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Chemoradiation and Adjuvant Chemotherapy in Cervical Cancer

Published on Jul 1, 1999in Journal of Clinical Oncology28.349
· DOI :10.1200/jco.1999.17.7.2055
Ling-Chui Wong19
Estimated H-index: 19
,
H. Y.S. Ngan1
Estimated H-index: 1
+ 3 AuthorsDamon Choy39
Estimated H-index: 39
Abstract
PURPOSE: Radiotherapy is the standard treatment for locally advanced cervical cancer, but treatment results remain disappointing, particularly for women with bulky central disease. We investigated the role of concurrent chemoradiation and adjuvant chemotherapy in a randomized trial. PATIENTS AND METHODS: Two hundred twenty patients with bulky stage I, II, and III cervical cancer were randomized to receive either standard pelvic radiotherapy or chemoradiation (epirubicin 60 mg/m2) followed by adjuvant chemotherapy with epirubicin 90 mg/m2 administered at 4-week intervals for five additional cycles. RESULTS: Fifty-nine patients have relapsed, with a median follow-up duration of 77 months. Patients whoreceived epirubicin radiation therapy showed a significantly longer disease-free (P = .03) and cumulative survival (P = .04). Patients who received radiation alone had significantly more distant metastasis than those who received chemoradiation (P = .012). There was no difference in long-term local tumor contro...
  • References (17)
  • Citations (103)
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References17
Newest
#1M H TattersallH-Index: 1
#2V LorvidhayaH-Index: 1
Last. M S YenH-Index: 1
view all 10 authors...
PURPOSEPelvic radiation is standard treatment for women with stage IIb to IVa cervical cancer, but treatment results are disappointing, particularly for women with bulky tumors. We investigated the role of primary chemotherapy followed by pelvic radiotherapy in a randomized trial.PATIENTS AND METHODSTwo hundred sixty patients with stage IIb and IVa cervical cancer received either standard pelvic radiotherapy or primary chemotherapy with cisplatin 60 mg/m2 and epirubicin 110 mg/m2 administered at...
148 CitationsSource
#1Luis SouhamiH-Index: 47
#2R. A. GilH-Index: 4
Last. T. R. P. SilveiraH-Index: 2
view all 7 authors...
Because of the poor results in stage III B carcinoma of the cervix with standard treatment using radiotherapy alone, we designed a randomized trial to determine whether administration of chemotherapy before pelvic irradiation would improve survival. Between May 1984 and August 1986, 107 patients with previously untreated squamous cell carcinoma were randomly assigned, after stratification by age (less than 50 v greater than 50 years), extent of parametrial involvement (unilateral v bilateral), a...
171 CitationsSource
#1Adolfo GiaroliH-Index: 9
#2Carlos SananesH-Index: 9
Last. G. di PaolaH-Index: 15
view all 9 authors...
Abstract One hundred and sixty-nine patients with squamous cancer of the cervix uteri treated with three courses of neoadjuvant chemotherapy with the modified VBP scheme are presented. All were subjected to a Wertheim-Meigs operation with paraaortic lymph-adenectomy. The incidence of lymph node metastases is analyzed according to clinical stage, tumor volume, residual tumor in the surgical specimen, and clinical response to neoadjuvant chemotherapy. A significant decrease in the incidence of lym...
51 CitationsSource
Concomitant chemoradiotherapy can be used in order to increase both the local and systemic control of solid tumors. The rationale for its use and experimental data for selected chemotherapy drugs are reviewed. Clinical trials have focused on increasing complete response (CR) and survival rates; in addition, improved quality of life by decreasing the use of conventional surgical procedures is being pursued. Both of these goals may have been achieved for some tumors, most notably for anal cell car...
329 CitationsSource
#1L.C. Wong (HKU: University of Hong Kong)H-Index: 19
#2Y.C. Choo (TTUHSC: Texas Tech University Health Sciences Center)H-Index: 1
Last. H. K. Ma (HKU: University of Hong Kong)H-Index: 20
view all 5 authors...
Between January 1982 and January 1983 all patients with advanced cervical cancer were randomized into three groups: radiotherapy only (group I), radiotherapy plus weekly cis-platinum (group II), and radiation plus twice-weekly cis-platinum (group III). Better initial central control was observed in group III patients. Long-term survival was similar in the three groups. Potentiation of radiotherapy with cis-platinum failed to show any significant improvement in long-term survival.
79 CitationsSource
#1Ling-Chui Wong (HKU: University of Hong Kong)H-Index: 19
#2Damon Choy (Queen Mary Hospital)H-Index: 39
Last. Ho‐Kri (HKU: University of Hong Kong)H-Index: 1
view all 5 authors...
