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Background@#Concurrent chemoradiotherapy composed of pelvic external beam radiotherapy (PEBRT) with weekly chemotherapy plus intracavitary brachytherapy (ICBT) remains to be the treatment of choice for locally advanced cervical cancer (LACC). However, some patients are not suitable to have ICBT right after pelvic radiation. Locally, active chemotherapy is being given to these patients until they can undergo the procedure.@*Objective@#The aim of the study was to determine the impact of ICBT in the treatment and survival outcomes of cervical cancer and to compare it with active chemotherapy.@*Methodology@#This was a retrospective study of patients with LACC treated with or without brachytherapy in a single institution from January 2002 to December 2017.@*Results@#The 5-year over-all survival (OS) and 5-year recurrence free survival (RFS) of patients with ICBT were both significantly improved compared to those without ICBT (p=0.001 and p=0.038), respectively. Factors that were significantly correlated with adequate response for brachytherapy were non-squamous cell histology (OR 0.65, CI 0.46- 092, p=0.016), initial tumor size of > 5cm (OR 0.41, CI 0.26-0.65, p=0.001), > 50% decrease in the original tumor size at the middle part of PEBRT (OR 1.83, CI 1.2-2.8, p=0.005), > 3 cycles of chemotherapy as radiosensitizers (OR 2.66, CI 1.79- 3.9, p=0.001), > 45 days duration of PEBRT (OR 0.63, CI 0.41-0.97, p=0.04) and > 2 episodes of anemia during PEBRT (OR 0.67, CI 0.52-0.85, p=0.001).@*Conclusion@#Brachytherapy offers significant improvement on tumor control and over-all survival for patients with LACC. Active chemotherapy may offer some benefit in terms of delaying tumor recurrence or progression. However, this did not translate to survival impact if the patient was not able to have brachytherapy at all.
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BrachytherapyABSTRACT
The choice of treatment in locally advanced cervical carcinoma is a hot topic in the controversy of treatment for gynecology tumor.The three primary therapies for locally advanced cervical carcinoma are concurrent chemotherapy and radiotherapy,direct radical hysterectomy and operation after radiotherapy.This article mainly discusses several types of treatment and advises personalized treatment for locally advanced cervical carcinoma.
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Objective To study the clinical data of patients with locally advanced cervical cancer(LACC)treated with preoperative radiotherapy plus chemotherapy combined with surgery. Methods Seventy patients with LACC(stage ⅠB2,ⅡA2 andⅡB)who were treated in our hospital from January 2012 to December 2016 were selected in this study.All the cases were randomly divided into two groups.The observation group(n=35)was treated with three-dimensional intracavitary brachytherapy plus chemotherapy combined with surgery, while the control group (n=35) was treated with radical radiotherapy.Patients of the two groups were followed up after the treatment.The recent and long term complications were recorded and observed in the two groups.Meanwhile,the survival curves were drawn by Kaplan-Meier,and the difference of total survival rate was compared with the Log-rank method between the two groups. Results The incidence of rectal reaction was less in the observation group than that in the control group(14.3% vs.37.1%,χ 2=4.786,P<0.05).There were no significant differences in bone marrow suppression,gastrointestinal reaction and bladder reaction between the two groups (P>0.05). The incidence rates of radioactive bladder injury (8.6% vs. 31.4%) and radionuclide injury (11.4% vs. 34.2%) were less in the observation group than those in the control group(χ2=5.714 and 5.185 respectively,P<0.05).The survival analysis showed that there was no significant difference in the total survival rate between the two groups of stageⅠB2+ⅡA2 and stageⅡB patients(Log rank χ2=0.081 and 0.376,P>0.05).Conclusion For patients with locally advanced cervical cancer, preoperative radiotherapy plus chemotherapy combined with surgery can reduce the incidence of related complications, meanwhile, there is no significant difference in the total survival rate and the mean survival time after the treatment of the two methods.
