Intermediate-risk Cervical Cancer Research Articles

Assessment of postoperative therapy de-escalation for early-stage, intermediate-risk cervical cancer: Japanese Gynecologic Oncology Group study

Assessment of postoperative therapy de-escalation for early-stage, intermediate-risk cervical cancer: Japanese Gynecologic Oncology Group study

Assessment of postoperative therapy de-escalation for early-stage, intermediate-risk cervical cancer

ObjectiveThe objective of this study was to assess the oncologic outcome of surgically-treated patients with early-stage, intermediate-risk cervical cancer according to postoperative therapy modality.MethodsThis retrospective cohort study queried the Japanese...

Adjuvant external beam radiotherapy combined with brachytherapy for intermediate-risk cervical cancer

ObjectivePatients with intermediate-risk cervical cancer receive external beam radiotherapy (EBRT) as adjuvant treatment. It is commonly administered with brachytherapy without proven benefits. Therefore, we evaluated the frequency of brachytherapy use,...

Effect of pelvic radiotherapy on patients with stageIB‑IIA cervical cancer after radical hysterectomy: A single‑center retrospective study.

The effects of post-operative adjuvant radiotherapy (RT) on intermediate-risk patients with cervical cancer have not been fully elucidated. Therefore, the present study aimed to investigate the impact of RT on intermediate-risk cervical cancer. The data of 112 patients with stage IB and IIA cervical cancer treated with radical hysterectomy between January 2009 and December 2018 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and the frequency of adverse events were compared between patients with and without adjuvant RT (RT+ and RT-, respectively). Subgroup analyses of PFS based on tumor size, cervical stromal invasion, lymphovascular space invasion and histology [squamous cell carcinoma (SCC) vs. non-SCC] were performed. Among the 112 patients, 41 received adjuvant RT. Although there were no significant differences in OS or PFS between the RT+ and RT- groups, the frequency of adverse events was much higher in the RT+ group. Patients in the RT+ group also had more recurrent risk factors than those in the RT- group. Based on the subgroup analyses, although no significant differences were observed between any of the groups, RT demonstrated a different impact on PFS between SCC and non-SCC: No difference was observed in the SCC group, whereas patients in the RT+ group tended to have poorer prognoses compared to those in the RT- group of the non-SCC group. These results suggest that the impact of post-operative RT on stage IB and IIA cervical cancer is limited and is accompanied by increased adverse events. The eligibility of patients for post-operative RT should be carefully determined based on the therapeutic effect of RT in each subgroup.

Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

ObjectiveThe “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size ≥2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer. MethodsWe analyzed data from patients with IR cervical cancer (tumor size 2–4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study. ResultsOf 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT−) and 418 (60.4%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT− and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size ≥4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282). ConclusionAmong patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease-free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy.

CERVANTES: an international randomized trial of radical surgery followed by adjuvant (chemo) radiation versus no further treatment in patients with early-stage, intermediate-risk cervical cancer (CEEGOG-CX-05; ENGOT-CX16)

BackgroundThe role of adjuvant treatment in the intermediate-risk group of patients with early-stage cervical cancer is controversial and is supported by a single randomized Gynecologic Oncology Group (GOG) 92 study...

Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality.

BackgroundThe treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria.Materials and methodsA retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method.ResultsAfter a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area.ConclusionsAdjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.

The baseline recurrence risk of patients with intermediate-risk cervical cancer.

