Neoadjuvant transarterial chemoembolization (TACE) using cisplatin with the combination of dose-dense intravenous administration of paclitaxel for the locally advanced cervical adenocarcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16518-e16518 ◽  
Author(s):  
H. Tsubamoto ◽  
R. Wada ◽  
R. Kanazawa ◽  
S. Komori ◽  
H. Maeda ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adenosquamous Carcinoma ◽  
Alternative Therapy ◽  
Locally Advanced ◽  
Sensory Neuropathy ◽  
Figo Stage ◽  
Cervical Adenocarcinoma ◽  
Stage Iiib ◽  
Clinical Response Rate ◽  
Dose Dense

e16518 Background: Adenocarcinoma (including adenosquamous carcinoma) of the uterine cervix has a tendency to early lymph node metastasis and is resistant to radiation therapy, thus results in poor prognosis compared with squamous cell carcinoma. Neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) for bulky cervical adenocarcinoma seems to be an alternative therapy to primary radiation. Methods: P2 at the single institution. Eligible criteria were as follows: Histologically diagnosed cervical adeno or adenosquamous carcinoma with FIGO stage IB2-IVA, Age < or equal to 75, PS 0–2, given informed consent. The NAC regimen consisted of paclitaxel (60mg/m2, iv, D1, D8, D15) and cisplatin (70 mg/m2, trans-uterine arterial infusion followed by embolization using the gelform, D2) repeated every 3 weeks for 2–3 cycles, followed by RH. Primary endpoints were clinical and pathological responses, and secondary endpoints were toxicities, relapse free survival (RFS) and overall survival (OS). Results: Enrolled patients: 22 (1998–2006), Age: median 51 (33–75), FIGO stage: IB2 (9), IIA-IIB (8), IIIB (3), IVA (2), adeno/adenosquamous: 16/6. Toxicities during NAC (CTCAE ver.3) were as follows: G3/G4 neutropenia 18% (4/22), G3/G4 anemia 14% (3/22), G3/G4 thrombocytopenia 0%, G2/G3 sensory neuropathy 0 %, G3/G4 creatinine elevation 0%, G2 alopecia 100%. Clinical response rate (RR: CR+PR) of the patients with stage IB2-IIB was 100%. 16 of 17 received RH, and no residual malignant cells were found pathologically (pCR) in 3. RR of the patients with stage IIIb-IVa was 80%, three patients completed RH with either modified anterior or posterior exenteration, and pCR was found in one patient. The rate of radiation therapy following either NAC or surgery among enrolled patients were 18% (3/17) with stage IB2-IIB and 40% (2/5) with IIIB-IVA. 5 year RFS/OS were 69%/68% with stage IB2-IIb and 60%/60% with stage IIIb-IVa. All 15 alive patients had RH. One patient with stage IVa had urostomy, and other 14 patients have no trouble in urination function. Conclusions: TACE with cisplatin and dose dense paclitaxel in the neoadjuvant setting is feasible and effective for cervical adenocarcinoma. [Table: see text]

Outcome analysis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix after definitive radiotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16503-e16503
Author(s):  
Jenny Ling-Yu Chen ◽  
Chao-Yuan Huang ◽  
Sung Hsin Kuo ◽  
Jason C. Cheng
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Treatment Response ◽  
Squamous Cell ◽  
Adenosquamous Carcinoma ◽  
Locally Advanced ◽  
Figo Stage ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Complete Treatment

e16503 Background: To compare tumor characteristics, treatment response, failure patterns, and clinical outcome of patients with cervix locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) and squamous cell carcinoma (SCC). Methods: Medical records for 36 patients with stage IIB–IVA histologically proven cervix AC/ASC and 199 patients with SCC who received definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) between 1995 and 2009 were retrospectively reviewed. The clinicopathologic features, radiation dose, treatment response, recurrent pattern, metastases pattern, and survival outcome between histologic groups were evaluated. Results: Compared with the SCC subgroup of patients, patients with AC/ASC were significantly younger (mean age, 56 vs. 62 years, p=0.007), more of them without clinical symptoms were diagnosed by abnormal Papanicolaou smear findings (16.7% vs. 5.5%, p = 0.019), and less responded to treatment (complete response, 72.2% vs. 86.9%, p = 0.024). After a median follow-up of 59.3 months, patients with AC/ASC had worse 5-year recurrence-free survival (RFS) (33.7% vs. 58.7%, p = 0.046), worse 5-year distant metastasis-free survival (40.2% vs. 70.3%, p = 0.002), and trends toward worse 5-year local recurrence-free survival (62.4% vs. 75.7%, p = 0.127) and worse 5-year overall survival (OS) (40.1% vs. 58.0%, p = 0.062) than those with SCC. In univariate analysis, early FIGO stage and complete treatment response were found to be significantly associated with both RFS and OS. Histology of non-AC/ASC and Point A biologically equivalent doses in 2-Gy fractions >85Gy were significantly associated with better RFS, and CCRT was significantly associated with better OS. In multivariate analysis, complete treatment response remained significant factor for predicting better RFS, and early FIGO stage, CCRT and complete treatment response remained significant factors for predicting better OS. Conclusions: Cervix AC/ASC may behave more aggressively than does SCC. For this subgroup of cervical cancer, more comprehensively effective treatment is warranted.