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Objective To investigate the effect of paclitaxel combined with platinum on neoadjuvant chemotherapy in patients with locally advanced cervical cancer (LACC).Methods A total of 58 cases with LACC were treated with neoadjuvant chemotherapy in our hospital were selected,of which 29 patients (group A) were treated with paclitaxel plus lobaplatin and 29 patients (group B) were treated with paclitaxel plus cisplatin.Both groups received Radical cervical cancer surgery.The short-term efficacy,serum tumor markers,incidence of toxic side effects and long-term prognosis were compared between the two groups.Results The remission rate in group A was 82.75 ％ and the total effective rate was 100.00％;the remission rate in group B was 68.97％ and the total effective rate was 96.55％;there was no significant difference between the two groups (P＞0.05).After chemotherapy,serum CYFRA21-1 and SCCAg levels in patients of group A and B were significantly lower than those before chemotherapy (P＜0.05).During chemotherapy,the incidence of nausea,vomiting and diarrhea in group A was 17.24％ and 6.90 ％,respectively.The incidence of nausea,vomiting and diarrhea in group B was 48.28％ and 31.03 ％,respectively,the difference between the two groups was statistically significant (P＜0.05).After 36 months of follow-up,the overall survival rate in group A was 68.97 ％,and the overall survival rate in group B was 62.07 ％,there was no significant difference between the two groups (x2 =0.305,P =0.581);there was no significant difference in survival time between the two groups (Z=0.381,P=0.537).Conclusion The effect of Paclitaxel combined with lobaplatin in the preoperative neoadjuvant chemotherapy of LACC patients is equivalent to paclitaxel and cisplatin.
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Objective To investigate the application value of extracorporeal extended field radiotherapy in locally advanced cervical cancer. Methods A total of one hundred and twenty patients with stage IIB?IVA cervical cancer in the First Affiliated Hospital of Hebei North University from June 2012 to June 2014 were randomly divided into two groups:the control group and the observation group,each with 60 cases. The routine concurrent chemoradiotherapy was adopted in the control group. The observation group was treated with extracorporeal extended field radiotherapy combined with concurrent chemotherapy. The patients have been followed up for three years. The total efficacy rate,toxicity reaction,local progression free survival time ( PFS) and survival rate of the two groups were compared. Results The total efficacy rate in the observation group was significantly higher than that of the control group ( 88. 3%( 53/60 ) vs. 73. 3%( 44/60 ) , χ2 = 4. 357, P=0. 037),while the incidences of toxicity reaction in the two groups were 18. 3%(11/60) and 16. 7%(10/60), the difference was not statistically significant (χ2=0. 058,P=0. 810) ,the percentages of I and II degree in the two groups were 3. 4%( 2/60 ) and 3. 4%( 2/60 ) , the difference between the two groups was not statistically significant (Z=0. 000,P=1. 000). The PFS value in the observation group was significantly longer than that of the control group ( 25. 6 months vs. 13. 8 months,χ2 = 25. 624, P= 0. 000 ) , and the survival rate in the observation group improved significantly ( 53. 3%( 32/60 ) vs. 33. 3%( 20/60 ) , the difference was statistically significant (χ2 = 4. 887, P= 0. 027 ) . Conclusion Extracorporeal extended field radiotherapy is safe and effective in the treatment of locally advanced cervical cancer.
