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 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.

scholarly journals PCV for Oligodendroglial Tumors: In Search of Prognostic Factors for Response and Survival

2001 ◽  
Vol 28 (3) ◽  
pp. 215-223 ◽  
Author(s):  
David Fortin ◽  
David. R. Macdonald ◽  
J. Gregory Cairncross ◽  
Larry Stitt
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Chemotherapy Response ◽  
Initial Symptom ◽  
Oligodendroglial Tumors ◽  
Vascular Proliferation ◽  
Predicting Outcome

Background:We report survival and pretreatment prognostic factors for survival and chemosensitivity in 53 oligodendrogliomas treated with PCV (procarbazine, lomustine and vincristine) chemotherapy.Methods:A total of 53 patients with histologically proven oligodendroglioma, anaplastic oligodendroglioma or oligo-astrocytoma and treated with PCVwere extracted from the London Regional Cancer Center database. A retrospective review was conducted to evaluate overall survival and pretreatment prognostic factors for survival and chemosensitivity.Results:The median survival time from diagnosis was 123.6 months. The overall five- and ten-year survival rates were 72.7% and 52.7% respectively. Age <40, seizure as an initial symptom, absence of cognitive deficit and presence of a homogeneous hypodense lesion without contrast enhancement on the initial pretreatment CT scan were all factors independently associated with favorable outcome. The presence of increased cellularity, pleomorphism, mitosis, vascular proliferation and grading as an anaplastic lesion using these surrogates on pathological assessment, were all associated with an unfavorable outcome in univariable analysis. In multivariable analysis, only the anaplastic grading and presence of increased cellularity were significant determinants of unfavorable survival. The only factor adversely associated with chemosensitivity was the presence of a focal symptom at presentation.Conclusion:Overall survival is significantly longer in oligodendroglial lesions than in fibrillary astrocytic tumors. A two tier grading system using standard morphological features seems accurate in predicting outcome in these patients. The presence of a neoplastic astrocytic component does not seem to impact the outcome. No clinical, radiological or pathological factor could be identified to reliably predict chemotherapy response.

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

2020 ◽  
Vol 30 (6) ◽  
pp. 865-872 ◽  
Author(s):  
Cem Onal ◽  
Melis Gultekin ◽  
Ezgi Oymak ◽  
Ozan Cem Guler ◽  
Melek Tugce Yilmaz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
Term Survival ◽  
Free Survival ◽  
Oligometastatic Disease

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.

Implementation of a community-based cervical cancer screening program using visual inspection with acetic acid and Lugol’s iodine in Kutch District, India.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12009-e12009
Author(s):  
Surbhi Grover ◽  
Melody Ju ◽  
Lilie L. Lin ◽  
Shobha Krishnan
Keyword(s):  
Cervical Cancer ◽  
Acetic Acid ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Screening Program ◽  
Cancer Center ◽  
Community Based ◽  
Screening Programs ◽  
Lugol’S Iodine

e12009 Background: Visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) is increasingly reframed as a bridge modality through which low resource countries can provide cervical cancer screening while waiting for the more effective HPV DNA tests to become affordable. Often the screening programs are organized by government bodies that lack the trust of the local communities and hence such programs suffer from poor participation. Here we aim to describe a locally-sustained VIA/VILI screening program in rural Kutch district in India directed by Kutch Mahlia Vikas Sangathan (KMVS), a local NGO committed to women empowerment. Methods: All capacity-building measures (funding, training, materials, and healthcare workers) were rooted in the local community. Heath workers were sent to Tata Memorial Cancer Center in Mumbai for training. NGO members held information sessions prior the screening camps educating women about the significance of screening. A three-visit screening model using VIA/VILI was implemented. At first visit, all women were consented and screened. VIA/VILI positive women returned for a second visit for biospy. Biopsy positive women then returned for a third visit to arrange for treatment. All the screening camps were conducted in community buildings such as schools with the collaboration of the village leaders. Results: Screening camps were set up in 17 villages in 2010-2011, screening a total of 832 married women upto the age of 50. There were 0 cervical intraepithelial neoplasia (CIN) positive lesions or invasive cancers found. None of the women were lost to follow-up. Conclusions: It is feasible to develop a community level screening program and to provide cancer prevention needs from within a community. Future directions include further evaluation of downstream protocols after VIA/VILI tests, increasing health worker diagnostic and treatment capacity, and determining positive recruitment factors in women attending screening camps. The KMVS screening program has been well-received and has been approached by several other NGO’s and training centers seeking to build similar community-based cervical cancer screening programs.

