Outcomes Of Cervical Cancer Patients Research Articles

PO-1299 Outcomes of cervical cancer patients treated with hybrid CT-X Ray based intracavitary applications.

PO-1299 Outcomes of cervical cancer patients treated with hybrid CT-X Ray based intracavitary applications.

Inflammatory Biomarkers as Promising Predictors of Prognosis in Cervical Cancer Patients

Introduction: Increasing evidence demonstrates a crucial role of inflammation in inducing and promoting several cancers. Pro-inflammatory upregulation of cytokines such as IL-6 has been implicated in cervical cancer development and progression through several mechanisms, for example, by inducing platelet production, activation, and aggregation. The aim of the study was to evaluate the effective prognostic impact of inflammatory biomarkers such as platelet count, platelet to lymphocyte ratio (PLR), and IL-6 in cervical cancer patients. Materials and Methods: Between 2016 and 2019, 108 out of 159 patients with cervical cancer have been enrolled. Cutoff level of pretreatment platelet count and PLR was identified by using the ROC curve. IL-6 tumoral and peritumoral expression was analyzed and stratified as low and high (low expression: 0 and +1; marked expression: +2 and +3). Results: Median follow-up duration was 30 months (range 16–44). Patients with higher platelet counts showed worse DFS and OS (DFS p < 0.001; OS p < 0.001). Cumulative rates of DFS and OS in patients with lower PLR were higher than in patients with higher values of PLR (DFS p = 0.032; OS p < 0.001). Survival analysis showed a better prognosis in patients with lower IL-6 expression (DFS p < 0.001; OS p < 0.001). Conclusion: Nowadays, causal relationship between inflammation, innate immunity, and cancer is more widely accepted. However, many of the molecular and cellular mechanisms mediating this relationship remain unresolved. Ongoing inflammatory response was associated with poor outcomes in cervical cancer patients. A higher pretreatment platelet count and PLR value associated with higher IL-6 tumoral expression could be used to predict poor prognosis in cervical cancer patients.

Survival outcomes of minimally invasive surgery for early-staged cervical cancer: A retrospective study from a single surgeon in a single center

Recent studies have shown that minimally invasive surgery (MIS) is associated with a higher recurrence rate in patients with early-stage cervical cancer. In this study, we aim to report the survival outcomes of patients with early-stage cervical cancer who received MIS, performed in a single center by the same surgeon. Eligible participants included patients with early-stage cervical cancer in stage IA1 with lymphovascular space invasion (LVSI+), IA2, and IB1. The surgeries were carried out by a single surgeon and survival outcomes of the 137 patients were evaluated retrospectively. The median follow-up time for the 137 patients was 53 (25-94) months, with the five-year disease-free survival (DFS) rate of 96.4% and the five-year overall survival (OS) rate of 96.8%. Among them, six (4.38%) patients relapsed and four (2.92%) of whom died. The five-year DFS rate was significantly higher in patients with tumor≤2cm in size than in those with tumor >2cm(P=0.013), however, with no significant difference in the five-year OS rate (P=0.219). According to the existing literature and the results of this study, for MIS, the proficiency levels of a surgeon may be associated with survival outcomes of cancer patients. Tumor size may also be an important factor affecting survival outcomes of cervical cancer patients.

PO-0178 Feasibility and Outcomes for Cervical Cancer Patients Treated with Hybrid Brachytherapy Applicators

PO-0178 Feasibility and Outcomes for Cervical Cancer Patients Treated with Hybrid Brachytherapy Applicators

Malnutrition and the Survival of Cervical Cancer Patients: A Prospective Cohort Study Using the PG-SGA Tool

