A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial / 부인종양

OBJECTIVE: To compare response rate and survivals of locally advanced stage cervical cancer patients who had standard concurrent chemoradiation therapy (CCRT) alone to those who had adjuvant chemotherapy (ACT) after CCRT. METHODS: Patients aged 18–70 years who had International Federation of Gynecology and Obstetrics stage IIB–IVA without para-aortic lymph node enlargement, Eastern Cooperative Oncology Group scores 0–2, and non-aggressive histopathology were randomized to have CCRT with weekly cisplatin followed by observation (arm A) or by ACT with paclitaxel plus carboplatin every 4 weeks for 3 cycles (arm B). RESULTS: Data analysis of 259 patients showed no significant difference in complete responses at 4 months after treatment between arm A (n=129) and arm B (n=130): 94.1% vs. 87.0% (p=0.154) respectively. With the median follow-up of 27.4 months, 15.5% of patients in arm A and 10.8% in arm B experienced recurrences (p=0.123). There were no significant differences of overall or loco-regional failure. However, systemic recurrences were significantly lower in arm B than arm A: 5.4% vs. 10.1% (p=0.029). The 3-year progression-free survival (PFS) and 3-year overall survival (OS) of the patients in both arms were not significantly different. The hazard ratio of PFS and OS of arm B compared to arm A were 1.26 (95% CI=0.82–1.96; p=0.293) and 1.42 (95% CI=0.81–2.49; p=0.221) respectively. CONCLUSIONS: ACT with paclitaxel plus carboplatin after CCRT did not improve response rate and survival compared to CCRT alone. Only significant decrease of systemic recurrences with ACT was observed, but not overall or loco-regional failure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036164 Thai Clinical Trials Registry Identifier: TCTR 20140106001

Synchronous and metachronous malignancy in endometrial cancer patients treated in a tertiary care center of Thailand / 부인종양

OBJECTIVE: To evaluate the prevalence and features of non-endometrial cancers in Thai endometrial cancer (EC) patients. METHODS: EC patients treated in our institution were identified and the following data were collected: age, EC stage, histopathology, adjuvant therapy, other cancers, living status, and cause of death. RESULTS: The mean age of the 344 patients was 56.8+/-10.8 years. Fifty (14.5%) had other synchronous and metachronous cancers. Mean ages of the patients with or without other cancers were not significantly different, 55.7+/-10.04 years versus 57.1+/-11.0 years, respectively (p=0.358). History of any cancer in the family and tumor in the lower uterine segment were more frequent among the patients with other cancers (6.0% vs. 1.7%, p=0.095; 12.0% vs. 1.0%, p or =2 other cancers. Ovarian, breast, and colon were the three most common other cancers. After a median follow-up of 57.1 months, 18.3% of patients had died: 30.0% of patients with other cancers and 16.3% of those without other cancers. The corresponding EC deaths were 14.0% and 11.2%. The 5-year overall survival was significantly lower in patients who had other cancers: 79.3% (95% confidence interval [CI], 68.3 to 90.3) vs. 86.0% (95% CI, 81.7 to 90.3) than in those without (p=0.023). However, the corresponding disease-specific survival was not significantly different: 85.1% (95% CI, 75.5 to 94.7) compared with 89.0% (95% CI, 85.1 to 92.9), respectively (p=0.514). CONCLUSION: Thai EC patients had a high incidence of other cancers. Overall survival of EC patients who had other cancers was worse than those without, while disease-specific survival was not significantly different.

Endometrial Cancer: Incidence of Retroperitoneal Lymph Node Metastasis and Clinico-pathological Factors Predicting Retroperitoneal Lymph Node Metastasis

Abstract Endometrial Cancer: Incidence of Retroperitoneal Lymph Node Metastasis and Clinico-pathological Factors Predicting Retroperitoneal Lymph Node Metastasis Surawute    Leelahakorn         MD* Siriwan       Tangjitgamol         MD* Sumonmal Manusirivithaya   MD, MSc (Clinical Epidemiology)* Jakkapan    Khunnarong         MD* * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objectives: To evaluate the incidence of retroperitoneal lymph node (RLN) metastasis in endometrial carcinoma (EMC) and to assess the clinico-pathological factors predicting RLN metastasis. Study design: Retrospective study. Subjects: Two hundred and twenty five patients with clinical stage I-II EMC who underwent surgical staging at our institute during January 1993 and December 2007. Methods: Medical and pathological records of all EMC patients were reviewed. Clinico-pathological characteristics and other data were extracted and analyzed. Main outcome measures: Retroperitoneal lymph node metastasis. Results: Mean age of the patients was 55.0 ± 9.8 years (30-84 years). All patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node resection. One hundred and seventy seven patients (78.7%) also had para-aortic lymph node resection. The most common histopathologic type was endometrioid adenocarcinoma (90.7%). Mean number of lymph nodes obtained was 23.2 ± 10.6 nodes. Retroperitoneal lymph node metastasis was found in 28 patients (12.4%): pelvic lymph node metastasis in 25 patients (11.1%) and para-aortic lymph node metastasis in 10 patients (4.4%). By univariable analysis, clear cell or papillary serous adenocarcinoma type, high grade (II-III) tumor, tumor size \> 2 cm, tumor located in lower uterine segment, cervical involvement, gross intra-abdominal metastasis, myometrial invasion more than inner half, lymph vascular space invasion and positive peritoneal cytology were significantly associated with RLN metastases. By multivariable analysis, only myometrial invasion more than inner half and lymph vascular space invasion were independently associated with RLN metastasis. Conclusion: RLN metastases were found in 12.4% of patients with clinical stage I and II EMC. Presence of myometrial invasion more than inner half and lymph vascular space invasion were significantly associated with RLN metastasis by multivariable analysis. Vajira Med J 2008 ; 52 : 129 - 138