Treatment patterns in cervical cancer patients initiating systemic therapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18009-e18009
Author(s):  
Anuj Shah ◽  
Nehemiah Kebede ◽  
Ruchit Shah ◽  
Shelby Corman ◽  
Chizoba Nwankwo
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Descriptive Analysis ◽  
Previous Treatment ◽  
Baseline Period ◽  
Treatment Patterns ◽  
Therapy Initiation ◽  
The Mean

e18009 Background: NCCN recommends the use of systemic treatment for advanced cervical cancer patients. However, no study has assessed treatment patterns in this population. This study described real-world treatments patterns among women with cervical cancer newly initiating a systemic therapy. Methods: Cervical cancer patients with ≥2 claims for systemic therapy (i.e., chemo- or immunotherapy) within a 4-week period between June 2014 – October 2018, no claims within 6 months prior to systemic treatment initiation (baseline period), and continuously enrolled within the baseline period and 3 months post therapy initiation were identified from the Optum Clinformatics DataMart database. Patients who had a cervical cancer-related surgery within ±3 months of therapy initiation were excluded to exclude adjuvant use. All claims for the same systemic therapy without a > 90-day gap or new systemic therapy started within 28 days of a previous treatment were considered to be part of the same LOT. Descriptive analysis, stratified for presence of non-cervical cancers during the baseline period, were conducted to identify most common treatments, durations, and use of mono versus combination therapy within each LOT. Results: 1,229 women newly initiated systemic therapy, 357 (29.0%) received LOT2 and 141 (11.5%) had a LOT3. Treatments received within each LOT are described in the table below. The proportion receiving radiation reduced from LOT1 (49.9%) to LOT2 (12.0%). The mean duration of LOT1 and LOT2 were 2.9 and 3.7 months. The proportion of patients receiving monotherapy in LOT1 and LOT2 were 77.8% and 64.1% respectively. Conclusions: The treatment received by patients in this analysis suggested receipt of guideline concordant care. [Table: see text]

Treatment patterns among newly diagnosed women with cervical cancer in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18019-e18019
Author(s):  
Anuj Shah ◽  
Nehemiah Kebede ◽  
Ruchit Shah ◽  
Shelby Corman ◽  
Chizoba Nwankwo
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Real World ◽  
External Beam Radiotherapy ◽  
Previous Treatment ◽  
The United States ◽  
Primary Treatment ◽  
Treatment Patterns ◽  
Newly Diagnosed ◽  
Real World Data

e18019 Background: To address the gap in US-based real-world data, this analysis described the real-world treatment patterns among newly diagnosed cervical cancer patients. Methods: Women newly diagnosed with cervical cancer between Jan 2015 – June 2018, with a confirmatory diagnosis or treatment within 2 months, and continuous enrollment for 12 months prior and 6 months post diagnosis were identified in the Optum Clinformatics DataMart database. Surgeries (hysterectomy, conization, lymphadenectomy and trachelectomy), radiation (external beam radiotherapy [EBRT]/brachytherapy) and systemic therapies (chemotherapy/immunotherapy) received after diagnosis were described by line of therapy (LOT). The start of the first LOT was the date of the first treatment. All treatments initiated within 90 days of a surgery or the end of radiotherapy, and all systemic treatment started within 28 days of any previous treatment were a part of the same LOT. Most frequently received treatments in LOT1 and 2 and time to treatment initiation were described. Results: Out of 1,004 newly diagnosed women, 655 (65.2%) received at least LOT1 and 162 (16.14%) received LOT2. Median time to first LOT was 1.5 (1.4 – 1.7) months from diagnosis. Surgery was the most common treatment in LOT1 (58.0%). Among patients receiving radiation, the majority received a combination of EBRT and brachytherapy (LOT1: 66.9%, LOT2: 58.0%). The use of chemotherapy increased with subsequent LOTs (LOT1: 53.3%, LOT2: 61.1%). Treatments received in LOT1 and LOT2 are described in the table. Conclusions: This analysis shows that newly diagnosed cervical cancer patients are primarily receiving guideline recommended treatment with surgery or chemoradiation as primary treatment. Radiation therapy includes EBRT and brachytherapy. Counts ≤ 10 are not reported (NR). [Table: see text]

scholarly journals Vaginal dose of radical radiotherapy for cervical cancer in China: a multicenter study