Background Cervical cancer is the second most common cancer among women in developing countries. Malnutrition is associated with poor prognosis and early detection of malnutrition and timely nutritional interventions can improve the outcome for cervical cancer patients. The study was aimed to assess the association between the nutritional status and survival of cervical cancer patients. Methods A prospective cohort study design was used. Overall 175 cervical cancer patients were followed over one year period with (median 8.5 mo, range (3.6-12). Results The prevalence of malnutrition determined by means of the PG-SGA was 17.7% at admission and 47.1% at the end of follow-up. According to the SGA, one in three (29.7%) patients required nutritional intervention at the end of follow-up. Patients who were malnourished (PG-SGA-B and C) had an increased risk of mortality (Hazard Ratio [HR]: 3.12, 95% CI: 1.23 − 7.86) as compared to those who were well nourished (PG-SGA-A). Patients from rural areas had an increased risk of mortality (HR: 6.99, 95% CI: 2.07 − 23.58) compared to patients from urban areas. Conclusion In the context of developing country setting and COVID19 outbreak, malnutrition significantly decreases cervical cancer survival. A thorough nutrition assessment using scored PG-SGA is needed.

Effects of Supportive Group Therapy on Levels of Hopelessness in Patients with Cervical Cancer at Cancer Diseases Hospital in Lusaka, Zambia

Background: Hopelessness is a subjective appraisal of negative expectations about the occurrence of a highly valued outcome coupled with the sense that one lacks control over desired events in the future. Hopelessness is an early symptom of depression and is comorbid with cervical cancer. Supportive Group therapy offers an economical and time efficient solution. In Zambia and particularly at Cancer Disease Hospital such structured supportive group therapy is not being offered. This study aims to ascertain whether supportive group therapy can reduce levels of hopelessness in cervical cancer patients at Cancer disease hospital in Lusaka Zambia.Methodology: This was a double blinded Randomized Controlled Trial conducted at Cancer Disease Hospital in Lusaka Zambia. It wasconducted between March 2019 and September 2020. Patients with histologically confirmed diagnosis of cervical cancer were recruited. Sociodemographic characteristics and clinical presentations were elicited by detailed history taking and file review. All the participants completed PreHAI Questionnaire and their results were noted. They were then divided into a control and intervention group using computer generated numbers. The intervention group then attended one hour Supportive group therapy sessions weekly for four weeks. The control group continued to receive the usual support of their family members and Cancer disease hospital staff. Both groups were then administered the Post- HAI Questionnaire and their results were noted.Results: 49 patients were recruited. Patient retention was 92% (n= 45). Majority of the participants were of the age group 41-50 years i.e. control group (n =12) intervention group (n= 7). Majority were; married control (n= 11) intervention (n= 12), unemployed control (n=14) intervention (n= 18), had social support control (n=14) intervention (n= 18). Only social support correlated with lower HAI scores (p= 0.047). There was no correlation between therapy and post HAI scores as both p- values i.e. control (p= 0.683) intervention (p= 0.368) were greater than confidence interval 0.05. The intervention group had a greater reduction in HAI scores from (p= 0.621 to p= 0.368) in comparison to the control group (p= 0.707 to p= 0.683).Conclusion: There was a difference (yet statistically insignificant) in treatment outcomes of cervical cancer patients receiving supportive group therapy to those not receiving supportive group therapy. That is to say that the intervention group showed a greater reduction in HAI scores in comparison to the control group. Social support is the only significant factor associated with lower levels of hopelessness.

Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation

Diversity of the gut microbiome is associated with higher response rates for cancer patients receiving immunotherapy but has not been investigated in patients receiving radiation therapy. Additionally, current studies investigating the gut microbiome and outcomes in cancer patients may not have adjusted for established risk factors. Here, we sought to determine if diversity and composition of the gut microbiome was independently associated with survival in cervical cancer patients receiving chemoradiation. Our study demonstrates that the diversity of gut microbiota is associated with a favorable response to chemoradiation. Additionally, compositional variation among patients correlated with short term and long-term survival. Short term survivor fecal samples were significantly enriched in Porphyromonas, Porphyromonadaceae, and Dialister, whereas long term survivor samples were significantly enriched in Escherichia Shigella, Enterobacteriaceae, and Enterobacteriales. Moreover, analysis of immune cells from cervical tumor brush samples by flow cytometry revealed that patients with a high microbiome diversity had increased tumor infiltration of CD4+ lymphocytes as well as activated subsets of CD4 cells expressing ki67+ and CD69+ over the course of radiation therapy. Modulation of the gut microbiota before chemoradiation might provide an alternative way to enhance treatment efficacy and improve treatment outcomes in cervical cancer patients.