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Objective To explore the application effect of paclitaxel combined with carboplatin neoadjuvant chemotherapy in patients with advanced cervical carcinoma.Methods Forty patients with stage Ⅱa and above cervical cancer who were treated between August 2015 and August 2016 were selected as the research objectives and all patients were diagnosed by pathological examination.They were divided randomly into experimental group(n=20)and control group(n=20).Patients in the experimental group were treated with intravenous chemotherapy before operation.This scheme included paclitaxel and carboplatin.It included 2 cycles,and the interval between the 2 cycles was 3 weeks.Extensive hysterectomy and pelvic lymphadenectomy were made in 14 days after chemotherapy.The patients in the control group were treated only with extensive hysterectomy and pelvic lymphadenectomy.The efficacy of neoadjuvant chemotherapy was evaluated according to WHO criteria,and observed the operation condition.Adverse drug reactions were evaluated according to WHO anti-cancer drug adverse reaction grade.The quality of life of the two groups was evaluated by the mos item short from health survey(SF-36).Results 20 patients completed chemotherapy,CR5 cases,PR11 cases,SD3 cases,PD1 cases,and the total effective rate(CR+PR)was 80％.At the same time,The paracervical tissue becomed soft in varying degrees,the gap widened,the invasive lesions were controlled in different degrees.Adverse reactions were mild and relieved without special treatment.There was no kidney and heart function damage.All cases were operated successfully after chemotherapy.There were no significant difference in operation time and blood loss between the two groups.The rate of lymph node metastasis,the infiltration rate of uterine tissue and the residual rate of tumor tissue in the vaginal margin were lower than those in the control group(P<0.01).The SF-36 scores of the two groups were higher than those before treatment,but the score of the experimental group was higher significantly than that of the control group,and the difference was statistically significant(P<0.01).Conclusion Paclitaxel combined with carboplatin in neoadjuvant chemotherapy of cervical cancer can reduce the tumor volume,increase the chance of surgery,has less toxic side effects,lower metastatic rate and improve the quality of life of patients.It is worthy of further clinical research and recommendation.
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OBJECTIVE:To observe therapeutic efficacy and safety of nedaplatin combined with paclitaxel in the treatment of advanced cervical cancer. METHODS:Totally 100 patients with advanced cervical cancer were randomly divided into observation group(50 cases)and control group(50 cases). Both groups were given 6MV linear accelerator radiotherapy combined with intra-cavitary irradiation. Based on it,control group was additionally given Cisplatin injection 20 mg/m2,d1+Paclitaxel injection 35 mg/m2,d1 intravenously within 3 h. Observation group was additionally given Nedaplatin for injection 20 mg/m2,d1+Paclitaxel injection intravenously(same usage and dosage as control group). A treatment course lasted for a week,and both groups received 6 courses of treatment. Short-term efficacies of 2 groups were observed,and the levels of vascular endothelial growth factor A(VEGF-A), VEGF-C and VEGF-D,lymphatic microvessel density(LVD),microvessel density(MVD),toxic reaction were also observed be-fore and after treatment. RESULTS: Total response rate(52.00% vs. 32.00%)and disease control rate(86.00% vs. 66.00%)of ob-servation group were significantly higher than those of control group,with statistical significance(P<0.05). After treatment,the levels of VEGF-A,VEGF-C and VEGF-D,LVD,MVD in 2 groups were significantly lower than before treatment,and the obser-vation group was significantly lower than the control group,with statistical significance(P<0.05). The incidence of thrombocyto-penia in observation group was significantly higher than control group,and the incidence of nausea and vomiting was significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS: Nedaplatin combined with paclitaxel can im-prove short-term efficacy of patients with advanced cervical cancer,reduce gastrointestinal reaction,VEGF level and inhibit the generation of tumor vessel,but great importance should be attached to platelet toxic reaction.