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Juan Wang ◽  
Kai-shuo Zhang ◽  
Tao Wang ◽  
Zi Liu ◽  
Rui-hua Wang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Multicenter Study ◽  
External Beam Radiotherapy ◽  
Dose Effect ◽  
Chinese Patients ◽  
Point System ◽  
Radiation Doses ◽  
Reference Length ◽  
The Mean

Abstract Background The posterior-inferior border of symphysis (PIBS) point system is a novel vaginal dose-reporting method and is a simple and reliable method proposed by the Medical University of Vienna proposed for both external-beam radiotherapy (EBRT) and brachytherapy (BT). In this multicenter study, we sought to first evaluate the vaginal radiation dose in Chinese cervical cancer patients according to the PIBS point system and then to analyze the factors influencing the dose distribution. Methods We collected data from the medical records of 936 cervical cancer patients who underwent concurrent radiochemotherapy at 13 different institutions in China. Radiation doses at points A, PIBS+ 2 cm, PIBS and PIBS-2 cm, International Commission on Radiation Units (ICRU)-R and ICRU-B were measured. Results The median total doses in EQD2α/β = 3 at points PIBS+ 2 cm, PIBS and PIBS-2 cm were 82.5 (52.7–392.1) Gy, 56.2 (51.4–82.1) Gy and 2.6 (0.9–7.4) Gy, respectively. The median total doses in EQD2α/β = 3 at ICRU-R and ICRU-B were 77.5 (54.8–132.4) Gy and 79.9 (60.7–133.7) Gy, respectively. The mean vaginal reference length (VRL) was 4.6 ± 1.0 cm (median, 4.5 cm). In patients with VRL ≤4.5 cm, the mean total doses in EQD2α/β = 3 at points PIBS+ 2 cm, PIBS and PIBS-2 cm were 128.5, 60.7 and 0.8 Gy, respectively. In patients with VRL > 4.5 cm, the mean total doses at these three points were 68.9, 0.5 and 54.5 Gy, respectively. Classification of patients revealed significant differences (P < 0.05) between these two groups. Conclusions With the PIBS point system, Chinese patients with a shorter VRL of < 4.5 cm received higher radiation doses at the PIBS+ 2 cm, PIBS and PIBS-2 cm points than European and American patients. Further studies are required to establish the dose–effect relationships with these points as references. The study was registered as a clinical trial (NCT03257475) on August 22, 2017.

scholarly journals Contemporary treatment patterns and survival of cervical cancer patients in Ethiopia

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Biniyam Tefera Deressa ◽  
Mathewos Assefa ◽  
Ephrem Tafesse ◽  
Eva Johanna Kantelhardt ◽  
Ivan Soldatovic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Waiting Time ◽  
Concurrent Chemotherapy ◽  
Treatment Patterns ◽  
Stage Migration ◽  
Case Scenario ◽  
Curative Intent ◽  
Worst Case ◽  
Early Presentation

Abstract Background Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country. Methods Women with histologically verified cervical cancer who were seen in 2014 (January 1, 2014 to December 31, 2014) at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients’ medical record files. The information on vital status was obtained from medical chart and through telephone calls. Result Among 242 patients included in the study, the median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.6 months (range 2 to 9 months). Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among 151 patients treated with curative intent, only 34 (22.5%) of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. The 5-year overall survival rate was 28.4% (20.5% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care. Conclusion The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy, leading to stage migration in substantial proportion of the cases. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical cancer and to shorten the unacceptable, long waiting time for radiotherapy.