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 Barriers and Challenges to Treatment Alternatives for Early-Stage Cervical Cancer in Lower-Resource Settings

2017 ◽  
Vol 3 (5) ◽  
pp. 572-582 ◽  
Author(s):  
Emily S. Wu ◽  
Jose Jeronimo ◽  
Sarah Feldman
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Early Stage ◽  
Human Papillomavirus Vaccination ◽  
Financial Barriers ◽  
Screening Programs ◽  
The World ◽  
Early Stage Cervical Cancer ◽  
Barriers And Challenges

Cervical cancer is one of the most common cancers among women worldwide, and approximately 85% of new diagnoses occur in less-developed regions of the world. Global efforts in cervical cancer to date have focused on primary and secondary prevention strategies of human papillomavirus vaccination and cervical cancer screening. Cervical cancer screening is effective to reduce the incidence of cervical cancer and can result in diagnosis at earlier stages, but it will take time to realize its full impact. With expansion of screening programs, there is now a greater imperative to increase access to treatment for women who have cervical cancer, particularly in earlier stages of disease, when it is still curable. Resources for multimodality treatment can be limited—or even absent—in many less-developed regions of the world and may be associated with geographic, social, and financial barriers for the patient. However, there is evidence that, in many cases, less-invasive and less–resource-intensive treatment options are still effective. To this end, the National Comprehensive Cancer Network and American Society of Clinical Oncology have published guideline adaptations for specific resource constraints, and research about more conservative approaches to the treatment of cervical cancer continues. This review focuses on potential barriers and challenges to provision of safe and effective treatment of early-stage cervical cancer in lower-resource settings, and it suggests future directions for expansion of access to cervical cancer treatment around the world.

Radiation with cisplatin or carboplatin for locally advanced cervix cancer: The experience of a tertiary cancer center.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15541-e15541
Author(s):  
George Au-Yeung ◽  
Linda R. Mileshkin ◽  
David Bernshaw ◽  
Srinivas Kondalsamy-Chennakesavan ◽  
Danny Rischin ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Advanced Cervical Cancer ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Distant Failure ◽  
Disease Free

e15541 Background: Definitive treatment with concurrent cisplatin and radiation is the standard of care for locally advanced cervical cancer. The optimal management of patients with a contraindication to cisplatin has not been established. We conducted a retrospective audit of the impact of concurrent chemoradiation in a cohort of patients (pts) with locally advanced cervical cancer. Methods: All pts with locally advanced cervical cancer treated with definitive radiation were entered into a prospective database. Information regarding their demographics, stage, histology, recurrence and survival were recorded. Pharmacy records were reviewed to determine concurrent chemotherapy use. The primary endpoint was overall survival, and secondary endpoints were disease free survival and rates of primary, nodal or distant failure. Univariate and multivariate analyses were performed, incorporating known prognostic factors of age, FIGO stage, uterine body involvement, tumour volume on MRI and nodal involvement. Results: 442 pts were treated from Jan 1996 to Feb 2011. Median age was 59 (range 22-94); 89% had squamous histology and 64% node-negative disease. 269 pts received cisplatin, 59 received carboplatin because of a contraindication to cisplatin and 114 received no concurrent chemotherapy (most prior to 1999). Overall survival adjusted for other prognostic factors was significantly improved with use of concurrent cisplatin compared to radiation alone (HR 0.53, p=0.001), as was disease free survival and the rate of distant failure. Use of concurrent carboplatin was not associated with any significant benefit compared to radiation alone in terms of overall survival or disease free survival on univariate or multivariate analyses. Conclusions: The results of this audit are consistent with the known significant survival benefit with concurrent cisplatin chemoradiation. However, there did not appear to be any significant benefit associated with concurrent carboplatin although there are potential confounding factors in this small cohort. The available evidence in the literature favors the use of non-platinum chemotherapy rather than carboplatin in pts with contraindications to cisplatin.