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OBJECTIVE:To explore the clinical efficacy and safety of nedaplatin combined with docetaxel in the treatment of advanced cervical cancer. METHODS:A total of 53 patients with advanced cervical cancer selected from our hospital during Apr. 2014-Apr. 2016 were divided into observation group(31 cases)and control group(22 cases)according to chemotherapy plan. Con-trol group was given Docetaxel injection 60 mg/m2,ivgtt,qw. Observation group was additionally given Nedaplatin for injection 35 mg/m2+0.9% Sodium chloride injection diluted into 500 mL,ivgtt (≥60 min),qw. A chemotherapy cycle lased for 21 d,and both groups received 2 cycles of chemotherapy. Clinical efficacies of 2 groups were evaluated 2 weeks after treatment,and the level of PCNA integal was detected before and 2 weeks after treatment. The occurrence of ADR was recorded. RESULTS:The total re-sponse rate of observation group (77.42%) was significantly higher than that of control group (63.64%),with statistical signifi-cance(P0.05). After treat-ment,PCNA integval of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Docetaxel combined with nedaplatin can significantly improve the clinical efficacy of patients with advanced cervical cancer,and does not increase the adverse reactions compared to docetaxel alone.
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Objective To investigate the effect of Xihuang Pill on the curative effect of paclitaxel combined with platinum based neoadjuvant chemotherapy in patients with advanced cervical cancer after operation.Methods 80 cases of patients with advanced cervical cancer treated in our hospitalfrom January 2014 to January 2017 were enrolled in the study.By random number table method,the patients were divided into the observation group and the control group with 40 cases in each group,and all patients were treated with radical hysterectomy.After operation,the control group were treated with paclitaxel and platinum (cisplatin) based neoadjuvant chemotherapy,while the observation group were treated with Xihuang Pill and platinum based neoadjuvant chemotherapy.The effective rate of chemotherapy,survival rate and recurrence rate were compared between the two groups.The levels ofT lymphocyte subsets (CD3+,CD4+,CD8+) and immunoglobulin (IgA,IgG,IgM) in two groups were determined before and after chemotherapy.The quality of life and cancer pain degree were evaluated with the Kamofsky Performance Scale (KPS) and the numeric rating scale (NRS),and adverse reactions were recorded.Results The effective rate of chemotherapy was slightly higher in the observation group than the control group (87.50％ vs 77.50％).Three months and six months after chemotherapy,the survival rate and recurrence rate showed no significant difference between the two groups.After chemotherapy,percentages of CD3+ and CD4+,levels of IgA,IgG and IgM were significantly higher in the observation group than the control group (P ＜ 0.05),and the percentage of CD8+ was lower than the control group (P ＜ 0.05).After treatment,KPS score of the observation group was significantly higher than the control group,and NRS score was significantly lower than the control group (P ＜ 0.05).The incidence of adverse reactions was significantly lower in the observation group than the control group (7.50％ vs 25.00％) (P ＜ 0.05).Conclusion Xihuang Pill combined with cisplatin based neoadjuvant chemotherapy is effective in the treatment of advanced cervical cancer after operation.The regimen can improve the immune function and quality of life,relieve pain degree and reduce adverse reactions.It will not increase the short-term survival rate and recurrence rate,and long-term efficacy needs further study.
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Objective To investigate the effect of Xihuang Pill on the curative effect of paclitaxel combined with platinum based neoadjuvant chemotherapy in patients with advanced cervical cancer after operation.Methods 80 cases of patients with advanced cervical cancer treated in our hospitalfrom January 2014 to January 2017 were enrolled in the study.By random number table method,the patients were divided into the observation group and the control group with 40 cases in each group,and all patients were treated with radical hysterectomy.After operation,the control group were treated with paclitaxel and platinum (cisplatin) based neoadjuvant chemotherapy,while the observation group were treated with Xihuang Pill and platinum based neoadjuvant chemotherapy.The effective rate of chemotherapy,survival rate and recurrence rate were compared between the two groups.The levels ofT lymphocyte subsets (CD3+,CD4+,CD8+) and immunoglobulin (IgA,IgG,IgM) in two groups were determined before and after chemotherapy.The quality of life and cancer pain degree were evaluated with the Kamofsky Performance Scale (KPS) and the numeric rating scale (NRS),and adverse reactions were recorded.Results The effective rate of chemotherapy was slightly higher in the observation group than the control group (87.50％ vs 77.50％).Three months and six months after chemotherapy,the survival rate and recurrence rate showed no significant difference between the two groups.After chemotherapy,percentages of CD3+ and CD4+,levels of IgA,IgG and IgM were significantly higher in the observation group than the control group (P ＜ 0.05),and the percentage of CD8+ was lower than the control group (P ＜ 0.05).After treatment,KPS score of the observation group was significantly higher than the control group,and NRS score was significantly lower than the control group (P ＜ 0.05).The incidence of adverse reactions was significantly lower in the observation group than the control group (7.50％ vs 25.00％) (P ＜ 0.05).Conclusion Xihuang Pill combined with cisplatin based neoadjuvant chemotherapy is effective in the treatment of advanced cervical cancer after operation.The regimen can improve the immune function and quality of life,relieve pain degree and reduce adverse reactions.It will not increase the short-term survival rate and recurrence rate,and long-term efficacy needs further study.