Thirty-eight patients with histologically proven recurrent cervical cancer were treated with epirubicin, an analogue of anthracycline. There were eight complete responders and ten partial responders. The overall response rate was 47.8%. The survival duration of the responders was significantly longer than that of the nonresponders. The optimal dose of epirubicin has yet to be determined. The dosage of 120 mg/m2 was well tolerated. The role of epirubicin as an adjuvant chemotherapeutic agent in t...
15 CitationsSource
#1F. Kirsten (Ludwig Institute for Cancer Research)H-Index: 1
#2K. H. AtkinsonH-Index: 13
Last. Martin H. N. Tattersall (Ludwig Institute for Cancer Research)H-Index: 73
view all 12 authors...
Summary Forty-seven patients with locally advanced cervical cancer at high risk of relapse received three cycles of chemotherapy with PVB (cisplatin, vinblastine and bleomycin) before definitive local treatment with either radical surgery or radiotherapy. Thirty-one of the 47 patients (66%) responded to initial chemotherapy, and 11 of them have relapsed compared with 13 of the 16 non-responders. Median time to recurrence was 31 weeks for PVB non-responders but has not yet been reached for PVB re...
47 CitationsSource
#1Y.C. Choo (HKU: University of Hong Kong)H-Index: 7
#2T.K. ChoyH-Index: 1
Last. H. K. Ma (HKU: University of Hong Kong)H-Index: 20
view all 4 authors...
Abstract Forty-five patients with Stages II and III cervical carcinoma were randomized to receive either radiation or cis -dichlorodiammine platinum (II) ( cis -DPP) with radiation, Cis -DPP was administered in bolus injections of 25 mg/m 2 at weekly intervals until completion of radium application. Complete response was noted in 1120 (55%) patients in the radio-chemotherapy group compared to 525 (20%) patients in the radiation group ( P cis -DPP to radiation. The combined use of cis -DPP and ra...
47 CitationsSource
#1Karen K. Fu (UCSF: University of California, San Francisco)H-Index: 41
The ultimate goal of combining chemotherapy and radiotherapy is to improve the therapeutic ratio. When chemotherapy is combined with radiotherapy, improved therapeutic effects may occur as a result of the following: (1) spatial cooperation; (2) enhancement of tumor response with less or no enhancement of normal tissue injury, and (3) diminution of normal tissue injury with less or no diminution of tumor response. Possible mechanisms of interaction between chemotherapeutic agents and radiation th...
120 CitationsSource
Abstract From June 1972, to December 1976, 40 patients with FIGO (International Federation of Gynaecology and Obstetrics) Stage IIB carcinoma of the uterine cervix were entered into a prospective, double-blind, randomized study to evaluate the possible radiation-potentiating properties (i.e., improved survival) of the S-phase cell cycle-specific inhibitor of DNA synthesis, hydroxyurea. All patients were documented to be without aortic lymph node metastasis by pretherapy staging para-aortic lymph...
106 CitationsSource
Cited By103
Newest
#1Anuja Jhingran (University of Texas MD Anderson Cancer Center)H-Index: 33
#2Patricia J. Eifel (UTMB: University of Texas Medical Branch)H-Index: 2
Last. Guillermo Tortolero-LunaH-Index: 33
view all 2 authors...
11 CitationsSource
#2Denisse Castro-Eguiluz (Consejo Nacional de Ciencia y Tecnología)H-Index: 1
Last. Lucely CetinaH-Index: 18
view all 7 authors...
BACKGROUND: In Mexico, 80% women with cervical cancer are diagnosed at locally advanced stages and are treated with concomitant chemoradiotherapy. The treatment modality and catabolic state confer a nutritional risk. The present study aimed to thoroughly evaluate the nutritional status and change in body composition of locally advanced cervical cancer (LACC) patients throughout treatment. METHODS: An observational prospective study, carried out at the Mexican National Cancer Institute, included ...
Source
#1Margaret M. Kozak (Stanford University)H-Index: 13
#2Julie L. Koenig (Stanford University)H-Index: 4
Last. Elizabeth A. Kidd (Stanford University)H-Index: 16
view all 4 authors...
Abstract Objective This study aimed to evaluate whether our institutional standard of less-than-whole-uterus irradiation affects locoregional control in patients with locally advanced cervical cancer. Methods and Materials We retrospectively reviewed 53 patients with stage IB to IVB cervical carcinoma who were treated with image guided intensity modulated radiation therapy and brachytherapy. The entire uterus was not included in the clinical target volume, as per our institutional standard. Dosi...
