Local treatment improves survival in patients with stage IVB cervical cancer

Xu, Jing‐Ying; Chen, Jun-Ni; Lei, Jian; Hu, Min; Wu, San‐Gang; Zhou, Juan

doi:10.1016/j.ygyno.2022.04.013

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…Growing studies have demonstrated that radiotherapy and chemotherapy are administrated for survival improvement in cervical cancer patients with metastatic disease. 8,[38][39][40][41] Besides, our results depicted longer survival in patients developing metastases after CCRT, which was compatible with the results in the previous study. 42 Furthermore, the effects remained significant and strong in the multiple metastases subgroup.…”

Section: Discussionsupporting

confidence: 92%

Dynamic Nomogram Based on the Metastatic Number and Sites and Therapy Strategies Predicting the Prognosis of Patients with Metastatic Cervical Cancer

Tan

et al. 2022

IJWH

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Background Individual survival prediction is of vital importance to optimize the individualized treatment of metastatic cervical cancer (mCC) patients. The goal of this study was to identify the potential risk factors for the survival of mCC patients and construct a nomogram for their prognosis. Methods Medical records of patients with newly diagnosed mCC at the First Affiliated Hospital of Xi’an Jiaotong University were reviewed retrospectively. Risk factors were identified using Cox proportional hazards analysis and Kaplan–Meier curves. Random forest was used to identify factors associated with therapy strategy. Nomogram and dynamic nomogram were established using ‘rms’ and “DynNom” R package. Results A total of 98 patients with mCC were finally identified. In Cox analyses, multiple metastases and concurrent chemoradiotherapy (CCRT) were identified as independent predictors for overall survival (OS). We further explored the prognostic value of metastatic number and sites and therapy strategies for mCC patients by Kaplan–Meier curves. A dynamic nomogram including metastases number and sites (multiple metastases, liver and lymph node (LN) above diaphragm metastases) and chemoradiotherapy strategies (CCRT, postradiotherapy chemotherapy, and radiotherapy to metastatic sites) was constructed for predicting the prognosis of mCC patients. For newly diagnosed patients, we strongly recommended the combination of chemotherapy and definitive pelvic radiotherapy and, if possible, radiation to metastatic site, but CCRT should be implemented with caution. We constructed a dynamic nomogram indicating that patients with younger age, shorter symptom duration, and better laboratory test results are suitable for CCRT. Conclusion Survival analyses showed that the metastatic number and sites and therapy strategies are associated with the prognosis of mCC patients. The CCRT and prognostic nomograms may help clinicians to make better clinical decisions and effectively predict the prognosis for newly diagnosed mCC patients.

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Section: Discussionsupporting

confidence: 92%

Dynamic Nomogram Based on the Metastatic Number and Sites and Therapy Strategies Predicting the Prognosis of Patients with Metastatic Cervical Cancer

Tan

et al. 2022

IJWH

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“…Two sequential reports using the National Cancer Database showed that treatment with chemoradiotherapy or surgery was associated with longer median overall survival than treatment with chemotherapy only (19.2 vs 10.1 months, p<0.001,14 and 14.4 vs 10.6 months, p<0.001,15 respectively). Several other single institution studies as well as two recent SEER (Surveillance, Epidemiology, and End Results) database studies also showed a survival benefit with the addition of pelvic radiotherapy to chemotherapy 13 16–18…”

Section: Discussionmentioning

confidence: 94%

Outcomes associated with treatment to all sites of disease in patients with stage IVB cancer of the cervix

Hasson

Felder

Helpman

et al. 2023

Int J Gynecol Cancer

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ObjectiveThe use of chemoradiation in patients with stage IVB cancer of the cervix was evaluated to determine if definitive treatment offers benefit.MethodsA database of 546 patients with cancer of the cervix treated between January 2005 and May 2021 at a tertiary academic medical center was reviewed retrospectively to identify patients with stage IVB disease. Log rank test, regression analysis, and the Kaplan–Meier method were used to identify and compare variables and estimate progression free survival and overall survival.ResultsThirty-three patients with stage IVB cervical cancer were identified. Median age was 53 years (range 28–78). Pathology subtypes were squamous cell (n=22, 67%), adenocarcinoma (n=8, 24%), and clear cell (n=3, 9%). Metastases were classified as lymphatic (n=14, 42%) or hematogenous (n=19, 58%). Following treatment to all sites with chemoradiotherapy and selected use of surgery (n=23), six patients (26%, lymphatic n=4, hematogenous n=2) remained disease free for a median duration of 4 years (range 3–17 years). Recurrences in the remaining patients were distant (n=13) or local (n=4). All patients in the chemotherapy group (n=10, 100%) progressed. Kaplan–Meier analysis showed that median progression free survival was longer for patients treated at all disease sites than for patients treated with chemotherapy alone (19 vs 11 months, p=0.01). However, this was not the case for overall survival (49 vs 33 months, p=0.15). Patients with metastases limited to lymph nodes also had longer median progression free survival (22 vs 11 months, p=0.04) but not overall survival (p=0.68).ConclusionsPatients with stage IVB cancer of the cervix may benefit from treatment to all sites of disease, if feasible and safe, as demonstrated by improved progression free survival.

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“…Radical RT plays an important role in the definitive treatment of locally-advanced disease, with 8-year survival rates of up to 67% when combined with concurrent CT [ 21 ]. Even in retrospective analysis, the addition of local RT at stage IVB seems to confer better results in specific survival [ 22 , 23 ], which is why at our institution the treatment is offered to those with inguinal metastasis. The therapy administered with an HDRBT boost is the standard of care [ 24 ]; IMRT or VMAT have become standard therapy methods, compared to 3D [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of three-dimensional radiation therapy versus intensitymodulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens

Díaz¹

2023

ecancer

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Background and objectives:The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low-and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods:From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results:The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs.

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Local treatment improves survival in patients with stage IVB cervical cancer

Cited by 7 publications

References 34 publications

Dynamic Nomogram Based on the Metastatic Number and Sites and Therapy Strategies Predicting the Prognosis of Patients with Metastatic Cervical Cancer

Dynamic Nomogram Based on the Metastatic Number and Sites and Therapy Strategies Predicting the Prognosis of Patients with Metastatic Cervical Cancer

Outcomes associated with treatment to all sites of disease in patients with stage IVB cancer of the cervix

Cost analysis of three-dimensional radiation therapy versus intensitymodulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens

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