Treatment patterns and survival in patients with late-stage hepatocellular carcinoma in France: A retrospective database analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 288-288
Author(s):  
Jean-frederic Blanc ◽  
Caroline Laurendeau ◽  
Nadia Kelkouli ◽  
Philippe Mathurin
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Late Stage ◽  
Systemic Treatment ◽  
Best Supportive Care ◽  
Treatment Patterns ◽  
Stage Disease ◽  
Systemic Treatments ◽  
Icd 10

288 Background: The prognosis for patients with late-stage hepatocellular carcinoma (HCC) is poor, with only one systemic treatment option available for patients until 2017. Aim: To describe treatment patterns and survival of French patients following diagnosis of late-stage HCC (Barcelona Clinic Liver Cancer classification B, C or D), using a comprehensive nationwide claims database, SNDS. Methods: The SNDS database was searched from 1 January 2015 to 31 December 2017 for patients with a diagnosis of HCC (ICD-10: C220) and late-stage disease, defined by the identification of transcatheter arterial chemoembolization (TACE) or radioembolization (TARE), HCC systemic therapy and/or best supportive care (BSC). Patients were followed up for a maximum of 2 years. Results: 17,298 patients (mean age: 68.7 years (SD: 11.3), 82.6% male) were identified, with 72.4% diagnosed at late stage. During follow-up, 29.6% of patients were treated with TACE or TARE, and 27.1% received systematic therapy (sorafenib in 99.5% of cases). The median duration of systemic treatment was 7.9 (95% CI: 7.4-8.5) months. In 62.5% of cases, this treatment was discontinued at 12 months; this proportion fell to 40.3% when using mortality as a competitive risk. Survival since diagnosis of late stage HCC differed according to the type of first treatment received. Median overall survival was 23.7, 11.9, 7.4 and 1 month in patients initially receiving TACE, TARE, systemic therapy or no treatment, respectively. Conclusions: These results confirm the high clinical burden of late-stage HCC over this period and the need for second-line systemic treatments to improve patient outcomes.

scholarly journals 30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

2018 ◽  
Vol 4 (4) ◽  
pp. 00030-2018 ◽  
Author(s):  
Jacobus Adrianus Burgers ◽  
Ronald Alphons Damhuis
Keyword(s):  
Lung Cancer ◽  
Mortality Rate ◽  
The Netherlands ◽  
Cancer Patients ◽  
Cell Lung Cancer ◽  
Systemic Therapy ◽  
Performance Indicator ◽  
Systemic Treatment ◽  
Multivariable Analysis ◽  
Lung Cancer Patients

Systemic treatment is the standard treatment for unresectable stage III and IV lung cancer. Nevertheless, a 5–10% death rate has been described within 30 days after the last systemic treatment, suggesting that these patient did not benefit. We analysed the 30-day mortality after start of systemic therapy.Data were retrieved from the Netherlands National Cancer Registry. From 2010 to 2015, 26 277 patients were included. 56% were men. The median age was 65 years and 31% of patients were aged ≥70 years. 27% involved small cell lung cancer and 73% nonsmall cell lung cancer. Overall mortality within 30 days after the start of systemic treatment was 6.2%. Multivariable analysis established the prognostic influence of age, histology, number of metastatic sites and type of systemic treatment. Chemotherapy was administered in 77 hospitals, treating each 15–161 lung cancer patients with systemic therapy annually. None of the hospitals had a significantly higher 30-day mortality according to hierarchical multivariable analysis, controlling for case-mix.In the Netherlands, the 30-day mortality rate after start of systemic therapy for lung cancer patients was comparable with earlier reports. Hospital volume did not influence the 30-day mortality rate. 30-day mortality rate is not a meaningful indicator to monitor quality of care.

scholarly journals Contemporary Treatment Patterns and Survival of Cervical Cancer Patients in Ethiopia

2021 ◽  
Author(s):  
Biniyam Tefera Deressa ◽  
Mathewos Assefa ◽  
Ephrem Tafesse ◽  
Eva Johanna Kantelhardt ◽  
Ivan Soldatovic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Waiting Time ◽  
Concurrent Chemotherapy ◽  
Treatment Patterns ◽  
Stage Migration ◽  
Case Scenario ◽  
Curative Intent ◽  
Worst Case ◽  
Early Presentation

Abstract Background: Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country. Methods: Women with histologically verified cervical cancer who were seen in 2014 at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients’ medical record files. The information on vital status was obtained from medical chart and through telephone calls. Result: Of the 349 cervical cancer patients treated at the radiotherapy center of TAHRC in 2014, medical records were retrieved for 242 patients. The median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.58 months. Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among 151 patients treated with curative intent, only 34 (22.5%) of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. Fifty-two months overall survival rate was 21.5% (14.6% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care. Conclusion: The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy, leading to stage migration in substantial proportion of the cases. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical cancer and to shorten the unacceptable, long waiting time for radiotherapy.

