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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 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 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 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.
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Humans , Cisplatin , Consolidation Chemotherapy , Disease-Free Survival , Fluorouracil , Follow-Up Studies , Lymph Nodes , Medical Records , Pelvis , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: We evaluated the prognostic factors, survivals and patterns of failure of the patients with locally advanced cervical cancer who received radical radiotherapy alone and induction chemotherapy followed by radiotherapy respectively. MATERIALS AND METHODS: Between May 1985 to December 1992, one hundred and sixty three patients with locally advaneed cervical cancer received curative radiotherapy. Patients were divided into two groups: control group included 69 patients who received curative radiotherapy and combined group included 94 patients who received induction chemotherapy followed by curative radiotherapy. The curative radiotherapy consisted of external pelvic radiotherapy and intracavitary brachytherapy. Induction chemotherapy was delivered in VBP (vincristine, bleomycin, cisplatin) and FP (5-FU, cisplatin). Follow up period ranged from 2 months to 99 months with median of 50 months. RESULTS: The overall response rate was 94.2% in the control group and 89.4% in the combined group. The response rate by control group was 66.7% for CR (complete response), 27.5% for PR (partial response), 5.8% for NR (no response). The response rate by combined group of CR, PR, NR were 64.9%, 24.5%, 10.6%, respectively. There was no difference in response for control group and combined group (p> 0.05). The 5-year overall survival had no significant difference in between control group and combined group (54.6% vs. 57.3%). The 5-year disease free survival also had no significant difference (52.9% vs. 55.0%). In the control group, 23 patients (33.3%) had treatment failure: twelve (17.4%) at a local recurrence, 9 (13.0%) as distant metastasis, and 2 (2.9%) with both local recurrence and distant metastasis. In the combined group, Thirty patients (31.9%) failed therapy, with local recurrence in 21 patients (22.3%), distant metastasis in 7 patients (7.5%), and both in 2 patients (2.1%). The difference between the two groups was not significant in view of patterns of failure. The major toxicities were nausea/ vomiting, leukopenia, anemia, and diarrhea. The prognostic factors affecting were hemoglobin level, KPS (karnofsky performance status), and treatment response in both group by multivariate analysis. CONCLUSION: This study did not prove the efficacy of induction chemotherapy followed by radiotherapy in locally advanced cervical cancer.