ObjectiveThis study aimed to investigate the prognosis of patients with intermediate-risk cervical cancer and to evaluate the necessity of adjuvant therapy.MethodsWe conducted a retrospective chart review of patients with stage IB–II cervical cancer who underwent type III radical hysterectomy with pelvic lymphadenectomy between 2008 and 2017. In our institution, radical hysterectomy is performed as an open surgery and not as a minimally invasive surgery, and adjuvant therapy is not administered to patients with intermediate-risk cervical cancer. The intermediate-risk group included patients with 2 or more of the following factors: tumor size >4 cm, stromal invasion >1/2, and lymphovascular stromal invasion. Intermediate-risk patients with squamous cell carcinoma were included in the I-SCC group, whereas those with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma were included in the I-Adeno group.ResultsThere were 34 and 18 patients in the I-SCC and I-Adeno groups, respectively. The 5-year recurrence-free survival (RFS) and overall survival rates in the I-SCC group were 90.5% (95% confidence interval [CI], 85.3–95.7%) and 100% (95% CI, 100%), respectively, whereas those in the I-Adeno group were 54.9% (95% CI, 42.0–67.9%) and 76.1% (95% CI, 63.7–88.4%), respectively. Multivariate analysis revealed that endocervical adenocarcinoma, usual type, or adenosquamous carcinoma, and tumor size >4 cm had worse RFS.ConclusionThe I-SCC group had good prognosis without adjuvant therapy; therefore, adjuvant therapy may be omitted in these patients. In contrast, the I-Adeno group had poor prognosis without adjuvant therapy; therefore, adjuvant therapy should be considered in their treatment.

Role of adjuvant therapy after radical hysterectomy in intermediate-risk, early-stage cervical cancer

ObjectiveAdjuvant treatment remains a controversial issue for intermediate-risk cervical cancer. The aim of this study was to compare the prognosis of patients who underwent no adjuvant treatment, pelvic radiotherapy alone,...

Is Adjuvant Therapy Necessary for Patients with Intermediate-Risk Cervical Cancer after Open Radical Hysterectomy?

Introduction: Adjuvant therapy is usually recommended for patients with intermediate-risk cervical cancer (deep stromal invasion [DSI], lymphovascular space invasion [LVSI], and bulky tumor) after radical hysterectomy. However, we previously reported that DSI, LVSI, and bulky squamous cell carcinoma (SCC) were not correlated with prognosis in multivariate analysis; therefore, the indications we use for adjuvant therapy include complete stromal invasion, not DSI or LVSI or bulky SCC. The objective of this study was to evaluate the adequacy of our therapeutic strategy for cervical cancer after radical hysterectomy. Methods: We performed 321 type III open radical hysterectomies for cervical cancer between 2001 and 2013. Eighty-two patients with DSI, LVSI, or bulky SCC did not receive adjuvant therapy after radical hysterectomy under informed consent. We retrospectively evaluated the prognosis of these 82 patients. Results: Forty-two patients had >2/3 DSI and 35 patients had 1/3–2/3 DSI. Five patients had LVSI alone. The mean patient age was 43 years (range, 27–72). Six patients (7%) experienced recurrence during a median follow-up period of 84 months (range, 1–206). Two of the 6 patients with recurrence suffered cervical cancer-related deaths, but the remaining 4 cases are alive without evidence of disease after treatment during a follow-up period of 87–165 months. The 5-year disease-free survival rate was 92.6%, and the 5-year overall survival rate was 96.3%. Conclusions: Adjuvant therapy for DSI, LVSI, or bulky SCC after open radical hysterectomy might not be necessary. Further data collection is warranted to determine the standard of care for patients with intermediate-risk cervical ­cancer.

Does post-operative chemoradiation improve survival compared to post-operative radiotherapy alone for patients with intermediate-risk cervical cancer initially treated with radical hysterectomy?

Does post-operative chemoradiation improve survival compared to post-operative radiotherapy alone for patients with intermediate-risk cervical cancer initially treated with radical hysterectomy?

Impact of postoperative intravaginal brachytherapy on survival for patients with intermediate-risk cervical cancer at National Cancer Institute (NCI), Egypt

