Chemoradiotherapy For Advanced Cervical Cancer Research Articles

The value of magnetic resonance blood oxygen level-dependent imaging in evaluating the efficacy of advanced cervical cancer combined with radiotherapy and chemotherapy.

Blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) is an imaging method used to analyze oxygenation status of the tumor. To investigate the feasibility of BOLD-MRI in evaluating the efficacy of advanced cervical cancer combined with radiotherapy and chemotherapy. This prospective study included 85 patients with advanced cervical cancer who received BOLD-MRI examination before and after concurrent chemoradiotherapy from October 2020 to December 2021. To investigate the changes of baseline R2* values and △R2* values of cervical cancers before and after treatment. 29 cases were complete response, 34 cases were partial response, and 22 cases showed progression. The baseline R2* values of the tumors were lower than that of the normal cervical muscle (P < 0.0001). After oxygen stimulation, the baseline R2* values of the tumors decreased (P = 0.012). After treatment, the baseline R2* values of the tumors increased (P = 0.007), and the dynamic △R2* values of the tumors decreased (P = 0.025). The baseline R2* value of the complete response was the highest (P = 0.000), the dynamic △R2* value of the complete response was the lowest (P = 0.017). BOLD-MRI can evaluate the efficacy of concurrent chemoradiotherapy for advanced cervical cancer.

Optimisation and evaluation of the random forest model in the efficacy prediction of chemoradiotherapy for advanced cervical cancer based on radiomics signature from high-resolution T2 weighted\xa0images

PurposeOur objective was to establish a random forest model and to evaluate its predictive capability of the treatment effect of neoadjuvant chemotherapy–radiation therapy.MethodsThis retrospective study included 82 patients with locally advanced cervical cancer who underwent scanning from March 2013 to May 2018. The random forest model was established and optimised based on the open source toolkit scikit-learn. Byoptimising of the number of decision trees in the random forest, the criteria for selecting the final partition index and the minimum number of samples partitioned by each node, the performance of random forest in the prediction of the treatment effect of neoadjuvant chemotherapy–radiation therapy on advanced cervical cancer (> IIb) was evaluated.ResultsThe number of decision trees in the random forests influenced the model performance. When the number of decision trees was set to 10, 25, 40, 55, 70, 85 and 100, the performance of random forest model exhibited an increasing trend first and then a decreasing one. The criteria for the selection of final partition index showed significant effects on the generation of decision trees. The Gini index demonstrated a better effect compared with information gain index. The area under the receiver operating curve for Gini index attained a value of 0.917.ConclusionThe random forest model showed potential in predicting the treatment effect of neoadjuvant chemotherapy–radiation therapy based on high-resolution T2WIs for advanced cervical cancer (> IIb).

Short term outcomes of helical tomotherapy during concurrent chemoradiotherapy for advanced cervical cancer.

The aim of the present study was to clarify the feasibility and efficacy of helical tomotherapy during concurrent chemoradiotherapy for treating cervical cancer. The medical records of 13 patients who underwent oncurrent chemoradiotherapy using helical tomotherapy for cervical cancer at Wakayama Medical University Hospital between 2013 and 2015 were retrospectively reviewed. A total of 15 patients who underwent oncurrent chemoradiotherapy using conventional radiotherapy (CRT) between 2008 and 2013 at our institution were also examined for comparison. The median age of patients treated with helical tomotherapy was 60 (range, 35-71), and the median age of patients treated with CRT was 57 (range, 43-77). The median follow-up period was 27 months (range, 3-46) in the tomotherapy group and 35 months (range, 7-88) in the CRT group. The frequency of G3/4 thrombocytopenia in the tomotherapy group was significantly higher than that in the CRT group (P=0.049). However, the platelet count spontaneously recovered without transfusion. There were no significant differences between the groups in terms of frequency of G3/4 neutropenia, diarrhea or late intestine injury. The rate of complete response in the tomotherapy group and the CRT group was 84.6 and 73.3%, respectively, and there was no significant difference in the response rate between the groups. There were no significant differences in the progression-free survival or progression-free rate in the irradiation field between the groups. Adverse events from concurrent chemoradiotherapy using helical tomotherapy were acceptable and clinically controllable. The present results suggest that helical tomotherapy is efficient during concurrent chemoradiotherapy for treatment of advanced cervical cancer.

Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly?

Cervical cancer (CC) is the second most common cancer in Brazilian women, and approximately 10% of cases occur in elderly patients (pts). In this age group, disease is usually diagnosed in more advanced stages and oncological therapies are usually less intensive, due to comorbidities and impaired performance status. Retrospective analysis of pts ≥65 years old with CC admitted at a Brazilian University Cancer Center from August 2008 to February 2012. We performed a descriptive analysis of baseline performance status (PS), disease stage (FIGO), histology, body mass index (BMI), treatment received and overall survival, using the Kaplan-Meier method. 900 medical records were analyzed and 75 pts (8%) fulfilled the inclusion criteria. Median age was 73.4 years old (±5.5 years). Squamous cell carcinoma (SCC) was the most common histology (71 pts, 94.7%). 67 (89.3%) had PS 0 or 1 and 52 pts (69.3%) were eutrophic (BMI 18.5-25 kg/m(2)). At presentation, disease staging consisted of 18 pts (24%) stage I, 35 pts (46.7%) stage II, 8 pts (10.7%) stage III, 12 pts (16%) stage IVa and 2 pts (2.7%) stage IVb. 24 pts (32%) underwent surgery (hysterectomy, adnexectomy, pelvic and paraaortic lymphadenectomy). Adjuvant treatment with radiotherapy (RT) was performed in 13 pts (total dose of external RT in pelvis ranged from 39.6 to 45 Gy, parametrial boost ranged from 14 to 20 Gy and 4 inserts from 7 to 7.5 Gy of brachytherapy); 8 of them received concomitant platinum-based chemotherapy (CT). 30 pts underwent definitive CRT, 17 definitive RT, 1 palliative CT and 3 best supportive care. In the CRT group, 18 pts received cisplatin (CDDP 40 mg/m(2)/w/6w) and 12 carboplatin (AUC 2/w/6w). During definitive CRT, treatment was discontinued in 39% of pts who received CDDP and 25% of pts who received carboplatin, all due to treatment toxicities. CDDP was associated with more nefrotoxicity (5 pts, 28%) than carboplatin (1 pt, 8.3%). The CDDP group also presented more radiodermatitis and stroke. However, myelosuppression and diarrhea were similar in both groups. After a 26.1-month follow-up, median OS was not reached. Despite advanced age, more than 60% of pts underwent complete CRT treatment. Thus, age should not be the only factor to guide therapeutic decisions in CC. Carboplatin was better tolerated than CDDP in CRT group, but prospective trials are necessary to evaluate the best treatment option in this population.

Early Efficacy of Endostar Combined with Chemoradiotherapy for Advanced Cervical Cancers

The aim of this study was to investigate the early outcome of Endostar combined with chemoradiotherapy for advanced cervical cancer. Fifty-two cases (FIGO IIb to IVa) were divided randomly into two groups, receiving chemoradiotherapy alone (CRT group) and Endostar combined with chemoradiotherapy (CRT+E group). For the patients in the CRT+E group, Endostar was administered daily with the dosage of 7.5 mg/m2, and cisplatin was administered weekly with the dosage of 20 mg/m2 during the radiation. The regimens lasted for 4 weeks with no difference in chemoradiotherapy between the two groups. The early outcome complete remission rate was 73.1%, partial remission rate was 23.1% and the total response rate was 96.2% in CRT+E group, a significnat improvement on the 34.6%, 42.3% and 76.9%, respectively, in the CRT group. One year survive rates were 100% and 84.6% in the CRT+E group and CRT groups, the difference being significant. Endostar combined with chemoradiotherapy can improve the early outcome of the advanced cervical cancer, and adverse effects were not encountered.