Long-Term Outcomes of Cervical Cancer Patients Treated With Definitive Chemoradiation Following a Complete Metabolic Response

AimsA complete metabolic response (CMR) on early post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a positive prognostic factor for cervical cancer patients treated with definitive chemoradiation, but long-term outcomes of this group of patients are unknown. Patterns of failure and risk subgroups are identified. Materials and methodsPatients who received curative-intent chemoradiation from 1998 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IB1–IVA cervical cancer and had a CMR on post-treatment FDG-PET within 5 months of treatment completion were included. Cox proportional hazards models determined factors associated with locoregional and distant failure. Kaplan–Meier estimates of freedom from any recurrence (FFR) of patient subgroups were compared with Log-rank tests. ResultsThere were 402 patients with a CMR after chemoradiation on FDG-PET. Initial T stage was T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%); initial FDG-avid nodal status was no nodes (50%)/pelvic lymph nodes (40%)/pelvic and para-aortic lymph nodes (10%). After a median follow-up of 6 years, 109 (27%) recurred. The pattern of recurrence was locoregional (27%), distant (61%) or both (12%). No factors were associated with locoregional failure. Distant recurrence was more likely in patients with T3–4 lesions (hazard ratio = 2.4, 95% confidence interval 1.5–3.8) and involvement of pelvic (hazard ratio = 1.6, 95% confidence interval 1.0–2.7) or para-aortic lymph nodes (hazard ratio = 2.7, 95% confidence interval 1.4–5.0) at diagnosis. The 5-year FFR rates for T1–2 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 85, 76 and 62%, respectively (P = 0.04, none versus para-aortic nodes). The 5-year FFR for T3–4 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 68, 56 and 25%, respectively (P = 0.09, none versus para-aortic nodes). ConclusionsT3–4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation.

Targeting the PD-1 Axis with Pembrolizumab for Recurrent or Metastatic Cancer of the Uterine Cervix: A Brief Update.

Even though cervical cancer is partly preventable, it still poses a great public health problem throughout the world. Current therapies have vastly improved the clinical outcomes of cervical cancer patients, but progress in new systemic treatment modalities has been slow in the last years. Especially for patients with advanced disease this is discouraging, as their prognosis remains very poor. The pathogen-induced nature, the considerable mutational load, the involvement of genes regulating the immune response, and the high grade of immune infiltration, suggest that immunotherapy might be a promising strategy to treat cervical cancer. In this literature review, we focus on the use of PD-1 blocking therapy in cervical cancer, pembrolizumab in particular, as it is the only approved immunotherapy for this disease. We discuss why it has great clinical potential, how it opens doors for personalized treatment in cervical cancer, and which trials are aiming to expand its clinical use.

Argonaute 3 (AGO3) promotes malignancy potential of cervical cancer via regulation of Wnt/β-catenin signaling pathway

We aimed to investigate the biological roles of Argonaute 3 (AGO3) in cervical cancer. RNA profiles containing 306 cervical cancer tissues and 13 normal samples revealed that AGO3 was significantly up-regulated in cervical cancer, and the expression of AGO3 was negatively associated with the outcome of cervical cancer patients. Cell proliferation and transwell assays showed that the depletion of AGO3 markedly inhibited cervical cancer cell growth and mobility. Importantly, we detected that knockdown of AGO3 exerted suppressive effect on cellular behaviors via inactivating Wnt/β-catenin signaling pathway. Collectively, we conclude that AGO3 is a novel tumor promoter in cervical cancer and has a potential to be a drug target and prognostic predictor of cervical cancer patients.

Effect of Quality Control Program in Surgical Management of Early Cervical Cancer.