Pathologic complete response to cisplatin with dose-dense paclitaxel as neoadjuvant chemotherapy for locally advanced cervical cancer: Preliminary results of a multicenter phase II study with additional mutation analysis of adeno/adenosquamous carcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5528-5528
Author(s):  
Maki Tanioka ◽  
Satoshi Yamaguchi ◽  
Shinya Sato ◽  
Shoji Nagao ◽  
Kazuhiro Takehara ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cell Carcinoma ◽  
Phase Ii ◽  
Adenosquamous Carcinoma ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Dose Dense

5528 Background: We report efficacy and safety of neoadjuvant cisplatin plus dose-dense paclitaxel (ddTP) within a phase II trial (UMIN-CTR ID: UMIN000006440), designed to investigate recurrence-free survival of neoadjuvant ddTP plus radical hysterectomy followed by adjuvant ddTP without radiotherapy for patients (pts) with stage IB2, IIA2, and IIB cervical cancer, whose driver mutations have been poorly understood. Methods: All enrolled pts received 3 cycles of cisplatin 75 mg/mq on day1 with paclitaxel 80 mg/mq on days 1, 8, and 15 every 21 days. Pathologic complete response (pCR) was defined as no evidence of malignancy in all surgical specimens observed. Using a selected panel of 535 oncogenes (Otogenetics, Norcross, GA), mutations of pretreatment biopsy tissues were analyzed in 6 non-pCR pts with adeno/adenosquamous carcinoma (AC/ASC). Results: Among 51 enrolled pts, 50 were evaluable (40 with squamous cell carcinoma [SCC], 9 with AC/ASC, and 1 with small cell carcinoma). Median age was 52 years (range 30-70), the FIGO stage was IB2 in 14 pts, IIA2 in 3, and IIB in 34. Eighteen pts achieved complete response and 29 pts achieved partial response, with response rate of 94% (47/50). A total of 14 pts (28%; 13 with SCC, 1 with AC) achieved pCR. Grade 3/4 adverse events were neutropenia (34%), nausea (12%), appetite loss (10%), fatigue (6%), and anemia (6%). Febrile neutropenia was uncommon (2%). The analysis of oncogenes revealed that all 6 pts had mutations in the mixed-lineage leukemia (MLL3) gene, a histone methyltransferase, whose mutations have recently been reported in breast, pancreas, and colorectal cancers. Specifically, in MLL3 gene, identical frameshift mutation was found in 2 pts and 2 common non-synonymous point mutations were found in 4 pts, despite no relevance to the ddTP response. No mutations were detected in TP53 and PIK3CA genes. Conclusions: The pCR rate with neoadjuvant ddTP for locally advanced cervical cancer was one of the highest reported in a prospective trial setting. Novel mutations of the MLL3 gene were identified in non-pCR pts with AC/ASC. Clinical trial information: UMIN000006440.

scholarly journals IVIM Magnetic Resonance Imaging in Guiding Target Delineation and Dose Escalation of Concurrent Radiochemotherapy in Recurrent Stage IIIB Pulmonary Adenosquamous Carcinoma: A Case Report

2020 ◽  
Author(s):  
Peng Xu ◽  
Yixuan Chen ◽  
Anwen Liu ◽  
Jing Cai
Keyword(s):  
Case Report ◽  
Dose Escalation ◽  
Adenosquamous Carcinoma ◽  
Locally Advanced ◽  
Tumour Volume ◽  
Stage Iiib ◽  
Target Area ◽  
Target Delineation ◽  
Concurrent Radiochemotherapy ◽  
Early Evaluation

Abstract Background: Concurrent radiochemotherapy is regarded as a standard treatment for inoperable, locally advanced non-small cell lung cancer (NSCLC). However, the local control rate is less than 50%. Functional imaging can reveal changes in the tumour microstructure and tumour volume early during the process of radiotherapy, which is beneficial for the early evaluation of efficacy and dose escalation radiotherapy.Case presentation: Here, we describe a case of recurrent stage IIIB pulmonary adenosquamous carcinoma. Intravoxel incoherent motion (IVIM) was used to guide the delineation of the target area and dose escalation of radical concurrent chemoradiotherapy, and complete remission was achieved.Conclusion: Our case report provides a novel method for IVIM functional MRI in guiding accurate target delineation and dose escalation of radical radiotherapy.

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