Early Efficacy of Taxotere and Cisplatin Chemo-Radiotherapy for Advanced Cervical Cancer

The aim of this study was to investigate the early outcome of the taxotere and cisplatin chemoradiotherapy to the advanced cervical cancer. Fifty-six cases with cervical cancer (FIGO II b to IVa) were divided randomly into two groups: radiotherapy alone (28 cases) and radiation plus chemotherapy (TP) group. There was no difference of radiotherapy between the two groups. The RT+C cases who received TP regimen during the radiation, and DDP once weekly injection of vain, according to 20 mg/m2 and taxotere once weekly i.v. according to 35 mg/m2.These regimen were given for 4~5 weeks, and some medicine for vomiting was given to the RT+C cases. Two groups were received an oral medicine MA 160 mg every day during the treatment. The early outcome: the complete remission rate was 64.3% and partial remission rate was 35.7% in RT+C. the complete remission rate was 32.1% and partial remission rate was 39.3% in RT. The total response rate and complete remission of RT+C group was higher than that of the RT group. There was significant difference between the two groups. The taxotere and cisplatin chemoradiotherapy can improve the early outcome of the advanced cervical cancer, the adverse effects being endurable.

Analysis of curative effect for concurrent chemoradiotherapy versus neoadjuvant chemotherapy for stage IIB-IIIB cervical cancer.

Objective To observe the effect and side effects of concurrent chemoradiotherapy for stage ⅡB～ⅢB cervical cancer. Methods 126 patients with stage ⅡB～ⅢB cervical cancer were randomly allocated into 2 groups. Concurrent chemoradiotherapy group: radiotherapy carried out same as the neoadjuvant chemotherapy group, i.e.firstly with cisplatin 20 mg iv d1-5, 5-Fu 750 mg iv d1-5, repeated every 28 days, total 4 cycle; the neoadjuvant chemotherapy group i.e.firstly with cisplatin 20 mg iv d1-5, 5-Fu 750 mg iv d1-5, repeated every 28 days, total 2 cycle, after chemotherapy received routine radiotherapy 2 Gy per day, 5 times a week to a total dose of 30 Gy with 192Ir brachytherapy, 7 Gy per week. When total dose reached 46 Gy, the middle field was shielded by plumbum, then continuous radiotherapy, total dose reach A point 65-70 Gy, B point 50-56 Gy. Results All patients were followed-up for more than five years. The follow-up rate was 94.4 %. In concurrent chemoradiotherapy group the 3 year survival rate and the 5 year survival rate were 82.8 %, 65.6 %, In neoadjuvant chemotherapy group the 3 year survival rate and the 5 year survival rate were 67.7 %, 46.8 %. There was a significant difference in two groups (X2=3.86, P＜0.05; X2=5.01, P＜0.05), no significant difference in toxicity-side effect. Conclusion Concurrent chemoradiotherapy for advanced cervical cancer can significantly improve the 3-year and 5-year survival rate and has little increase in toxicity-side effect. Key words: Uterine cervical neoplasms; Chemotherapy, adjuvant; Drug therapy, combination

Multiple Bowel Stenosis and Perforation as Long-Term Complications of Chemoradiotherapy for Advanced Cervical Cancer in a Young Woman: Case Report

Although combined treatment (chemoradiotherapy) appears to improve the overall and progression-free survival of patients wih locally advanced cervical cancer, some acute toxicity is increased (hematological toxicity, nausea, vomiting) while the long-term side effects are unclear. A 35-year-old Caucasian woman with a diagnosis of advanced cervical cancer (FIGO stage IIIB) was treated with neoadjuvant chemoradiotherapy not followed by radical surgery. She underwent whole pelvic radiation therapy for a total of 40 Gy in fractions of 2.5 Gy given 4 times per week for 4 consecutive weeks followed by 2 sessions of intracavitary brachytherapy starting within 7 days of completion of external beam radiotherapy (3500 mg/h and 2500-3000 mg/h). Cis-DDP IV was administered at a dose of 25 mg/m2 on day 1 and then weekly until completion of the radiotherapeutic protocol. After several months the patient presented persistent gastrointestinal symptoms and an X-ray showed findings consistent with bowel occlusion. The patient underwent emergency surgery and multiple bowel stenosis with perforation was diagnosed. This is the first report in which neoadjuvant chemoradiotherapy is associated with the late complication of multiple stenosis and bowel perforation in a young woman with advanced cervical cancer. Considering that despite the large number of studies about non-cisplatin agents there is not enough evidence to justify treatment with alternative agents, this case report might provide new important data regarding the late morbidity of cisplatin-based concurrent chemoradiation.