The Prognostic Value of Tumor Size, Volume and Tumor Volume Reduction Rate During Concurrent Chemoradiotherapy in Patients With Cervical Cancer

Sun, Chang; Wang, Shubin; Ye, Wenjing; Wang, RanLin; Tan, Min; Zhang, Hanyi; Zhou, Jie; Li, Minglun; Wei, Lichun; Xu, Peng; Zhu, Guiquan; Lang, Jinyi; Lü, Shun

doi:10.3389/fonc.2022.934110

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…Therefore, we conducted a subgroup analysis of patients with and without concurrent chemotherapy and found that in patients receiving CCRT, TVR had important prognostic value in both OS and PFS. This is consistent with a number of previous studies [9,10,15]. It is worth noting, however, that among patients who received RT alone, TVR was not signi cantly associated with OS.…”

Section: Analysis Of Different Risk Subgroups Of Lacc Patientssupporting

confidence: 92%

“…Although previous studies have shown that TVR is signi cantly associated with prognosis in CC patients, the cut-off values used by different studies vary widely [8-10] and most of the previous studies have set the median as the continuous tumor reference cut-off. Therefore, Sun et al [15] used a more scienti c 'Youden index' as the cut-off value and found that among 217 LACC patients who received CCRT, patients with TVR ≥ 82.19% had a better prognosis. We also used the Youden index to determine the optimal cutoff value for patients and found that this was different from the results of previous studies.…”

Section: Analysis Of Different Risk Subgroups Of Lacc Patientsmentioning

confidence: 99%

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Prognostic value of tumor volume reduction during radiotherapy in patients with locally advanced cervical cancer in different risk groups

lin

Xiao

et al. 2023

Preprint

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Objective: To evaluate the risk factors of patients with locally advanced cervical cancer (LACC) undergoing radical radiotherapy (with or without concurrent chemotherapy) and to assess the prognostic value of tumor volume regression (TVR) based on magnetic resonance imaging (MRI) in different risk groups. Methods: A retrospective analysis was performed on 176 individuals diagnosed with stage IIA-IVA cervical cancer (CC) who underwent radical intensity-modulated radiotherapy in our center between January 2012 and December 2020. The tumor volume before radiotherapy (TVp) and before brachytherapy (TVmid) were evaluated based on three-dimensional MRI images, TVR = (TVp -TVmid)/TVp×100%. Kaplan-Meier curves were used to assess patient’s overall survival (OS) and progression-free survival (PFS). Prognostic factors were identified using Cox proportional hazards models. Results: For the entire cohort, patients with TVR ≥ 94% had better 5-year OS (82.7% vs 49.8%, p<0.001) and 5-year PFS (82.5% vs 51.1%, p<0.001) compared to TVR < 94%. Patients with TVR ≥ 94% were more likely to receive concurrent chemoradiotherapy (CCRT) than those with TVR < 94% (70.1% vs 40.5%, p<0.05). Among patients undergoing CCRT, those with a TVR ≥ 94% had a better prognosis than those with a TVR < 94%. However, among patients who received RT alone, those with TVR ≥ 94% had better PFS but no statistically significant difference in OS. Likewise, among patients with CYFRA21-1 < 7.7 ng/ml, patients with TVR ≥ 94% had a better prognosis. However, TVR was not a prognostic factor in patients with CYFRA21-1 ≥ 7.7 ng/ml. Both CYFRA21-1 (OS, PFS interaction, p<0.001) and FIGO stage (PFS interaction, p=0.035) were found to significantly impact predictive effects of TVR. Conclusion: In LACC patients with CRYFA21-1 < 7.7 ng/ml who received CCRT, TVR was an important prognostic factor. However, in patients with CRYFA21-1 ≥7.7 ng/ml who received RT alone, the prognostic value of TVR needs to be further explored.

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Section: Analysis Of Different Risk Subgroups Of Lacc Patientssupporting

confidence: 92%

Section: Analysis Of Different Risk Subgroups Of Lacc Patientsmentioning

confidence: 99%

Prognostic value of tumor volume reduction during radiotherapy in patients with locally advanced cervical cancer in different risk groups

lin

Xiao

et al. 2023

Preprint

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“…The size of the initial tumor represents another factor with a major impact on survival. In general, between mortality and the size of the tumor is a directly proportional relationship, but if a favorable response to neoadjuvant therapy is obtained, the survival rate increases [20,21]. In our study, however, this parameter did not appear to be statistically significant, but these results may be influenced by the small number of patients.…”

Section: Discussioncontrasting

confidence: 82%

The Impact of Patient Characteristics, Risk Factors, and Surgical Intervention on Survival in a Cohort of Patients Undergoing Neoadjuvant Treatment for Cervical Cancer