BackgroundRegular assessments of clinical performance in gynecologic cancer surgery is important for the safety of patients. We evaluated the effects of quality control (QC) program on the treatment pattern and clinical outcomes of early cervical cancer.MethodsMedical records of cervical cancer patients who received operation in our institution from January 2007 to December 2018 were retrospectively reviewed. Cases were divided into 2 groups, before and after the initiation of QC program, group 1 (2007–2013) and group 2 (2014–2018), based on the operation date. Two groups were compared in clinicopathologic variables, surgical methods, operative details, adjuvant treatments, recurrence and survival.ResultsA total of 305 cervical cancer patients were included in the analysis, 210 in group 1 and 95 in group 2. In group 2, minimally invasive surgery (MIS) was more frequently performed (60.0% vs. 76.8%, P = 0.004), especially in earlier stages (stage IA, 72.6% vs. 100.0%; stage IB, 52.2% vs. 69.5%). However, the median tumor size treated by MIS was decreased in stage IB (20 mm vs. 17 mm, P = 0.015). Frequency of adjuvant treatment was also reduced in stage IB (56.5% vs. 37.3%, P = 0.016). Recurrence within 3 years, 3-year disease free survival and overall survival did not show significant difference; however, 3-year recurrence after MIS was significantly reduced in stage IB.ConclusionQC program enforced stricter patient selection criteria for MIS and positively affected clinical outcomes in cervical cancer patients who underwent surgery. Systemic monitoring should be considered for patient safety.

Long-term outcomes of cervical cancer patients with complete metabolic response after definitive chemoradiotherapy.

ObjectiveWe investigated the importance of metabolic parameters measured with 18F-fluorodeoxyglucose positron-emission tomography integrated with computed tomography (FDG-PET/CT) for predicting progression-free survival (PFS) and overall survival (OS) in cervical cancer with complete metabolic response (CMR) after chemoradiotherapy (ChRT).MethodsThe clinical data and PET parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of 122 patients having CMR in post-treatment 18F-FDG-PET/CT delivered a median of 3.9 months after ChRT completion were analyzed.ResultsWith a median follow-up of 8.4 years, 55 patients (45%) presented with disease a median of 19.7 months after ChRT. For SUVp, MTVp, TLGp, SUVln, MTVln, and TLGp, the cut-off values for OS determined by receiver operating curve analysis were 15.8, 48.7 cm3, 552.3, 8.7, 7.0 cm3, respectively. All metabolic PET parameters were significant prognostic factors for OS and PFS in univariate analysis. International Federation of Gynecology and Obstetrics (FIGO) stage was predictive of both OS and PFS, while pelvic and/or para-aortic lymph node metastasis were predictive of OS only. In multivariate analysis, FIGO stage ≥IIB, MTVp ≥49.8 cm3, and TLGp ≥597.4 were predictive of worse OS. Advanced stage, presence of lymph node metastasis, higher TLGp, and larger MTVln were significant factors for poor PFS rates.ConclusionWe found that advanced stage and higher TLGp values were significant predictors for poor survival and higher progression rates. Volumetric PET parameters could be used to predict treatment outcomes in patients with CMR after definitive ChRT.

PRMT5 disruption drives antitumor immunity in cervical cancer by reprogramming T cell-mediated response and regulating PD-L1 expression.