Sporadic rectal cancers in young adults: Experience from a tertiary cancer center in India.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14694-e14694
Author(s):  
Monica Malik ◽  
Kesava Ramgopal Adavikolanu ◽  
Swapna Jilla ◽  
Vindhya Vasini Andra ◽  
Yugandhar Lella ◽  
...  
Keyword(s):  
Overall Survival ◽  
Young Adults ◽  
Dietary Habits ◽  
Positive Family History ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Neoadjuvant Chemoradiation ◽  
Cancer Center ◽  
Screening Programs ◽  
Rectal Cancers

e14694 Background: Recent years have witnessed a trend towards an increase in incidence of rectal cancers in young adults both in western and asian populations. It has been noted that these cancers are more aggressive and associated with poorer outcomes. Methods: We conducted a retrospective analysis of young adults (age ≤ 40 years) with rectal cancers treated at our institute from 2007 to 2012. Information regarding stage, histology, treatment and outcomes were collected from patient records. Patients/family members were contacted for information regarding demographic, socioeconomic, dietary habits and occupational parameters. Disease free and overall survival was analyzed by Kaplan Meier estimates using the SPSS version 20. Results: A of total of 153 cases of rectal cancer were treated between 2007 to 2012 of which 48 patients (31%) were ≤ 40 years of age. Median age at presentation for the younger patients (≤40 years) was 30 years. There were 29 males and 19 females. None of these patients had a positive family history and no synchronous cancers were detected. Six patients were agricultural laborers and four worked in coal or cement factories. 23% of patients hailed from the coastal agricultural belt. At presentation, 41 patients had locally advanced disease and 7 had distant metastases. 25 patients received neoadjuvant chemoradiation, 17 underwent surgery and adjuvant chemoradiation and 6 were treated with palliative intent. Four patients progressed during treatment and eight had recurrent disease during follow up. Median overall survival (OS) was 21 months. 5-year OS was 37.5%. On multivariate analysis, poorly differentiated/mucinous tumors were associated with worse survival (p=0.01). Conclusions: 2-10% of colorectal cancers are reported to occur in young adults with many showing a familial association. In our series we had a higher proportion of young adults with sporadic cancers. Various occupational and environmental factors may be associated with these cancers. They are often detected in late stages and are associated with an aggressive course and unfavorable outcomes; hence early detection is of vital importance. Towards this end, identification of risk factors and screening programs need to be carried out.

scholarly journals HOUT-18. TREATMENT STRATEGIES FOR GLIOBLASTOMA IN OLDER PATIENTS: AGE IS JUST A NUMBER

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi115-vi116
Author(s):  
Michael Youssef ◽  
Ethan Ludmir ◽  
Jacob Mandel ◽  
Akash Patel ◽  
Ali Jalali ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Multivariable Analysis ◽  
Treatment Strategies ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Optimal Care ◽  
Poor Overall Survival

Abstract BACKGROUND Optimal care for elderly patients with glioblastoma (GBM) remains in question due to their exclusion from and underrepresentation in clinical trials (including EORTC 22981) as well as their historically-poor overall survival. METHODS Retrospective chart review was conducted at a single high-volume cancer center for newly-diagnosed elderly (65 years old or older) GBM patients diagnosed from 2011 through 2017. RESULTS A total of 158 newly-diagnosed GBM patients aged 65 years and older were identified. 144 patients (91.1%) underwent radiation therapy. One-hundred thirty patient (90.3%) received concurrent temozolomide with radiotherapy. A minority of patients (23%) discontinued temozolomide during concurrent or adjuvant treatment due to side effects or complications of chemotherapy. Sixty-one patients (38.6%) completed concurrent chemoradiation and 6 cycles of adjuvant temodar. The median overall survival (OS) time for our cohort was 18.6 months, with estimated OS rates of 74.8%, 35.9%, and 9.5% at 1, 2, and 5 years, respectively. On multivariable analysis, higher KPS (p=0.002, HR 0.46; 95% CI: 0.63–0.82), completing planned course of radiation (p=0.01, HR 0.29; 95% CI: 0.11–0.75), and completing 6 cycles of adjuvant temozolomide (p=0.01, HR 2.62; 95% CI: 1.67–4.12) were associated with improved OS. CONCLUSIONS Our cohort of elderly GBM patients were predominately treated with a standard of care based on EORTC 22981. Despite their age, these patients tolerated treatment well and had a favorable overall survival compared to outcomes reported for patients treated on EORTC 22981. Using age alone as the reason to de-escalate treatment or as an exclusionary criteria in clinical trials should be discouraged.

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