Radiochemotherapy to treat cervical cancer
Long-term results
Abstract
Introduction: radiochemotherapy may be used to cure cervical cancer, particularly for patients treated in Uruguayan hospitals, whose diagnosis is made in locally advanced stages. The study aims to analyse therapy results and chronic toxicity of such treatment at the Pereira Rossell Hospital Center (CHPR).
Method: 164 carriers of cervical-uterine cancer who completed the radiochemotherapy treatment between June 2006 and November 2008 were included in the study. External radiochemotherapy consisted in pelvic irradiation (in combination with weekly cisplatin) and uterus-vaginal brachytherapy. Effective biological doses for tumor were calculated, for the rectum and the bladder. Locoregional control rate and survival after 5 years, as well as chronic complications, were analysed using the Kaplan-Meier method.
Results: global five-year survival rate was 67%, there being significant differences between stage II (78%) and stage III (49%) (Log-rank test, p = 0.0002). According to RTOG (Radiation Therapy Oncology Group) Grade 3/4 chronic complications rate was 1.8% for urinary complications and 3.7% for digestive complications.
Initial local control was 89% and lesion persistence was 10.3%, locoregional recurrence (LR) throughout the period was 19.5%; metastases with and without LR was 10.3%.
Conclusions: therapeutic effectiveness of radiochemotherapy for to treat cervical cancer is confirmed in our context. In most cases recurrence or persistence resulted from lack of locoregional follow-up after initial treatment. Treatment was well tolerated, with low percentage of chronic complications, what is comparable to international literature.
References
(2) Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61(2):69-90.
(3) Rodríguez G, Alonso R. Programa de Prevención de Cáncer de Cuello Uterino en el Uruguay. Montevideo: CHLCC, 2008.
(4) Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350(9077):535-40.
(5) Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev 2010; (1):CD008285.
(6) 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(35):5802-12.
(7) Leborgne F, Leborgne JH, Zubizarreta E, Fowler JF, Maisonneuve J, Ferrari D, et al. High-dose-rate brachytherapy at 14 Gy per hour to point A: preliminary results of a prospectively designed schedule for cancer of the cervix based on the linear-quadratic model. Int J Gynecol Cancer 2001; 11(6):445-53.
(8) Fowler JF. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 1989; 62(740):679-94.
(9) International Commission on Radiation Units and Measurements. ICRU Report 38: dose and volume specifications for reporting intracavitary therapy in oncology. Bethesda, Maryland: ICRU, 1985.
(10) Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31(5):1341-6.
(11) Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol 2004; 22(5):872-80.
(12) Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, 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(5):1339-48.
(13) Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy or locally advanced cervical cancer. N Engl J Med 1999; 340(15):1144-53.
(14) Kato S, Ohno T, Thephamongkhol K, Chansilpa Y, Cao J, Xu X, et al. Long-term follow-up results of a multi-institutional phase 2 study of concurrent chemoradiation therapy for locally advanced cervical cancer in east and southeast Asia. Int J Radiat Oncol Biol Phys 2013; 87(1):100-5.
(15) Katz A, Eifel PJ. Quantification of intracavitary brachytherapy parameters and correlation with outcome in patients with carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000; 48(5):1417-25.
(16) Corn BW, Hanlon AL, Pajak TF, Owen J, Hanks GE. Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix. Gynecol Oncol 1994; 53(3):294-300.
(17) Viswanathan AN, Moughan J, Small W Jr, Levenback C, Iyer R, Hymes S, et al. The quality of cervical cancer brachytherapy implantation and the impact on local recurrence and disease-free survival in radiation therapy oncology group prospective trials 0116 and 0128. Int J Gynecol Cancer 2012; 22(1):123-31.
(18) Hareyama M, Sakata K, Oouchi A, Nagakura H, Shido M, Someya M, et al. High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix: a randomized trial. Cancer 2002; 94(1):117-24.
(19) Inoue T, Hori S, Miyata Y, Ozeki S, Shigematsu Y. High versus low dose rate intracavitary irradiation of carcinoma of the uterine cervix: a preliminary report. Acta Radiol Oncol Radiat Phys Biol 1978; 17(4):277-82.
(20) Patel FD, Sharma SC, Negi PS, Ghoshal S, Gupta BD. Low dose rate vs. high dose rate brachytherapy in the treatment of carcinoma of the uterine cervix: a clinical trial. Int J Radiat Oncol Biol Phys 1994; 28(2):335-41.
(21) Pearce A, Craighead P, Kay I, Traptow L, Doll C. Brachytherapy for carcinoma of the cervix: a Canadian survey of practice patterns in a changing era. Radiother Oncol 2009; 91(2):194-6.
(22) Charra-Brunaud C, Harter V, Delannes M, Haie-Meder C, Quetin P, Kerr C, et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol 2012; 103(3):305-13.
(23) van de Bunt L, van der Heide UA, Ketelaars M, de Kort GA, Jürgenliemk-Schulz IM. Conventional, conformal, and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer: the impact of tumor regression. Int J Radiat Oncol Biol Phys 2006; 64(1):189-96.
(24) Gerszten K, Colonello K, Heron DE, Lalonde RJ, Fitian ID, Comerci JT, et al. Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix. Gynecol Oncol 2006; 102(2):182-8.
(25) Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer 2003; 39(17):2470-86.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
