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Definitive Concurrent Chemoradiotherapy in Cervical Cancer - a University of Malaya Medical Centre Experience

  • Zamaniah, W.I. Wan (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Mastura, M.Y. (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Phua, C.E. (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Adlinda, A. (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Marniza, S. (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Rozita, A.M. (Clinical Oncology Unit, Faculty of Medicine, University of Malaya)
  • Published : 2014.11.06

Abstract

Background: The efficacy of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer is well established. We aimed to investigate the long-term efficacy of definitive concurrent chemoradiotherapy for cervical cancer in the University of Malaya Medical Centre. Materials and Methods: A cohort of 60 patients with FIGO stage IB2-IVA cervical cancer who were treated with definitive concurrent chemoradiotherapy with cisplatin followed by intracavitary brachytherapy or external beam radiotherapy (EBRT) boost between November 2001 and May 2008 were analysed. Patients were initially treated with weekly intravenous cisplatin ($40mg/m^2$) concurrent with daily EBRT to pelvis of 45-50Gy followed by low dose rate brachytherapy or EBRT boost to tumour. Local control rate, progression free survival, overall survival and treatment related toxicities graded by the RTOG criteria were evaluated. Results: The mean age was 56. At the median follow-up of 72 months, the estimated 5-year progression-free survival (PFS) (median PFS 39 months) and the 5-year overall survival (OS) (median OS 51 months) were 48% and 50% respectively. The 5-year local control rate was 67.3%. Grade 3-4 late gastrointestinal and genitourinary toxicity occurred in 9.3% of patients. Conclusions: The 5-year PFS and the 5-year OS in this cohort were lower than in other institutions. More advanced stage at presentation, longer overall treatment time (OTT) of more than fifty-six days and lower total dose to point A were the potential factors contributing to a lower survival.