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Objective To compare the efficacy and toxicity of concurrent chemoradiotherapy with cisplatin and docetaxel in combination with classical single drug cisplatin in locally advanced cervical cancer. Methods From 2010 to 2014 in Baoji hospital affiliated to Xi'an medical university, 48 patients with advanced cervical cancer( stage II B-stage IV A), who received concurrent chemoradiotherapy were selected, all patients were treated with 3DCRT technique, pelvic external irradiation combined with intracavitary brachytherapy, the dose of radiotherapy reached a radical dose. According to the same chemotherapy divided into docetaxel cisplatin group (group A, n=24), specific drugs: Cisplatin 60mg/ (m2?d) d1 intravenous drip, or 2 days, docetaxel 60mg/ (m2?d) d1 intravenous drip, repeated every 21 days, a total of 3 cycles of cisplatin group; (group B, n=24), cisplatin 40mg/(m2?d)intravenous drip, 1 times a week, a total of 5~6 weeks. The long-term clinical efficacy and adverse effects of radiotherapy and chemotherapy were compared between the two groups. Results The recent effective rate in group A and group B respectively were 91.7 % and 87.5%, the difference was not statistically significant; 2 year progression free survival in group A and group B respectively was 75.00 %and 54.2 %, the difference was statistically significant (P<0.05); Grade III and IV hematologic toxicity in group A and group B respectively was 45.9 %, 33.3 %, the differenc was statistically significant , (P<0.05). Acute and late gastrointestinal reactions, urinary tract reaction rate in the two groups had no significant difference. Conclusion There was no significant difference between radical radiotherapy and cisplatin combined with docetaxel and cisplatin for locally advanced cervical cancer and compare the efficacy, 2 year progression free survival rate was significantly higher than single drug cisplatin group and cisplatin combined with docetaxel chemotherapy group but hematologic toxicities were obvious, and non-hematologic adverse reactions of radiotherapy and chemotherapy without significant difference.
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Objective To compare the efficacy and toxicity of concurrent chemoradiotherapy with cisplatin and docetaxel in combination with classical single drug cisplatin in locally advanced cervical cancer. Methods From 2010 to 2014 in Baoji hospital affiliated to Xi'an medical university, 48 patients with advanced cervical cancer( stage II B-stage IV A), who received concurrent chemoradiotherapy were selected, all patients were treated with 3DCRT technique, pelvic external irradiation combined with intracavitary brachytherapy, the dose of radiotherapy reached a radical dose. According to the same chemotherapy divided into docetaxel cisplatin group (group A, n=24), specific drugs: Cisplatin 60mg/ (m2?d) d1 intravenous drip, or 2 days, docetaxel 60mg/ (m2?d) d1 intravenous drip, repeated every 21 days, a total of 3 cycles of cisplatin group; (group B, n=24), cisplatin 40mg/(m2?d)intravenous drip, 1 times a week, a total of 5~6 weeks. The long-term clinical efficacy and adverse effects of radiotherapy and chemotherapy were compared between the two groups. Results The recent effective rate in group A and group B respectively were 91.7 % and 87.5%, the difference was not statistically significant; 2 year progression free survival in group A and group B respectively was 75.00 %and 54.2 %, the difference was statistically significant (P<0.05); Grade III and IV hematologic toxicity in group A and group B respectively was 45.9 %, 33.3 %, the differenc was statistically significant , (P<0.05). Acute and late gastrointestinal reactions, urinary tract reaction rate in the two groups had no significant difference. Conclusion There was no significant difference between radical radiotherapy and cisplatin combined with docetaxel and cisplatin for locally advanced cervical cancer and compare the efficacy, 2 year progression free survival rate was significantly higher than single drug cisplatin group and cisplatin combined with docetaxel chemotherapy group but hematologic toxicities were obvious, and non-hematologic adverse reactions of radiotherapy and chemotherapy without significant difference.