Rationale: Protein arginine methyltransferase 5 (PRMT5) is an oncogene that promotes tumor cell proliferation, invasion and metastasis. However, the underlying mechanisms by which PRMT5 contributes to the progression of cervical cancer and especially the tumor microenvironment remain poorly understood.Methods: PRMT5 expression level was analyzed by Q-PCR, western blot, immunohistochemistry, and TCGA database. The role of PRMT5 in tumor growth was observed by transplanted tumor models, and the function of T cells in tumor microenvironment and in vitro co-culture system was investigated through flow cytometry. The transcriptional regulation of PRMT5 was analyzed using luciferase reporter and chromatin immunoprecipitation (ChIP) assay. The therapeutic effect of PRMT5 inhibitor was evaluated in a cervical cancer cell line transplanted tumor model.Results: We observed that the mRNA and protein expression levels of PRMT5 were increased in cervical cancer tissues, and the high expression of PRMT5 was associated with poor outcomes in cervical cancer patients. The absence of PRMT5 significantly inhibited tumor growth in a cervical cancer transplanted tumor model, and importantly, PRMT5 absence in tumors led to increase the number and enhance the function of tumor infiltrating T cells. Mechanistically, PRMT5 enhanced the transcription of STAT1 through symmetric dimethylation of histone H3R2 and thus promoted PD-L1 expression in cervical cancer cells. Moreover, in an in vitro co-culture system, knockdown of PRMT5 in tumor cells could directly enhance the expression of IFN-γ, TNF-α and granzyme B in T cells. These results suggested that PRMT5 promoted the development of cervical cancer by the crosstalk between tumor cells and T cells. Furthermore, the PRMT5 inhibitor EPZ015666 treatment could suppress tumor growth in a cervical cancer transplanted tumor model.Conclusion: Our results clarify a new mechanism which PRMT5 knockdown in cervical cancer cells drives an antitumor function via reprogramming T cell-mediated response and regulating PD-L1 expression. Thus, our study highlights that PRMT5 may be a potential target for cervical cancer therapy.

Apolipoprotein C1 (APOC1): A Novel Diagnostic and Prognostic Biomarker for Cervical Cancer.

BackgroundPrevious reports showed that APOC1 was associated with several cancers but the function of APOC1 in cervical cancer was unknown. This study aimed to investigate the clinical effect and function of APOC1 in cervical cancer.Materials and MethodsIn this study, the relative expression of APOC1 in cervical cancer was detected by RT-qPCR. In order to determine the cell proliferation and migration and invading ability and apoptosis more accurately, we used CCK8 assay, Edu assay, wound healing assay, migration and invasion assay, flow cytometry assay, co-immunoprecipitation, proteomics and Western blot by silencing and overexpressing APOC1, respectively. The role of APOC1 on tumor progression was explored in vitro and vivo.ResultsThe relative expression of APOC1 in cervical cancer tissues was up-regulated (P<0.05). In cervical cancer cell lines, silencing of APOC1 restrained cell progression and EMT, while over-expression of APOC1 accelerated cell progression and EMT in vivo and vitro (P<0.05).ConclusionAPOC1 acts as an oncogene in cervical cancers and knockdown of APOC1 inhibited cervical cancer cells growth in vitro and in vivo. There is a close relationship between the relative expression of APOC1 and clinical outcome in cervical cancer patients.

Abstract PO-230: Improved clinical outcomes with shorter intervals between concurrent chemoradiation and brachytherapy in FIGO IB2-IVA cervical cancer patients among a predominantly African-American population