Dicu-Andreescu,

Marincaș,

Prunoiu

et al. 2023

Medicina

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Introduction: Cervical cancer is among the most frequent types of neoplasia worldwide and remains the fourth leading cause of cancer death in women, a fact that raises the necessity for further development of therapeutic strategies. NCCN guidelines recommend radiation therapy with or without chemotherapy as the gold standard for locally advanced cervical cancer. Also, some studies claim that performing surgery after chemo-radiation therapy does not necessarily improve the therapeutic outcome. This study aims to determine the impact of the risk factors, various characteristics, and surgical treatment for patients in different stages of the disease on survival rate. Material and methods: Our study started as a retrospective, observational, unicentric one, carried out on a cohort of 96 patients diagnosed with cervical cancer from the surgical department of the Bucharest Oncological Institute, followed from 1 January 2019 for a period of 3 years. After the registration of the initial parameters, however, the study became prospective, as the patients were closely monitored through periodical check-ups. The end-point of the study is either the death of the participants or reaching the end of the follow-up period, and, therefore, we divided the cohort into two subgroups: the ones who survived after three years and the ones who did not. All 96 patients, with disease stages ranging from IA2 to IIIB, underwent radio-chemotherapy followed by adjuvant surgery. Results: Among the 96 patients, 45 (46%) presented residual tumor after radio-chemotherapy. Five patients (5%) presented positive resection margins at the post-operative histopathological examination. The presence of residual tumor, the FIGO stage post-radiotherapy, positive resection margins, and lympho-vascular and stromal invasions differed significantly between the subgroups, being more represented in the subgroup that reached the end-point. Variables correlated with the worst survival in Kaplan–Meier were the pelvic lymph node involvement—50% at three years (p—0.015)—and the positive resection margins—only 20% at three years (p < 0.001). The univariate Cox model identified as mortality-associated risk factors the same parameters as above, but also the intraoperative stage III FIGO (p < 0.001; HR 9.412; CI: 2.713 to 32.648) and the presence of post-radiotherapy adenopathy (p—0.031; HR: 3.915; CI: 1.136 to 13.487) identified through imagistic methods. The independent predictors of the overall survival rate identified were the positive resection margins (p—0.002; HR: 6.646; CI 2.0 to 22.084) and the post-radiotherapy stage III FIGO (p—0.003; HR: 13.886; CI: 2.456 to 78.506). Conclusions: The most important predictor factors of survival rate are the positive resection margins and the FIGO stage after radiotherapy. According to the NCCN guidelines in stages considered advanced (beyond stages IB3, IIA2), the standard treatment is neoadjuvant chemoradiotherapy. In our study, with radical surgery after neoadjuvant therapy, 46% of patients presented residual tumor at the intraoperative histopathological examination, a fact that makes the surgical intervention an important step in completing the treatment of these patients. In addition, based on the patient’s features/comorbidities and the clinical response to chemotherapy/radiotherapy, surgeons could carefully tailor the extent of radical surgery, thus resulting in a personalized surgical approach for each patient. However, a potential limitation can be represented by the relatively small number of patients (96) and the unicentric nature of our study.

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“…Several studies have shown that tumor reduction determined on MRI during EBRT was a significant prognostic factor ( 6 , 7 , 16 , 17 ). Most of these studies used treatment without CS and reported a cutoff value of 80–90% tumor volume reduction during EBRT of 45–50 Gy.…”

Section: Discussionmentioning

confidence: 99%

The prognostic effect of tumor volume, reduction ratio, and cumulative doses on external beam radiotherapy with central-shielding method and image-guided adaptive brachytherapy for cervical cancer

Ohtaka,

Ando,

Oike

et al. 2024

Front. Oncol.

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ObjectiveTo evaluate the prognostic effect of tumor volume at diagnosis, tumor reduction ratio during external beam radiotherapy (EBRT) with central-shielding method, and cumulative minimal dose to 90% of the high-risk clinical target volume (CTVHR D90) on combined EBRT and image-guided adaptive brachytherapy (IGABT) for cervical cancer.MethodsConsecutive patients who underwent definitive radiotherapy or concurrent chemoradiotherapy for cervical cancer at Gunma University Hospital between January 2010 and December 2019 were retrospectively reviewed. Tumor volume at diagnosis and reduction ratio were calculated using magnetic resonance imaging at diagnosis and before the first IGABT session. The cumulative dose of EBRT and IGABT was calculated as an equivalent dose in 2 Gy fractions (EQD2). Optimal cutoff values were determined according to a receiver operating characteristic curve. Treatment outcomes were evaluated using the Kaplan–Meier method and compared using the log-rank test and Cox proportional hazards regression.ResultsA total of 254 patients were included in the analysis. The median follow-up for all patients was 57 (2–134) months. The 5-year overall survival (OS) was 81.9%, progression-free survival (PFS) was 71.3%, and local control (LC) was 94.5%. The patients were divided into four groups according to tumor volume at diagnosis and reduction ratio. The group with tumor volume at diagnosis ≥ 34.1 cm3 and reduction ratio < 68.8% showed significantly worse OS, PFS, and LC than the other three groups (All p < 0.05). In this group, the patients with a cumulative CTVHR D90 < 69.6 GyEQD2 showed significantly worse PFS and LC (p = 0.042 and p = 0.027, respectively). In the multivariate analysis of OS, adenocarcinoma/adenosquamous carcinoma, International Federation of Gynecology and Obstetrics 2009 stage III/IV, and a reduction ratio of < 68.8% were independent significant poor prognostic factors (p = 0.045, p = 0.009 and p = 0.001, respectively). In the univariate analysis of LC, a reduction ratio of < 68.8% was the only poor prognostic factor (p = 0.041).ConclusionThe patients with large and poorly responding tumors had significantly worse prognoses in terms of OS, PFS, and LC, suggesting that dose escalation should be considered for such tumors.

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The Prognostic Value of Tumor Size, Volume and Tumor Volume Reduction Rate During Concurrent Chemoradiotherapy in Patients With Cervical Cancer

Cited by 9 publications

References 38 publications

Prognostic value of tumor volume reduction during radiotherapy in patients with locally advanced cervical cancer in different risk groups

Prognostic value of tumor volume reduction during radiotherapy in patients with locally advanced cervical cancer in different risk groups

The Impact of Patient Characteristics, Risk Factors, and Surgical Intervention on Survival in a Cohort of Patients Undergoing Neoadjuvant Treatment for Cervical Cancer

The prognostic effect of tumor volume, reduction ratio, and cumulative doses on external beam radiotherapy with central-shielding method and image-guided adaptive brachytherapy for cervical cancer

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