scholarly journals Image guided interstitial brachytherapy for locally advanced disease after external beam radiotherapy in a case of carcinoma cervix – our institutional experience

2016 ◽  
Author(s):  
S. Tandon ◽  
S. Mitra ◽  
M. K. Sharma ◽  
U. Saxena ◽  
P. Ahlawat ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
External Beam Radiotherapy ◽  
Descriptive Analysis ◽  
Locally Advanced ◽  
Early Response ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Image Guided ◽  
The Mean

Purpose/Objective: Cervical cancer is the third most common cancer in women worldwide. Definitive chemoradiation is the accepted standard of care for patients especially for locally advanced cervical cancers. Intracavitary brachytherapy (ICBT) is an important part of definitive radiotherapy shown to improve overall survival. Interstitial brachytherapy (ISBT) is generally reserved for patients either with extensive pelvic and/or vaginal residual disease after external beam radiotherapy (EBRT) or with anatomy not allowing ICBT with standard applicators in an attempt to improve local control. We have conducted an observational study for patients who underwent image guided HDR-ISBT at our institute. Materials and Methods: Seven patients; diagnosed as a case of carcinoma cervix; were selected from the period of 2012 to 2015 who received EBRT by IMRT and for whom ICBT couldn’t be done for various reasons. These patients were then taken up for Martinez Universal Perineal Interstitial Template (MUPIT) image based ISBT. A descriptive analysis was done for doses received by HRCTV, bladder, rectum and sigmoid colon. At the end of treatment, early response at 3 months along with overall survival (OS) and disease free survival (DFS) was also calculated. Results: All the patients recruited were locally advanced with 3 patients in IIB, 1 patient in IIIA and 3 patients belonging to IIIB. The mean dose received by 95% high risk CTV (HRCTV) by IMRT was 49.75 Gy. Out of 7 patients, 3 were taken up for ISBT due to anatomical restriction whereas remaining 4 patients were included because of lack of dose coverage by ICBT. The mean doses received by 90% of HRCTV, 2 cc bladder, 2 cc rectum and 2 cc sigmoid colon were 20.58 Gy, 2.73 Gy, 3.19 Gy and 2.82 Gy respectively. The early response at 3 months was 57.14%. The DFS at one year and OS at 3 year were 53.6% and 53.3% respectively. Conclusions: Our descriptive analysis of seven patients being treated by image based ISBT have revealed that locally advanced cervical cancer patients for whom ICBT is unsuitable can achieve equitable LRC and OS with a combination of EBRT by IMRT and image based HDR-ISBT.

Predicting tumor recurrence in patients with cervical carcinoma treated with definitive chemoradiotherapy: value of quantitative histogram analysis on diffusion-weighted MR images

2016 ◽  
Vol 58 (4) ◽  
pp. 481-488 ◽  
Author(s):  
Gurcan Erbay ◽  
Cem Onal ◽  
Elif Karadeli ◽  
Ozan C Guler ◽  
Sami Arica ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Tumor Recurrence ◽  
Disease Recurrence ◽  
Definitive Chemoradiotherapy ◽  
Node Metastasis ◽  
The Mean

Background Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results The mean and median ADC values for the cohort were 1.043 ± 0.135 × 10−3 mm2/s and 1.018 × 10−3 mm2/s (range, 0.787–1.443 × 10−3 mm2/s). The mean ADC was significantly lower for patients with advanced stage (≥IIB) or lymph node metastasis compared with patients with stage <IIB or no lymph node metastasis. The mean ADC, 75th percentile ADC (ADC75), 90th percentile ADC (ADC90), and 95th percentile ADC (ADC95) were significantly lower in patients with tumor recurrence compared with patients without recurrence. In multivariate analysis, tumor size, ADC75 and ADC95 were independent prognostic factors for both overall survival and disease-free survival. Conclusion ADC histogram parameters could be markers for disease recurrence and for predicting survival outcomes. ADC75, ADC90, and ADC95 of the primary tumor were significant predictors of disease recurrence in cervical cancer patients treated with definitive CRT.

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