Source
#1Shagun Misra (SGPGIMS: Sanjay Gandhi Post Graduate Institute of Medical Sciences)H-Index: 1
#2Punita Lal (SGPGIMS: Sanjay Gandhi Post Graduate Institute of Medical Sciences)H-Index: 14
Last. Shaleen Kumar (SGPGIMS: Sanjay Gandhi Post Graduate Institute of Medical Sciences)H-Index: 22
view all 8 authors...
Abstract Background A randomised trial was carried out comparing chemo-radiation (CTRT) vs. radiotherapy (RT) in patients of carcinoma cervix and showed similar rates of pelvic disease control, disease free survival and overall survival. Late toxicity is presented. Methods Between December 2000 and July 2006, 180 patients of carcinoma cervix were randomly assigned to RT + weekly cisplatin (n = 94) or RT alone (n = 86). Late toxicity was prospectively scored using RTOG criteria in 156 evaluable p...
1 CitationsSource
#1Mei Liu (Peking Union Medical College)H-Index: 13
#2Jusheng An (Peking Union Medical College)H-Index: 2
Last. Lingying Wu (Peking Union Medical College)H-Index: 9
view all 12 authors...
MicroRNAs (miRNAs) are small non-coding RNA that target protein-coding mRNAs at the post-transcriptional level. The aim of this study was to define the role of miR-492 in cervical squamous cell carcinomas. After microRNA profiling and comparison, we firstly detected miR-492 expression in 104 tumor tissues biopsies derived from advanced staged (FIGO IIB-IIIB) cervical squamous cell carcinoma patients before receiving concomitant chemoradiotherapy and found miR-492 expression was significantly hig...
5 CitationsSource
#1Nasir Ali (Aga Khan University Hospital)H-Index: 1
#2Azmina Tajdin Valimohammad (Aga Khan University Hospital)
Last. Bilal Mazhar Qureshi (Aga Khan University Hospital)H-Index: 2
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PurposeTo report the long-term outcome in lymph nodal–metastatic cervical squamous cell cancer after chemoradiation followed by adjuvant chemotherapy.Patients and MethodsBetween 2010 and 2013, five patients were diagnosed with advanced cervical cancer with clinically involved para-aortic lymph nodes (ie, International Federation of Gynecology and Obstetrics stage IVB). These patients were treated with concurrent chemoradiation therapy followed by adjuvant chemotherapy. Concurrent chemoradiation ...
Source
#1Jinju Oh (DCU: Catholic University of Daegu)H-Index: 3
#2Ki Ho Seol (DCU: Catholic University of Daegu)H-Index: 3
Last. Jin Young Bae (DCU: Catholic University of Daegu)H-Index: 3
view all 6 authors...
PURPOSE: This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of t...
4 CitationsSource
#1Daniela Luvero (Sapienza University of Rome)H-Index: 13
#2Francesco Plotti (Sapienza University of Rome)H-Index: 24
Last. Roberto Angioli (Sapienza University of Rome)H-Index: 35
view all 11 authors...
We report the long-term follow-up in patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy (NACT) + radical surgery (RS) + adjuvant chemotherapy (ACT) analyzing prognostic factors which may more influence, in a long time, the survival outcome using univariate and multivariate analysis. In this study, we included all patients with diagnosis of locally advanced cervical cancer (IB2-IIB) treated with NACT + RS + ACT from June 2000 and February 2007 as previously descr...
3 CitationsSource
#1Dan Chen (SJTU: Shanghai Jiao Tong University)H-Index: 13
#2Ulf Gyllensten (Science for Life Laboratory)H-Index: 80
Cervical cancer has a heritable genetic component. A large number of genetic associations with cervical cancer have been reported in hypothesis-driven candidate gene studies, but many of these results are either inconsistent or have failed to be independently replicated. Genome-wide association studies (GWAS) have identified additional susceptibility loci previously not implicated in cervical cancer development, highlighting the power of genome-wide unbiased association analyses. Post-GWAS analy...
24 CitationsSource
#1Siriwan Tangjitgamol (Navamindradhiraj University)H-Index: 11
#2Kanyarat Katanyoo (Navamindradhiraj University)H-Index: 6
Last. Busaba Supawattanabodee (Vajira Hospital)H-Index: 1
view all 6 authors...
Background Current standard treatment for patients with cervical cancer who have locally advanced stage disease (International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IVA) is concurrent chemoradiation therapy (CCRT). However, less than two-thirds of patients in this group survive for longer than five years post treatment. Adjuvant chemotherapy (ACT) can be given in an attempt to improve survival by eradicating residual disease in the pelvis and treating occult disease outside...
20 CitationsSource