Abstract Purpose: To assess if the time interval between concurrent chemo radiotherapy [conc ChemoRT] followed by brachytherapy [B] determines the clinical outcomes in cervical cancer patients (FIGO stage IB2 – IVA) among a predominantly African- American population in a state university medical center. Methods: A retrospective analysis of 147 cervical cancer patients diagnosed with stage IB2- IVA treated with conc ChemoRT followed by B at various time intervals between 2005 and 2018 was performed. Survival analysis with several treatment [TX] duration interval parameters (pre 2010 and post 2010 to evaluate the significant organizational advancements); conc ChemoRT and B completed ≤ 60 days and &amp;gt; 60 days per American College of Surgeons cervical cancer surveillance measure; and TX intervals 6 to 10 weeks were evaluated. The overall survival [OS], local control [LC] and distant control [DC] were estimated by using Kaplan- Meier method. Uni, bi and multi- variable Cox hazard regression analyses were used to compare the risk of death among cervical cancer patients with different TX intervals. The SPSS v.24.0 was used for statistical analyses. Results: The 147 cervical cancer patients (median age, 55 y; range 28-83 y) had a median follow-up of 32 months (range 0 to 164 months). Our patient cohort included 34% patients treated pre 2010 and 66% post 2010; 42.2% ≤60 days and 57.8% &amp;gt; 60 days; 53.1% ≤ 6 to 8 weeks, 12.2% ≤ 8 to 10 weeks and 34.7% d&amp;gt;10 weeks. The patients diagnosed and treated post 2010 had better 5-year OS rates (65% vs. 32%) compared to pre 2010; p=0.000; patients treated ≤ 60 days had better 5-year OS rates (59.3% vs. 40.3%) to &amp;gt; 60 days; p=0.094; patients treated ≤ 6 to 8 weeks had better 5-year OS rates (56.1% vs. 53.1% and 34.3%) compared to ≤ 8 to 10 weeks and &amp;gt; 10 weeks; p=0.188 respectively. The 5-y OS rates for FIGO stages were IB2 (65.8%); IIA (62.5%); IIB (40.4%); IIIA (50%); IIIB (42.4%); and IVA (25.2%); p=0.508. There was no trend for improved LC (p=0.331; p=0.962; p=0.616) and DC (p= 0.284; p=0.596; p=0.606) observed among patients with different TX intervals. In the bi-variate analysis for TX year group, after adjusting for age, race, insurance, income level, distance travelled, tobacco exposure, alcohol history, and tumor stage, BMI-lower had twice the risk of death (hazard ratio [HR], 2.74; 95% CI, 1.34-5.59; p= 0.005). For patients treated ≤ 60 days, their insurance-private had a 63% reduction (HR, 0.37; 95% CI, 0.15-0.90; p=0.029), and for the weekly TX group by the multivariate analysis, insurance-private showed a 76% reduction in the risk of death (HR, 0.35; 95% CI, 0.14-0.87; p=0.024). Conclusion: Our analysis suggests better OS among patients diagnosed and treated post 2010; ≤ 60 days duration; and ≤ 6 to 8 weeks with a shorter interval between conc ChemoRT and B to be superior to that of the patients undergoing longer TX’s. Citation Format: Mary R. Nittala, Satyaseelan Packianathan, Eswar K. Mundra, Maurice L. King, Shivanthidevi Gandhi, Robert M. Albright, Maria L. Smith, William C. Woods, Toms V. Thomas, Mildred Ridgway, Srinivasan Vijayakumar. Improved clinical outcomes with shorter intervals between concurrent chemoradiation and brachytherapy in FIGO IB2-IVA cervical cancer patients among a predominantly African-American population [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-230.

Prognostic implication of human papillomavirus types in cervical cancer patients: a systematic review and meta-analysis

BackgroundTo estimate the prognostic relevance of human papillomavirus (HPV) 16 and HPV 18 in patients with cervical cancer.MethodWe searched PubMed, EMBASE, American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO), CNKI, and Wanfang databases to search primary articles illustrating the survival outcomes in cervical cancer patients with or without HPV 16/18 infection. A meta-analysis was conducted to generate a combined hazard ratio (HR) with 95% confidence intervals (CI) for progression-free survival (PFS), disease free survival (DFS) and overall survival (OS).ResultsA total of 13 studies were included. Our meta-analysis revealed that HPV 16 positive did not have any impact on OS (HR, 0.76; 95% CI = 0.37–1.54; P = 0.44). Cervical cancer patiensts infected with HPV 18 had worse OS (HR, 1.66; 95% CI = 1.28–2.17; P = 0.0001), DFS (HR, 2.10; 95% CI = 1.73–2.54; P < 0.0001) and worse PFS (HR, 2.97; 95% CI = 1.69–5.23; P = 0.00012) compared with those not infected with HPV 18. cervical cancer patiensts infected with HPV 18 had worse PFS compared with those infected with HPV 16 ((HR, 1.34; 95% CI = 1.06–1.70; P = 0.01).ConclusionCervical cancer patients infected with HPV 18 had worse survival compared with cervical cancer patients with HPV 16 infection.