AbstractBackgroundCervical cancer is considered to be the fourth most frequent cancer among women. Postoperative treatment is indicated depending up on surgical findings and disease stage.ObjectiveThe objective of this study was to assess the long-term postoperative outcomes of cervical cancer patients with intermediate risk factors who have received pelvic external beam radiotherapy with or without vaginal brachytherapy, and treatment-related toxicities.Patients and methodsIn this retrospective study, the records were collected for all patients with cervical cancer who received postoperative radiotherapy at the National Cancer Institute between the years 2008 and 2013. The end points of the study were local control, progression-free survival, overall survival (OS) and delayed complications.ResultsOut of 248 patients, the median age of patients who did not receive brachytherapy was 53 years and the median age of patients who received brachytherapy was 52 years. A statistically significant difference was found in OS, progression-free survival and recurrence-free survival for those who received brachytherapy, with a p value&lt;0·001, 0·01 and 0·004, respectively.ConclusionThe addition of brachytherapy to postoperative external beam radiotherapy improves OS, progression-free survival and local control for patients with intermediate-risk cervical cancer.

Phase I study of weekly PTX+ DDP, and postoperative radiotherapy for early cervical cancer in Chinese women

Objective To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of weekly PTX and DDP concurrent postoperative radiotherapy in Chinese women with high-and intermediate-risk early cervical cancer. Methods Women with high risks postoperative cervical carcinoma, ECOG≤2 were eligible. Pelvis RT (6/10 MV X-ray, 3DCRT 40 Gy/20f, para-metrial boost 10-20 Gy/5-10f) was followed by 2-4f brachytherapy applications (192Ir, 5 Gy/f). Concurrent weekly chemotherapy was started at DDP 20 mg/m2 and PTX 10 mg/m2 weekly, and escalated in three-patient cohorts according to 3+ 3 methods. Results 25 patients were enrolled and treated over seven doses levels until dose-limiting toxicity (DLT) was reached. Median age was 48 years (range, 34-66). All of patients finished RT in 7 weeks. Grade 3, 4 non-hematologic toxicities were diarrhea and observed in two patients (4 cycles, DLT) at level 7.Grade 3, 4 hematologic, principally leukopenia and neutropenia, and occurs late cycles. One grade 4 leukopenia and neutropenia was observed at dose level 6 but not seen in three additional patients. No one was delayed treatment time by concurrent chemotherapy.22 patients finished 6 cycles. Median follow-up is 59.5 months. Three patients have died of cancer metastasis and recurrence. One patient has died of respiratory failure. Conclusions Combination PTX and DDP administered concurrently with pelvic EBRT can be safely administered at the MTD of DDP 35 mg/m2 and PTX 30 mg/m2 weekly for six cycles in Chinese women with postoperative cervical cancer. Key words: Cervical neoplasms/chemoradiotherapy; Radiotherapy, three-dimensional conformal; Chemotherapy, PTX+ DDP; Phase Ⅰ study

Long-Term Follow-Up Results of Simultaneous Integrated or Late Course Accelerated Boost With EBRT to Vaginal Stump in Intermediate-Risk Cervical Cancer Patients After Radical Hysterectomy

Long-Term Follow-Up Results of Simultaneous Integrated or Late Course Accelerated Boost With EBRT to Vaginal Stump in Intermediate-Risk Cervical Cancer Patients After Radical Hysterectomy

Vaginal Dose and Patient Reported Sexual Adjustment With MR-Guided Brachytherapy for Cervical Cancer

