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21.10.2021 | original article

Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer

A retrospective single institution study

verfasst von: Krešimir Tomić, MD, Gordana Berić Jozić, Ana Parić, Inga Marijanović, Ivan Lasić, Dragan Soldo, Eduard Vrdoljak

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 21-22/2021

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Summary

Background

Given the lack of primary and secondary prevention programs and cancer awareness in general, cervical cancer remains one of the main causes of cancer-related death in developing countries, such as Bosnia and Herzegovina. Optimization of combinations of external radiation therapy (ERT), brachytherapy and chemotherapy is still needed to improve outcomes in the treatment of advanced cervical cancer.

Patients and methods

We retrospectively analyzed 48 consecutive patients with Fédération Internationale de Gynecologie et d’Obstetrique (FIGO) 2009 stage IB2-IVA, who were treated with primary concomitant chemobrachyradiotherapy (CCBRT) and consolidation chemotherapy at the Department of Oncology, University Hospital Mostar, Bosnia and Herzegovina between December 2012 and June 2020. Patients were treated with ERT plus two cycles of concomitant chemobrachytherapy with ifosfamide and cisplatin and low-dose rate (LDR) brachytherapy followed by four cycles of consolidation chemotherapy at 3‑week intervals. We evaluated local control rate (LCR), disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and toxicity.

Results

After 45.5 months (interquartile range, IQR = 47 months) of median follow-up, 5‑year DFS was 72.8% (95% confidence interval. CI 59–78%), OS was 76.6% (95% CI 60–79%), and DSS was 88% (95% CI 71–86%) with acceptable toxicity. LCR was 94%.

Conclusion

Primary CCBRT and consolidation chemotherapy applied in standard clinical practice in the treatment of locally advanced cervical cancer (LACC) produce respectable outcomes.

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Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8:e191–e203. https://doi.org/10.1016/S2214-109X(19)30482-6.CrossRefPubMed

Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;7:889–99. https://doi.org/10.1016/S0140-6736(13)60022-7.CrossRef

Ditzian LR, David-West G, Maza M, et al. Cervical cancer screening in low- and middle-income countries. Mt Sinai J Med. 2011;78:319–26. https://doi.org/10.1002/msj.20263.CrossRefPubMed

Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–61. https://doi.org/10.1056/NEJM199904153401503.CrossRefPubMed

Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–43. https://doi.org/10.1056/NEJM199904153401501.CrossRefPubMed

Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–53. https://doi.org/10.1056/NEJM199904153401502.CrossRefPubMed

Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a gynecologic oncology group and southwest oncology group study. J Clin Oncol. 1999;17:1339–48. https://doi.org/10.1200/JCO.1999.17.5.1339.CrossRefPubMed

Peters WA 3rd, Liu PY, Barrett RJ 2nd, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–13. https://doi.org/10.1200/JCO.2000.18.8.1606.CrossRefPubMed

Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12. https://doi.org/10.1200/JCO.2008.16.4368.CrossRefPubMedCentral

10.

Todo Y, Watari H. Concurrent chemoradiotherapy for cervical cancer: background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups. Chin J Cancer Res. 2016;28:221–7. https://doi.org/10.21147/j.issn.1000-9604.2016.02.10.CrossRefPubMedPubMedCentral

11.

National Comprehensive Cancer Network. Cervical cancer. 2021. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed 30 Dec 2020.

12.

Wong LC, Ngan HY, Cheung AN, et al. Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol. 1999;17:2055–60. https://doi.org/10.1200/JCO.1999.17.7.2055.CrossRefPubMed

13.

Tang J, Tang Y, Yang J, Huang S. Chemoradiation and adjuvant chemotherapy in advanced cervical adenocarcinoma. Gynecol Oncol. 2012;125:297–302. https://doi.org/10.1016/j.ygyno.2012.01.033.CrossRefPubMed

14.

Vrdoljak E, Prskalo T, Omrcen T, et al. Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: results of a phase II study. Int J Radiat Oncol Biol Phys. 2005;61:824–9. https://doi.org/10.1016/j.ijrobp.2004.06.248.CrossRefPubMed

15.

Petrić Miše B, Boraska Jelavić T, Strikic A, et al. Long follow-up of patients with locally advanced cervical cancer treated with concomitant chemobrachyradiotherapy with cisplatin and ifosfamide followed by consolidation chemotherapy. Int J Gynecol Cancer. 2015;25:315–9. https://doi.org/10.1097/IGC.0000000000000336.CrossRefPubMed

16.

World Medical Association. World medical association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4. https://doi.org/10.1001/jama.2013.281053.CrossRef

17.

National Cancer Institute. NCI funded research portfolio. 2020. http://fundedresearch.cancer.gov/nciportfolio/. Accessed 30 Dec 2020.

18.

Choi CH, Lee JW, Kim TJ, et al. Phase II study of consolidation chemotherapy after concurrent chemoradiation in cervical cancer: preliminary results. Int J Radiat Oncol Biol Phys. 2007;68:817–22. https://doi.org/10.1016/j.ijrobp.2006.12.038.CrossRefPubMed

19.

Zhang MQ, Liu SP, Wang XE. Concurrent chemoradiotherapy with paclitaxel and nedaplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: preliminary results of a phase II study. Int J Radiat Oncol Biol Phys. 2010;78:821–7. https://doi.org/10.1016/j.ijrobp.2009.08.069.CrossRefPubMed

20.

Mahasittiwat P, Leumwananonthachai N, Setakornnukul J, et al. Phase II consolidation chemotherapy with ifosfamide and cisplatin in locally advanced squamous cell carcinoma of the cervix uteri. Int J Radiat Oncol Biol Phys. 2011;81:452. https://doi.org/10.1016/j.ijrobp.2011.06.969.CrossRef

21.

Dueñas-González A, Zarbá JJ, Patel F, et al. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol. 2011;29:1678–85. https://doi.org/10.1200/JCO.2009.25.9663.CrossRefPubMed

22.

Tangjitgamol S, Tharavichitkul E, Tovanabutra C, et al. A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial. J Gynecol Oncol. 2019;30:e82. https://doi.org/10.3802/jgo.2019.30.e82.CrossRefPubMedPubMedCentral

23.

Lorvidhaya V, Chitapanarux I, Sangruchi S, et al. Concurrent mitomycin C, 5‑fluorouracil, and radiotherapy in the treatment of locally advanced carcinoma of the cervix: a randomized trial. Int J Radiat Oncol Biol Phys. 2003;55:1226–32. https://doi.org/10.1016/s0360-3016(02)04405-x.CrossRefPubMed

24.

Jelavić TB, Miše BP, Strikic A, Ban M, Vrdoljak E. Adjuvant chemotherapy in locally advanced cervical cancer after treatment with concomitant chemoradiotherapy—room for improvement? Anticancer Res. 2015;35:4161–5.PubMed

25.

Datta NR, Stutz E, Liu M, et al. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: a systematic review and meta-analysis. Gynecol Oncol. 2017;145:374–85. https://doi.org/10.1016/j.ygyno.2017.01.033.CrossRefPubMed

Titel: Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer
A retrospective single institution study
verfasst von: Krešimir Tomić, MD
Gordana Berić Jozić
Ana Parić
Inga Marijanović
Ivan Lasić
Dragan Soldo
Eduard Vrdoljak
Publikationsdatum: 21.10.2021
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift / Ausgabe 21-22/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-021-01958-0

Springer Medizin Österreich

Summary

Background

Patients and methods

Results

Conclusion

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