Keywords

References

  1. Akila N.V, Sushil B, et al (2012). American brachytherapy society consensus guidelines for locally advanced carcinoma of the cervix. part II: high-dose-rate brachytherapy. Brachytherapy, 11, 47-52. https://doi.org/10.1016/j.brachy.2011.07.002
  2. Amourzegar Hashemi F, Akbari EH, Kalaghchi B, Esmati E (2013). Concurrent chemoradiation with weekly gemcitabine and cisplatin for locally advanced cervical cancer. Asian Pac J Cancer Prev, 14, 5385-9. https://doi.org/10.7314/APJCP.2013.14.9.5385
  3. Arai T, Nakano T, Morita S, et al (1992). High dose rate remote afterloading intracavitary therapy for cancer of the uterine cervix. A 20-year experience. Cancer, 69, 175-80. https://doi.org/10.1002/1097-0142(19920101)69:1<175::AID-CNCR2820690129>3.0.CO;2-B
  4. American Cancer Society (2011). Global cancer facts and figures 2nd edition. Atlanta: American cancer society.
  5. Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S (2000). FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO committee on gynecologic oncology. Int J Gynecol Obstet, 70, 209-62 https://doi.org/10.1016/S0020-7292(00)90001-8
  6. Chemoradiotherapy for cervical cancer meta-analysis collaboration (2010). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database Syst Rev. 20, 008285.
  7. DeVita VT, Lawrence TS, Rosenberg SA, Ronald AD, Weinberg RA (2011). Cancer Principles & Practice of Oncology 9Th Edition, Lippincott Williams & Wilkins, 1311-45.
  8. Fyles A, Keane T. J, Barton M, Simm J (1992). The effect of treatment duration in the local control of cervix cancer. Radiother Oncol, 25, 273-9. https://doi.org/10.1016/0167-8140(92)90247-R
  9. Haffty BG, Wilson LD (2009). Radiation Oncology Basic Principles and Clinical Protocol, Jones and Bartlett Publisher, 538-603.
  10. Information and Documentation System Unit (2010). Malaysian ministry of health.
  11. Krusun S, Pesee M, Supakalin N, Thamronganantasakul K, et al., (2014). Treatment interruption during concurrent chemoradiotherapy of uterine cervical cancer; analysis of factors and outcomes. Asian Pac J Cancer Prev, 15, 5653-57. https://doi.org/10.7314/APJCP.2014.15.14.5653
  12. Landoni F, Maneo A, Colombo A, et al (1997). Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervcal cancer. Lancet, 350, 535-40. https://doi.org/10.1016/S0140-6736(97)02250-2
  13. Laudico A, Mapua C (2011). Cancer survival in Manila Philippines, 1994-1995 in cancer survival in Africa, Asia, the caribbean and central America', Eds Sankaranarayan R and Swaminathan R. IARC Scientific Publications No 162, IARC Press, Lyon.
  14. Levitt SH, Purdy JA, Perez CA, et al (2011). Technical basis of radiation therapy: practical clinical applications. 5th edition. Springer, 829-54.
  15. Lorvidhaya V, Tonusin A, Changwiwit W, et al (2000). High dose rate afterloading brachytherapy in carcinomas of the cervix; an experience of 1992 patients. Int J Radiat Oncol Biol Phy, 46, 1185-91. https://doi.org/10.1016/S0360-3016(99)00383-1
  16. Morris M, Eifel PJ, Lu J, et al (1999). Pelvic radiation with concurrent chemotherapy compared with pelvic and paraaortic radiation for high-risk cervical cancer. N Engl J Med, 340, 1137-43. https://doi.org/10.1056/NEJM199904153401501
  17. National Cancer Institute (1999). NCI clinical announcement. Bethesda, MD, United States Department of Health and Human Services, Public Health Service, National Institute Of Health.
  18. Nuradhiathy AR, Khattak MN, Yong ZZ, Nyi NN, Nik MZ (2013). Estimating the five-year survival of cervical cancer patients treated in hospital university Sains Malaysia. Asian Pac J Cancer Prev, 14, 825-8. https://doi.org/10.7314/APJCP.2013.14.2.825
  19. Pesee M, Krusun S, Padoongcharoen P (2000). High dose rate Cobalt-60 afterloading intracavitary therapy of the uterine cervical carcinoma in Srinagarind hospital, analysis of survival. Asian Pac J Cancer Prev, 11, 1469-71.
  20. Pesee M, Kirdpon W, Puapairoj A, Kirdpon S, Pranthnadi (2013). Palliative treatment of advanced cervical cancer with radiotherapy and Thai herbal medicine as supportive remedyanalysis of survival. Asian Pac J Cancer Prev, 13, 1593-6.
  21. Perez CA, Grigsby PW, Castro-Vita H, Lockett MA (1995). Carcinoma of uterine cervix. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Rad Oncol Biol Phys, 32, 1275-88. https://doi.org/10.1016/0360-3016(95)00220-S
  22. Peters WA, Liu PY, Barret RJ, et al (2000). Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high risk early-stage cancer of cervix. J Clin Oncol, 18, 1606-13.
  23. Petereit DG, Sarkaria JN, Chappell R (1995). The adverse effect of treatment prolongation in cervical carcinoma, Int J Radiat Oncol Biol Phys, 32, 1301-7. https://doi.org/10.1016/0360-3016(94)00635-X
  24. Qing-Hua K, Shi-Qiong Z, Wei Du et al. (2013). Early efficacy of taxotere and cisplatin chemo-radiotherapy for advanced cervical cancer. Asian Pac J Cancer Prev, 13, 617-9. https://doi.org/10.7314/APJCP.2012.13.2.617
  25. Rose PG, Bundy BN, Watkins EB, et al (1999). Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 340, 1144-53. https://doi.org/10.1056/NEJM199904153401502
  26. Rose PG, Ali S, Watkins E, et al (2007). Long-term follow up of randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy or hydroxyurea during pelvic irradiation for locally advanced cervical cancer; a gynaelogy group study. J Clin Oncol, 25, 2804-10. https://doi.org/10.1200/JCO.2006.09.4532
  27. Shingo K, Tatsuya O, Kullathorn T, et al (2013). Long-term follow-up results of a multi-institutional phase 2 study of concurrent chemoradiation therapy for locally advanced cervical cancer in East and Southeast Asia. Int J Radiation Oncol Biol Phys, 87, 100-5. https://doi.org/10.1016/j.ijrobp.2013.04.053
  28. Sirait Am, Soetiarto F, Oemiatil R (2003). Survival rate of cervical cancer patients in Dharmais Cancer Hospital, Jakarta Bul Penel Kesehatan, 31, 13-24.
  29. Takashi N, Shingo K, Jianping C, et al (2007). A regional cooperative clinical study of radiotherapy for cervical cancer in East and South-east Asian countries. Radiotherapy Oncology, 84, 314-9. https://doi.org/10.1016/j.radonc.2007.05.012
  30. The Royal College of Radiologist (2009). Implementing imageguided brachytherapy for cervix cancer in the UK, London; the Royal College of Radiologists.
  31. Whitney CW, Sause W, Bundy BN, et al (1999). Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a gynecologic oncology group and Southwest oncology group study. J Clin Oncol, 17, 1339-48.
  32. Zainal Ariffin O, Nor Saleha IT (2011). National cancer registry report 2007, Ministry of Health, Malaysia.

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