Treatment Outcome of Cervical Cancer Patients Treated with Low-Versus High Dose Rate Brachytherapy after Concurrent Chemo-Radiation

Cervical cancer (CC) is the commonest gynecological cancer seen in the Ghanaian woman. Majority of patients here present with locally advanced diseases due poor screening practices aimed at detecting and treating precancerous conditions. The current standard curative treatment for locally advanced CC is concurrent cisplatin-based chemo-radiation plus intracavitary brachytherapy. The brachytherapy (BT) component has been Low-Dose Rate (LDR) BT for almost a century now until a few decades ago when High-Dose Rate (HDR) BT was developed to overcome disadvantages of LDR BT such as long treatment duration. In October 2014, HDR BT was introduced as the BT technique for the management of CC patients at this Centre, after several years of using LDR BT. The hypothesis for this study was that there was no difference in the treatment outcomes of CC patients treated with HDR BT compared with those who received LDR BT at this center. The aim of this study was to compare the treatment outcomes and toxicity of CC patients treated with LDR BT versus HDR BT treated at this Centre. Patients with histologically confirmed CC treated from January 2008 to December 2017 were enrolled after applying the inclusion and exclusion criteria. Information regarding patient demographics, stage of disease, type of BT received, total radiation dose received, response to treatment and treatment related toxicities experienced were extracted from the medical records of the patients. The primary end points of the study included local control (LC), disease free survival (DFS) and overall survival (OS) all at 2 years. Toxicities were also assessed. Primary endpoints were estimated using the Kaplan-Meier method. Comparisons between treatment groups were performed using the log-rank test and Cox proportional hazards models. Over the 10-year period, 284 LDR (2008 –mid-2014) and 136 HDR (mid-2014-2017) patients fit the inclusion criteria. The median follow-up was 22 months (1-132months) vs. 11 months (1-41months) in LDR vs. HDR group respectively. For stages IB, IIA, IIB, IIIA and IIIB disease, the 2-year LC rates for LDR vs. HDR were 63 % vs. 61% p = 0.348, 86% vs. 90% p = 0.680, 86% vs. 88% p = 0.829, 66% vs. 60% p = 0.556 and 77% vs. 40% p = 0.005 respectively. The 2-year DFS for LDR vs. HDR BT were 64% vs. 61% p = 0.495, 81% vs. 69% p = 0.179, 81% vs. 80% p = 0.540, 62% vs. 33%, p = 0.818, and 71% vs.30%, p = 0.001 for stages IB, IIA, IIB, IIIA and IIIB respectively. The OS were comparable in both treatment groups stage for stage. Frequencies of acute and chronic toxicities for LDR vs. HDR were 22.6 % vs. 23.5%, and 3.9% vs. 6.9%, respectively. Comparable LC, DFS and OS were observed for IB, IIA, IIB and IIIA patients treated with LDR vs. HDR BT. HDR BT for the treatment of CC is therefore an acceptable alternative to LDR BT. However, the poorer LC and DFS rates observed for IIIB patients, and the higher frequencies of toxicities in the HDR BT cohort highlights the need for refining the HDR BT techniques at the Centre.

Salvage Concurrent Chemoradiotherapy Should be Considered for Local Recurrence after Radical Hysterectomy in Cervical Cancer

