Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

Jacinto, Alexandre Arthur; Castilho, Marcus Simões; Novaes, Priscila; Novick, P.; Viani, Gustavo Arruda; Salvajoli, João Víctor; Ferrigno, Robson; Pellizzon, Antônio Cássio Assis; Lima, Stella Sala Soares; Maia, Maria Aparecida Conte; Fogaroli, R.C.

doi:10.1186/1748-717x-2-9

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…In certain institutions in more advanced stages (I/B2-II/B) the preoperative treatment is combined RT (tele+brachytherapy), with or without concomitant ChT, followed by adjuvant hysterectomy. The majority of these studies concluded that in patients with pCR obtained by preoperative BT the LTC and the OS was better than in cases that showed minimal or no regression to RT [4,5,7,19]. However, most of the studies that deal with the effect of preoperative RT are retrospective, with no control group, so there is no direct comparison between the results of surgery alone versus preoperative BT followed by surgery.…”

Section: Discussionmentioning

confidence: 90%

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

Vízkeleti

Vereczkey

Fröhlich

et al. 2014

Pathol. Oncol. Res.

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The role of preoperative intrauterine brachytherapy (BT) in the multidisciplinary treatment of early stage cervical carcinoma (ESCC) is controversial. In 2005, a prospective randomized multicenter study was initiated in Hungary in order to explore the potential advantages of preoperative high-dose-rate (HDR) BT. In this article we evaluate the efficiency of preoperative HDR BT by the rate of pathologic complete remission (pCR) in the first 185 patients enrolled in the study at the National Institute of Oncology and at the Uzsoki Municipal Cancer Center in collaboration with the 1st Department of Gynaecology and Obstetrics of Semmelweis University, Budapest, Hungary. In arm A, patients received 2x8Gy preoperative intracavitary HDR BT, while in arm B no preoperative treatment was given. In both arms patients underwent radical Wertheim (Piver III) hysterectomy. The pCR rate was 25.7% after preoperative HDR BT, while it was only 11.2% with surgery alone (p=0.03), in these cases the tumor was eliminated during the diagnostic excision or conisation. The rate of positive surgical margins was 1.5% after preoperative BT, while it was as high as 11.4% without preoperative RT (p=0.02). There was no significant difference in the local tumor control (LTC), distant metastases free survival (DMFS) and overall survival (OS) between the two arms. According to our preliminary results preoperative intracavitary HDR BT significantly increases the rate of pCR and decreases the rate of positive surgical margins in patients with ESCC. Longer follow-up is required to establish the possible impact of pCR on the ultimate LTC and OS.

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Section: Discussionmentioning

confidence: 90%

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

Vízkeleti

Vereczkey

Fröhlich

et al. 2014

Pathol. Oncol. Res.

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“…This may related to effect of radiotherapy to shrink the tumor mass that compress the ureter. 26 Our study did have certain limitations. The study population was retrospectively enrolled from a single center in Indonesia.…”

Section: Discussionmentioning

confidence: 87%

Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Noegroho

Mustafa

2019

UIJ

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Cervical cancer is the 3rd most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P<0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.

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“…Definitive RT includes external beam radiation therapy (EBRT) to the pelvis and intracavitary brachytherapy (BT). RT in combination with surgery has been used for treatment of local disease, where RT has been added postoperatively to cases, showing unfavorable prognostic feature at surgery or has been given preoperatively [1–4]. Comparisons between treatment regimens with different fractionations, dose rates and treatment time as well as the evaluation of their effectiveness on tumor and normal tissues is possible through the use of bioeffect dose models that take into account the variation of the response with all the above-mentioned factors.…”

Section: Purposementioning

confidence: 99%

Clinical Investigations Biological effective dose evaluation and assessment of rectal and bladder complications for cervical cancer treated with radiotherapy and surgery

Beskow¹,

Ågren-Cronqvist²,

Lewensohn³

et al. 2012

jcb

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PurposeThis study aims to retrospectively evaluate dosimetric parameters calculated as biological effective dose in relation to outcome in patients with cervical cancer treated with various treatment approaches, including radiotherapy with and without surgery.Material and methodsCalculations of biological effective dose (BED) were performed on data from a retrospective analysis of 171 patients with cervical carcinoma stages IB-IIB treated with curative intent, between January 1989 and December 1991. 43 patients were treated only with radiotherapy and 128 patients were treated with a combination of radiotherapy and surgery. External beam radiotherapy was delivered with 6-21 MV photons from linear accelerators. Brachytherapy was delivered either with a manual radium technique or with a remote afterloading technique. The treatment outcome was evaluated at 5 years.ResultsThe disease-specific survival rate was 87% for stage IB, 75% for stage IIA and 54% for stage IIB, while the overall survival rates were 84% for stage IB, 68% for stage IIA and 43% for stage IIB. Patients treated only with radiotherapy had a local control rate of 77% which was comparable to that for radiotherapy and surgery patients (78%). Late complications were recorded in 25 patients (15%). Among patients treated with radiotherapy and surgery, differences in radiation dose calculated as BED10 did not seem to influence survival. For patients treated with radiotherapy only, a higher BED10 was correlated to a higher overall survival (p = 0.0075). The dose response parameters found based on biological effective dose calculations were D50 = 85.2 Gy10 and the normalized to total dose slope of the dose response curve γ = 1.62 for survival and D50 = 61.6 Gy10 and γ = 0.92, respectively for local control.ConclusionsThe outcome correlates with biological effective dose for patients treated with radiation therapy alone, but not for patients treated with radiotherapy and surgery. No correlations were found between BED and late toxicity from bladder and rectum.

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Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

Cited by 3 publications

References 35 publications

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Clinical Investigations Biological effective dose evaluation and assessment of rectal and bladder complications for cervical cancer treated with radiotherapy and surgery

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