Purpose/Objective(s): To assess the efficacy of simultaneous integrated or late course accelerated boost with EBRT to vaginal stump in intermediate risk cervical cancer patients after radical hysterectomy. Materials/Methods: Between October 2009 and January 2012, patients with intermediate risk cervical cancer who had undergone radical surgery for stage IB-IIB were enrolled in this study. Patients were delivered either simultaneous integrated boost intensive modulated radiotherapy (IMRT) / volumetric modulated arc therapy (VMAT) (arm-A) or late course accelerated boost with three dimensionalconformal radiotherapy (3D-CRT) after IMRT/VMAT to the pelvic (arm-B). Chemotherapy with paclitaxel + cisplatin (TP) or 5-Fu + cisplatin (FP) were given concomitantly. The clinical target volume 1 (CTV1) was delineated according to the consensus guidelines of CTV in postoperative treatment of endometrial and cervical cancer. The vaginal dump was delineated to be CTV2. The planning target volume, PTV1 and PTV2 were created by extending the CTV1 and CTV2, respectively, using a margin of 10 mm in the axial plane except in the front of the rectal, where the margin is 5 mm. All the plans were performed in the pinnacle treatment plan system (TPS). In arm-A, 50.4Gy/28f and 60.2Gy/28f were delivered to PTV1 and PTV2, respectively, with simultaneous integrated boost IMRT/VMAT technique. In arm-B, a dose of 50Gy/25f was delivered to the PTV1 with IMRT/VMAT technique; and then, 9Gy/3f was boosted to PTV2 with 3D-CRT. Progress-free survival (PFS), the rate of local-regional failure and distance recurrence were compared between two arms. Results: Overall, 80 patients were enrolled in this study (42 in arm-A, 38 in arm-B). Median follow-up was 37 months (15-49m) in arm A and 32 months (16-47m) in arm B. 3year PFS rates was 90.5% in arm-A and 92.1% in arm-B (pZ 0.78). 3 year rate of local-regional failure and distant metastasis were 2.38% vs. 0%, and 7.14% vs. 7.89%, respectively. Conclusions: Both simultaneous integrated boost IMRT/VMAT and late course accelerated boost with EBRT after IMRT/VMAT to the pelvic are feasible and effective to the intermediate risk cervical cancer patients after radical hysterectomy. Author Disclosure: X. Wang: None. Y. Shen: None. Y. Zhao: None. Z. Li: None. S. Bai: None. F. Xu: None.

A Retrospective Review of Patient Outcomes Following High-Dose-Rate Brachytherapy in the Treatment of Cervical Cancer

Purpose/Objective(s): To assess the efficacy of simultaneous integrated or late course accelerated boost with EBRT to vaginal stump in intermediate risk cervical cancer patients after radical hysterectomy. Materials/Methods: Between October 2009 and January 2012, patients with intermediate risk cervical cancer who had undergone radical surgery for stage IB-IIB were enrolled in this study. Patients were delivered either simultaneous integrated boost intensive modulated radiotherapy (IMRT) / volumetric modulated arc therapy (VMAT) (arm-A) or late course accelerated boost with three dimensionalconformal radiotherapy (3D-CRT) after IMRT/VMAT to the pelvic (arm-B). Chemotherapy with paclitaxel + cisplatin (TP) or 5-Fu + cisplatin (FP) were given concomitantly. The clinical target volume 1 (CTV1) was delineated according to the consensus guidelines of CTV in postoperative treatment of endometrial and cervical cancer. The vaginal dump was delineated to be CTV2. The planning target volume, PTV1 and PTV2 were created by extending the CTV1 and CTV2, respectively, using a margin of 10 mm in the axial plane except in the front of the rectal, where the margin is 5 mm. All the plans were performed in the pinnacle treatment plan system (TPS). In arm-A, 50.4Gy/28f and 60.2Gy/28f were delivered to PTV1 and PTV2, respectively, with simultaneous integrated boost IMRT/VMAT technique. In arm-B, a dose of 50Gy/25f was delivered to the PTV1 with IMRT/VMAT technique; and then, 9Gy/3f was boosted to PTV2 with 3D-CRT. Progress-free survival (PFS), the rate of local-regional failure and distance recurrence were compared between two arms. Results: Overall, 80 patients were enrolled in this study (42 in arm-A, 38 in arm-B). Median follow-up was 37 months (15-49m) in arm A and 32 months (16-47m) in arm B. 3year PFS rates was 90.5% in arm-A and 92.1% in arm-B (pZ 0.78). 3 year rate of local-regional failure and distant metastasis were 2.38% vs. 0%, and 7.14% vs. 7.89%, respectively. Conclusions: Both simultaneous integrated boost IMRT/VMAT and late course accelerated boost with EBRT after IMRT/VMAT to the pelvic are feasible and effective to the intermediate risk cervical cancer patients after radical hysterectomy. Author Disclosure: X. Wang: None. Y. Shen: None. Y. Zhao: None. Z. Li: None. S. Bai: None. F. Xu: None.