Long-Term Efficacy and Toxicity of Intensity-Modulated Radiotherapy in Bulky Cervical Cancer

Wang, Yu; Lo, Tan-Tzu; Wang, Lily; Hsu, Shih-Tien; Hwang, Sheau-Feng; Lu, Chien-Hsing; Sun, Lou

doi:10.3390/ijerph20021161

Cited by 9 publications

(2 citation statements)

References 46 publications

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“…Our study incorporated tumor size (>4.5 cm) as one of the EDM predictors. Several studies have proven that tumor size larger than 4 cm was a predictor of increasing DM occurrence or treatment failure in CC patients 24,25 . A commonly accepted theory was that as cancer grew, tumor cells acquired the capability to spread, survive, and flourish 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have proven that tumor size larger than 4 cm was a predictor of increasing DM occurrence or treatment failure in CC patients. 24 , 25 A commonly accepted theory was that as cancer grew, tumor cells acquired the capability to spread, survive, and flourish. 26 Furthermore, tumor size has proven to be associated with risk factors of DM occurrence including lymph‐vascular space invasion, 27 parametrial involvement, 28 , 29 and hypoxic volume.…”

Section: Discussionmentioning

confidence: 99%

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A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

Liu,

Lin,

Deng

et al. 2023

Cancer Medicine

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ObjectThis study aimed to establish an effective risk nomogram to predict the early distant metastasis (EDM) probability of cervical cancer (CC) patients treated with radical radiotherapy to aid individualized clinical decision‐making.MethodsA total of 489 patients with biopsy‐confirmed CC between December 2018 and January 2021 were enrolled. Logistic regression with the stepwise backward method was used to identify independent risk factors. The nomogram efficacy was evaluated by using the area under the receiver operating characteristic curve (AUC), C‐index by 1000 bootstrap replications, etc. Finally, patients were divided into high‐ and low‐risk groups of EDM based on the cut‐off value of nomogram points.Results36 (7.36%) CC patients had EDM, and 20 (55.6%) EDM had more than one metastatic site involved. Age below 51 (OR = 2.298, p < 0.001), tumor size larger than 4.5 cm (OR = 3.817, p < 0.001) and radiotherapy (OR = 3.319, p < 0.001) were independent risk factors of EDM. For the nomogram model, C‐index was 0.701 (95% CI = 0.604–0.798), and 0.675 (95% CI = 0.578–0.760) after 1000 bootstrap resampling validations. The Hosmer–Lemeshow test demonstrated no overfitting (p = 0.924). According to the Kaplan–Meier curve of risk score, patients with high risk were more prone to get EDM (p < 0.001).ConclusionThis is the first research to focus on EDM in CC patients. We have developed a robust scoring system to predict the risk of EDM in CC patients to screen out appropriate cases for consolidation therapy and more intensive follow‐up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

Liu,

Lin,

Deng

et al. 2023

Cancer Medicine

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A comprehensive overview of radiation therapy impacts of various cancer treatments and pivotal role in the immune system

Srinivasan,

Subbarayan,

Srivastava

et al. 2024

Cell Biochemistry & Function

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The cancer treatment landscape is significantly evolving, focusing on advanced radiation therapy methods to maximize effectiveness and minimize the adverse effects. Recognized as a pivotal component in cancer and disease treatment, radiation therapy (RT) has drawn attention in recent research that delves into its intricate interplay with inflammation and the immune response. This exploration unveils the underlying processes that significantly influence treatment outcomes. In this context, the potential advantages of combining bronchoscopy with RT across diverse clinical scenarios, alongside the targeted impact of brachytherapy, are explored. Concurrently, radiation treatments serve multifaceted roles such as DNA repair, cell elimination, and generating immune stress signaling molecules known as damage‐associated molecular patterns, elucidating their effectiveness in treating various diseases. External beam RT introduces versatility by utilizing particles such as photons, electrons, protons, or carbon ions, each offering distinct advantages. Advanced RT techniques contribute to the evolving landscape, with emerging technologies like FLASH, spatially fractionated RT, and others poised to revolutionize the field. The comprehension of RT, striving for improved treatment outcomes, reduced side effects, and facilitating personalized and innovative treatments for cancer and noncancer patients. After navigating these advancements, the goal is fixed to usher in a new era in which RT is a cornerstone of precision and effectiveness in medical interventions. In summarizing the myriad findings, the review underscores the significance of understanding the differential impacts of radiation approaches on inflammation and immune modulation, offering valuable insights for developing innovative therapeutic interventions that harness the immune system in conjunction with RT.

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Radiochemotherapy and interstitial brachytherapy for cervical cancer: clinical results and patient-reported outcome measures

Alfrink,

Aigner,

Zoche

et al. 2024

Strahlenther Onkol

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Objective To evaluate clinical results and long-term patient-reported outcome measures (PROMs) on quality of life in cervical cancer patients following radiochemotherapy (RCT) and brachytherapy (BT) as definitive treatment. Materials and methods Between 2003 and 2023, a total of 132 patients with advanced cervical cancer were evaluated for possible treatment. Patients treated by postoperative RCT, palliative radiotherapy, and those treated for recurrent disease were excluded. Thus, 46 patients receiving standard RCT and BT as their curative treatment were included in this study. PROMs were assessed prospectively by patients’ self-completion of the EORTC-QLQ-C30 and EORTC-QLQ-CX24 questionnaires. Results Five-year overall survival (OS), distant metastases-free survival (DMFS), and pelvic tumor-free survival rates (PTFS) were 53%, 54%, and 83%, respectively. A significant impact on OS was seen for FIGO (International Federation of Gynecologic Oncology) stage (IIB–IIIA: 79% vs. IIIB–IVA: 33%, p = 0.015), for overall treatment time (OTT; 50–65 d: 64% vs. > 65 d: 38%, p = 0.004), and for rectal D2cc (≤ 73 Gy: 50% vs. > 73 Gy: 38%, p = 0.046). The identical parameters were significantly associated with DMFS (FIGO stage: p = 0.012, OTT: p = 0.008, D2cc: p = 0.024). No parameters with a significant influence on PTFS were seen. In multivariate analysis, an impact of FIGO stage on OS (p = 0.05) and DMFS (p = 0.014) was detected, and of rectal D2cc on DMFS (p = 0.031). The overall QoL score was 63/100. Cognitive function was the least impaired (84/100), while role functioning was the worst (67/100). On the symptom scale, insomnia (46/100), fatigue (41/100), dyspnea (32/100), pain (26/100), and financial difficulties (25/100) were scored the worst. According to EORTC-QLQ-CX24, peripheral neuropathy (36/100) and lymphedema (32/100) occurred most frequently. Impaired sexual/vaginal functioning (32/100) and body image (22/100) were also frequently recorded. Conclusion In patients with advanced cervical cancer, a combination of RCT and BT remains an excellent treatment option. In terms of patient-reported long-term quality of life, specific support is needed to alleviate symptoms including lymphedema, peripheral neuropathy, and impaired sexual activity.

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Long-Term Efficacy and Toxicity of Intensity-Modulated Radiotherapy in Bulky Cervical Cancer

Cited by 9 publications

References 46 publications

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

A novel nomogram and risk stratification for early metastasis in cervical cancer after radical radiotherapy

A comprehensive overview of radiation therapy impacts of various cancer treatments and pivotal role in the immune system

Radiochemotherapy and interstitial brachytherapy for cervical cancer: clinical results and patient-reported outcome measures

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