Patterns of Treatment Failure after Concurrent Chemoradiotherapy or Adjuvant Radiotherapy in Patients with Locally Advanced Cervical Cancer

Abstract

<b><i>Objective:</i></b> To identify patterns of therapy failure after radiotherapy in Chinese patients with locally advanced cervical cancer (LACC). <b><i>Methods:</i></b> A retrospective study was conducted at a Chinese hospital from June 2012 to July 2018. All analyses were done using SPSS 26. <b><i>Results:</i></b> 105 patients with treatment failure were included. After a median follow-up of 27 months (range 10–82), the 3-year survival rate after therapy failure was 19.4%. In multivariate analysis, squamous cell carcinoma antigen (SCC-Ag) <4 ng/mL (<i>p</i> < 0.001) and disease-free interval >12 months (<i>p</i> = 0.013) showed significant survival benefits. We identified 3 types of failure: distant lymph node metastasis (<i>n</i> = 50), hematogenous metastasis (<i>n</i> = 53) and pelvic failure (<i>n</i> = 48). Most metastatic para-aortic lymph nodes (PALN) were inferior to the level of left renal hilum (84.8%, <i>n</i> = 28). A total of 80% of patients with supraclavicular lymph nodes (SCLN) metastasis ignored imaging on supraclavicular region. For solitary SCLN or lung metastasis, the prognosis was better than that combined with other sites failure, respectively (<i>p</i> = 0.005; <i>p</i> = 0.001). Many patients with central sites recurrence received insufficient doses of intracavitary brachytherapy (IBT) for low tolerance to pain. <b><i>Conclusion:</i></b> The distribution of metastatic PALN is asymmetrical and optimizing clinical target volume to minimize toxicity of para-aortic radiation is necessary. The effect of ultrasonography as preliminary screening and follow-up means on SCLN metastasis can be expected. Pain management and psychological interventions are essential for patients receiving IBT.

Identification of a 12-LncRNA long Lymph Node Metastasis Prognostic Signature for Cervical Cancer

“…CESC remains the second leading cause of female death worldwide and is a growing concern to the public. Despite the advances in immune checkpoint inhibitor treatment, over three-fourths of patients suffered from recurrences within the rst 2 -3 years, even with the standard treatments [23]. LNM, the most important route of metastasis in CESC, showed a greater resistance for chemotherapy and should be critically determined by the prognosis [24,25].…”

Modern diagnostics and treatment of distant metastasis of cervical cancer

“…Пациентки с высоким SUV (>8) или низким SUV (<4,3) имеют более низкий трехлетний показатель OВ по сравнению с пациентками с промежуточным SUV (от 4,3 до 8). Более того, латентный период менее 2 лет, уровни антигена плоскоклеточной карциномы (SCC-Ag) ≥4 нг/мл и рецидив, выходящий за пределы SCLN, были значительными неблагоприятными прогностическими факторами [21]. Для пациенток с метастазами как PALN, так и SCLN возможны ЛТ и последующая химиотерапия с приемлемой поздней токсичностью, несмотря на высокий уровень острой гематологической токсичности.…”

Elevated pretreatment squamous cell Carcinoma Antigen indicates unfavorable treatment outcomes in cervical cancer patients receiving definitive radiotherapy

“…treatment modalities, a significant proportion of patients still experience treatment failure and unfavorable clinical outcomes. [2][3][4][5] Therefore, identifying reliable prognostic factors is crucial to improve risk stratification, guide personalized treatment strategies, and ultimately enhance patient survival. 6 As a tumor surrogate biomarker, the squamous cell carcinoma antigen (SCC Ag) has been extensively investigated in squamous cell Prec Radiat Oncol.…”

“…Cervical cancer is the fourth most commonly diagnosed carcinoma among women globally, accounting for substantial morbidity and mortality worldwide 1 . Despite advancements in screening, prevention, and treatment modalities, a significant proportion of patients still experience treatment failure and unfavorable clinical outcomes 2–5 . Therefore, identifying reliable prognostic factors is crucial to improve risk stratification, guide personalized treatment strategies, and ultimately enhance patient survival 6 …”