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Objective To explore the clinical efficacy and side effects of paclitaxel combined with cisplatin chemotherapy for patients with locally advanced cervical cancer. Methods From May 2008 to May 2009,78 patients with locally advanced cervical cancer in our hos-pital were randomly divided into PF group (39 cases) and Taxol group (39 cases). Patients from PF group were treated with cisplatin com-bined 5-Fu while patients in Taxol group were cured with paclitaxel combined with cisplatin. After chemotherapy,all patients were given anes-thesia extensive hysterectomy and pelvic lymph node dissection. The clinical efficacy,side effects and three-year survival of 2 groups were as-sessed and compared. Results The main adverse reactions of PF group were gastrointestinal reactions,oral mucositis and bone marrow sup-pression;the major side effects of Taxol group were bone marrow suppression,oral mucositis and renal toxicity. After chemotherapy,the com-plete remission rate of Taxol group reached 30. 77%,which was higher than that of PF group 10. 26% (χ2 =5. 032,P=0. 025). The average survival time of PF group and Taxol group were 33. 5 months and 34. 7 months,the three-year survival were 59. 6% and 70. 2%,respectively (χ2 =1. 859,P=0. 173),and the difference was not statistically significant. Conclusion The adverse effects of different chemotherapy were observed in 2 groups. The clinical efficacy of Taxol group were better than that of PF group.
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Objective:To explore the effect of sodium cantharidate vitamin B6 injections in the adjuvant treatment of advanced cer-vical cancers. Methods:Totally 60 cases of advanced cervical cancer patients were randomly divided into the observation group and the control group, and the control group was given common DP chemotherapy and radiotherapy, while the observation group was given sodium cantharidate vitamin B6 injections additionally. After the 6-week treatment, the short-term curative effect, bone marrow inhibi-tion adverse reaction, immune function and life quality were compared between the two groups. Results:The short-term curative effect in the observation group was 66. 7%, which was significantly higher than that in the control group (40%)(P<0. 05). The degree of adverse reaction was significantly lower than that in the control group with statistical significance (P<0. 05). After the treatment, CD8 +, NK cells and CD8 + / CD4 + in the two groups were significantly improved, and those in the observation group were all better than those in the control group (P<0. 05). The improvement of life quality in the observation group was more notable than that in the control group with statistical significance (P <0.05). Conclusion: Sodium cantharidate vitamin B6 injections can significantly in-crease the short-term curative effect and immune function, decrease bone marrow inhibition and improve life quality of advanced cervi-cal cancer patients.