Little is known about the impact of salvage chemoradiotherapy on the long-term outcomes of cervical cancer patients with recurrence after radical hysterectomy. This study aims to evaluate the efficacy and safety of salvage chemoradiotherapy and share our own experience. 95 cervical cancer patients with local recurrence received salvage chemoradiotherapy between January 2011 and November 2018. All patients had not received adjuvant pelvic radiotherapy before. The dose of residual tumor and metastatic lymph nodes were all boosted to 64-82Gy (EQD2, a/β = 10) after pelvic irradiation in 50Gy/25F. The boost techniques were three-dimensional conformal radiotherapy, intensity-modulated radiotherapy or brachytherapy. Cisplatin-based chemotherapy was given concurrent with radiotherapy. Kaplan-Meier survival curve was used to analyze the outcomes of the patients. The median age of all patients was 51 years (range: 26-75 y). Median time from surgery to recurrence was 19.2 months (range：0.6-131.8 months). 91 patients had squamous cell carcinoma (95.8%), and 4 patients had adenocarcinoma (4.2%). The maximum diameter of residual mass with≥3cm occurred in 51 cases (53.7%). There were 26 cases (27.4%) with lymph node metastasis and 10 cases (10.5%) with adjacent organ invasion. 80 patients (84.2%) had received total radiation dose of 64-70Gy (EQD2, a/β = 10) for recurrent lesions, while 15 patients (15.8%) got 71-82Gy. 75 patients (78.9%) received concurrent chemotherapy. The median follow-up time was 32.7 months (range: 3.4-100.6 months). 13 patients died during follow-up. Kaplan-Meier survival curve analysis showed that the 3-year overall survival （OS）, disease-free survival (DFS), distant metastasis-free survival (DMFS), and local control （LC） were 87.5%, 84.6%, 84.8%, and 92.3%, respectively. 3-year OS for patients with vs without adjacent organ invasion was 58.7% and 94.8%, respectively (P < 0.001). 3-year OS for patients with or without lymph node metastasis was 50.5% and 91.8%, respectively (P = 0.007). 3-year OS for patients with mass ≥3cm or < 3cm was 80.5% and 95.4%, respectively (P = 0.018). The higher radiotherapy dose did not improve the local control rate. And the 3-year local control rate (LC) with total irradiation dose of 64-70Gy and 71-82Gy was similar 92.3% (p = 0.913). The number of patients with grade 3 or 4 myelosuppression during treatment was 40 cases (42.1%), and grade 3 or 4 gastrointestinal toxicity was 1 case (1.1%). There was no grade 3 or 4 late complication, according to RTOG toxicity grading. Salvage concurrent chemoradiotherapy for patients with local recurrence after radical hysterectomy showed favorable clinical outcomes without severe complications.

Impact of the Learning Curve on the Survival of Abdominal or Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer.

PurposeThe objective of this study was to define the learning curve required to attain satisfactory oncologic outcomes of cervical cancer patients who were undergoing open or minimally invasive surgery for radical hysterectomy, and to analyze the correlation between the learning curve and tumor size.Materials and MethodsCervical cancer patients (stage IA–IIA) who underwent open radical hysterectomy (n=280) or minimal invasive radical hysterectomy (n=282) were retrospectively reviewed. The learning curve was evaluated using cumulative sum of 5-year recurrence rates. Survival outcomes were analyzed based on the operation period (“learning period,” P1 vs. “skilled period,” P2), operation mode, and tumor size.ResultsThe 5-year disease-free and overall survival rates between open and minimally invasive groups were 91.8% and 89.0% (p=0.098) and 96.1% and 97.2% (p=0.944), respectively. The number of surgeries for learning period was 30 and 60 in open and minimally invasive group, respectively. P2 had better 5-year disease-free survival than P1 after adjusting for risk factors (hazard ratio, 0.392; 95% confidence interval, 0.210 to 0.734; p=0.003). All patients with tumors < 2 cm had similar 5-year disease-free survival regardless of operation mode or learning curve. Minimally invasive group presented lower survival rates than open group when tumors ≥ 2 cm in P2. Preoperative conization improved disease-free survival in patients with tumors ≥ 2 cm, especially in minimally invasive group.ConclusionMinimally invasive radical hysterectomy required more cases than open group to achieve acceptable 5-year disease-free survival. When tumors ≥ 2 cm, the surgeon’s proficiency affected survival outcomes in both groups.

Management and outcomes of partial metabolic response on post-therapy positron emission tomography in cervical cancer patients treated with definitive radiation

Objective: The aim of this study was to describe the management and analyze the outcomes of cervical cancer patients with a partial metabolic response on post-radiation 18F-fluorodeoxyglucose positron emissions tomography (FDG-PET) scan.