating immune cells were demonstrated to be associated with patient survival and responses of targeted therapy. However, in melanoma, there is no reliable and individualized prognostic signatures based on comprehensive evaluation of the immune profile inferred from bulk tumor transcriptomes. In this study, we aimed to develop immunoscores associated with prognosis and responses of anti-PD1 targeted therapy in stage III-IV melanoma.Methods: The immunoscore and immunoscore-based prognostic nomogram were constructed based on the melanoma cohort from the Cancer Genome Atlas (TCGA), and validated in the population from the Gene Expression Omnibus (GEO). Besides, in another cohort obtained from the GEO database, we developed an immunoscore for predicting responses of anti-PD1 therapy. Twenty-two types of immune cell fraction were estimated using CIBERSORT. The least absolute shrinkage and selection operator (Lasso) regression model was utilized to develop individualized immunoscores.Results: With the Lasso regression, an immunoscore was constructed consisting of nine types of immune cell subtypes. In both of the training (192 cases) and validation (227 cases) cohorts, significant difference was observed between immunoscore-low and immunoscore-high groups in overall survival (OS). Multivariable analysis demonstrated that the immunoscore was an independent prognostic factor (P < 0.001) for OS. The prognostic value of the immunoscore was also confirmed by the ROC curves. Nomogram integrating immunotype and other clinical characteristics also showed good discrimination, calibration and usability in both of the training and validation cohorts. Finally, in another GEO cohort (218 cases), an immunoscore was constructed based on nine immune cell types for predicting anti-PD1 therapy response. Conclusion: The proposed immunoscores represent promising models for estimating overall survival and anti-PD1 treatment response in patients with stage III-IV melanoma.

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.

scholarly journals Effect of High-dose Antithrombin Supplementation in Patients with Septic Shock and Disseminated Intravascular Coagulation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youn-Jung Kim ◽  
Byuk Sung Ko ◽  
Seo Young Park ◽  
Dong Kyu Oh ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Disseminated Intravascular Coagulation ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
High Dose ◽  
Inverse Probability ◽  
Intravascular Coagulation ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Improvement In Survival

Abstract The efficacy of antithrombin (AT) administration in patients with septic shock and disseminated intravascular coagulation (DIC) was uncertain. This study aimed to investigate whether high-dose AT administration improves outcomes in patients with septic shock and DIC. This observational, prospective cohort study included consecutive adult septic shock patients with DIC who showed AT activity <70% between March 2016 and August 2018. The 28 day mortality of the patients treated with AT and without AT was evaluated by propensity score matching and inverse probability of treatment weighting. Among 142 patients with septic shock and DIC, 45 patients (31.7%) received AT supplementation and 97 did not. The 28 day mortality rate was lower in the AT group, but no statistically significant difference persisted after matching. Multivariable analysis showed that AT supplementation was independently associated with 28 day mortality (odds ratio [OR], 0.342; 95% CI [confidence interval], 0.133−0.876; P = 0.025); however, no such association was observed after matching (OR, 0.480; 95% CI, 0.177−1.301; P = 0.149). High-dose AT administration in septic shock patients with DIC showed the improvement in survival, but the improvement was not observed after matching. Further larger studies are needed to conclusively confirm these findings.

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