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Objective To investigate the clinical efifcacy and adverse reactions of gemcitabine combined with radiotherapy in the treatment of elderly patients with advanced cervical cancer. Methods 80 elderly patients with advanced cervical cancer in the First Affiliated Hospital of Henan University of Science and Technology from June 2009 to Febrary 2012 were selected and randomly divided into control group(n=40) and observation group(n=40). Control group was given radiotherapy, while observation group was given gemcitabine combined with radiotherapy. The clinical efifcacy, incidences of adverse reactions and quality of life between two groups were compared. Results The total effective rates in 6 weeks after treatment were signiifcantly better than 1 week in both two groups(P<0.05), but there was no difference between two groups. The quality-of-life scores in observation group were signiifcantly higher than control group(P<0.05), but the incidence of adverse reactions in observation group was also signiifcantly higher than control group(P<0.05). Conclusion Gemcitabine combined with radiotherapy in the treatment of elderly patients with advanced cervical cancer has better clinical efifcacy and patients could enjoy a better quality of life, but it has a higher incidence of adverse reactions, so this combination therapy should depend on the speciifc situation of patients.
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Objective To investigate the effects and clinical value of neoadjuvant chemotherapy in patients with locally advanced cervical cancer.Methods 102 cases with locally advanced cervical cancer treated were randomly divided into observation group and control group,the observation group received the surgery after the neoadjuvant chemotherapy,and the control group was given a direct surgical treatment.Operative time,blood loss and postoperative pathologic results were observed,and chemotherapy and toxicity evaluation were made for the observation group.Results The chemotherapy effective rate of the observation group was 74.51％,and the toxicity could be tolerated;the operation time and blood loss of the observation group were significantly lower than those of the control group(all P ＜ 0.05) ;surgical trauma and postoperative complications' occurrence rate of the observation group were significantly lower than those of the control group (all P ＜ 0.05) ; pelvic lymph node metastasis and vaginal cutting edge of the residues of the observation group were significantly lower than those of the control group (all P ＜ 0.05).Conclusion For locally advanced cervical cancer,NACT has a positive significance in reducing the tumor volume,low-er tumor stage,and at the same time reducing the difficulty of operation,surgical trauma,postoperative complications,and preventing recurrence and metastasis,which can be used as a better adjuvant treatment program for locally advanced cervical cancer.
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OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
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Humans , Cisplatin , Consolidation Chemotherapy , Disease-Free Survival , Fluorouracil , Follow-Up Studies , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
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Humans , Cisplatin , Consolidation Chemotherapy , Disease-Free Survival , Fluorouracil , Follow-Up Studies , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer. METHODS: From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone. RESULTS: There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival. CONCLUSION: As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.
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Humans , Hysterectomy , Lymph Nodes , Neoplasm Metastasis , Paclitaxel , Platinum , Prognosis , Quality of Life , Radiotherapy, Adjuvant , Recurrence , Risk Factors , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: To evaluate the efficacy of concurrent chemoradiation (CCRT) using 5-flurouracil (5-FU) and cisplatin for locally advanced cervical cancer. METHODS: We reviewed the medical records of 57 patients with locally advanced cervical cancer (stage IIB-IVA and bulky IB2-IIA tumor) who underwent the CCRT at Dong-A University Hospital from January 1997 to June 2007. The CCRT consisted of 5-FU, cisplatin and pelvic radiation. Every three weeks, 75 mg/m(2) cisplatin was administered on the first day of each cycle and 5-FU was infused at the dose of 1,000 mg/m(2)/d from the second day to the fifth day of each cycle. Radiation was administered to the pelvis at a daily dose of 1.8 Gy for five days per week until a medium accumulated dose reached to 50.4 Gy. If necessary, the radiation field was extended to include paraaortic lymph nodes. Consolidation chemotherapy was performed using 5-FU and cisplatin. RESULTS: Fifty-seven patients were enrolled and the median follow-up duration was 53 months (range 7-120 months). The overall response rate was 91.5% (74% complete response and 17.5% partial response). The 5-year overall survival and 3-year progression free survival rates were 69.4% and 74.9%, respectively. During the follow-up period (median 23 months, range 7-60 months), fourteen patients were diagnosed as recurrent disease. CONCLUSION: CCRT with 5-FU and cisplatin which is the primary treatment for patients with locally advanced cervical cancer was effective and well tolerated.