Subscribe to RSS
DOI: 10.5935/2526-8732.20210014
Radiotherapy alone in locally advanced cervical cancer: a palliative treatment? Real-world data
Radioterapia isolada no câncer cervical localmente avançado: um tratamento paliativo? Dados do mundo real
Financial support: none to declare.ABSTRACT
Objective: To investigate the benefit of radiotherapy alone in patients diagnosed with locally advanced cervical cancer when the addition of chemotherapy was contraindicated. Methods: A single-center cohort study of patients diagnosed with locally advanced cervical cancer as defined by the FIGO 2009 (stage IB2 to IVA) and contraindication for concomitant chemotherapy was retrospectively evaluated. Patients included were treated with radiotherapy in a curative intent and those patients who completed the external beam radiotherapy were considered for brachytherapy. Patient's demographics, reasons for not receiving concomitant chemotherapy and treatment responses were analyzed. Disease-free survival (DFS) and overall survival (OS) were calculated. Results: With a median follow-up of 13.9 months (range 0.10-81.8), the median DFS was 11.6 months (95% CI: 10.2-13.1), and the median OS was 15.9 months (95% CI: 11.5-20.3). Conclusion: This real-world study provides descriptive information confirming that radiotherapy with curative intent should be offered to patients with locally advanced cervical cancer even when chemotherapy is not an option due to clinical or laboratory contraindications.
RESUMO
Objetivo: Investigar o benefício da radioterapia isolada em pacientes com diagnóstico de câncer cervical localmente avançado quando a adição de quimioterapia foi contraindicada. Métodos: Um estudo de coorte unicêntrico de pacientes com diagnóstico de câncer cervical localmente avançado, conforme definido pela FIGO 2009 (estágio IB2 a IVA) e contraindicação para quimioterapia concomitante foi retrospectivamente avaliada. Os pacientes incluídos foram tratados com radioterapia com intenção curativa e os pacientes que completaram a radioterapia com feixe externo foram considerados para braquiterapia. Dados demográficos do paciente, razões para não receber quimioterapia concomitante e respostas ao tratamento foram analisados. Sobrevida livre de doença (SLD) e sobrevida global (SG) foram calculadas. Resultados: Com um acompanhamento médio de 13,9 meses (intervalo de 0,10-81,8), a SLD mediana foi de 11,6 meses (IC 95%: 10,2-13,1) e a SG mediana foi de 15,9 meses (IC 95%: 11,5-20,3). Conclusão: Este estudo do mundo real fornece informações descritivas que confirmam que a radioterapia com intenção curativa deve ser oferecida a pacientes com câncer cervical localmente avançado, mesmo quando a quimioterapia não é uma opção devido a contraindicações clínicas ou laboratoriais.
Publication History
Received: 12 September 2020
Accepted: 16 April 2021
Article published online:
08 July 2021
© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Tiago Pontes Braz, Eduardo Paulino, Alvaro Henrique Ingles Garces, Rachele Grazziotin Reisner, Gustavo Guitmann, Luiz Claudio Santos Thuler, Andreia Cristina de Melo. Radiotherapy alone in locally advanced cervical cancer: a palliative treatment? Real-world data. Brazilian Journal of Oncology 2021; 17: e-20210014.
DOI: 10.5935/2526-8732.20210014
-
REFERENCES
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A.. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; Nov; 68 (06) 394-424
- Kamangar F, Dores GM, Anderson WF.. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006; May; 24 (14) 2137-2150
- Villa LL.. Cervical cancer in Latin America and the Caribbean: the problem and the way to solutions. Cancer Epidemiol Biomarkers Prev 2012; Sep; 21 (09) 1409-1413
- LaVigne AW, Triedman SA, Randall TC, Trimble EL, Viswanathan AN.. Cervical cancer in low and middle income countries: addressing barriers to radiotherapy delivery. Gynecol Oncol Rep 2017; Nov; 22: 16-20
- De Vuyst H, Alemany L, Lacey C, Chibwesha CJ, Sahasrabuddhe V, Banura C. et al The burden of human papillomavirus infections and related diseases in Sub- Saharan Africa. Vaccine 2013; Dec; 31 (05) F32-46
- Ministério da Saúde (BR). Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA). Estimativa 2020 - Incidência de Câncer no Brasil [Internet]. Brasília (DF): Ministério da Saúde/INCA;; 2020. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/estimativa-2020-incidencia-de-cancer-no-brasil.pdf
- Colpani V, Bidinotto AB, Falavigna M, Giozza SP, Benzaken AS, Pimenta C. et al Prevalence of papillomavirus in Brazil: a systematic review protocol. BMJ Open 2016; Nov; 6 (11) e011884
- Ayres ARG, Silva GA.. Prevalência de infecção do colo do útero pelo HPV no Brasil: revisão sistemática. Rev Saúde Pública 2010; Oct; 44 (05) 963-974
- Ries LAG, Young Junior JL, Keel GE, Eisner MP, Lin YD, Horner MJ. SEER survival monograph: cancer survival among adults: U.S. SEER Program, 19882001, patient and tumor characteristics. Bethesda: National Cancer Institute (NCI)/SEER Program;; 2007
- Banerjee R, Kamrava M.. Brachytherapy in the treatment of cervical cancer: a review. Int J Womens Health 2014; May; 6: 555-564
- Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA. et al Concurrent cisplatinbased radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999; Apr; 340 (15) 1144-1153
- Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL. et al Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999; Apr; 340 (15) 1154-1161
- Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS. et al 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 the cervix. J Clin Oncol 2000; Apr; 18 (08) 1606-1613
- Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler Junior WC. et al 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 1999; May; 17 (05) 1339-1348
- Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE. et al Pelvic radiation with concurrent chemotherapy compared with pelvic and paraaortic radiation for high-risk cervical cancer. N Engl J Med 1999; Apr; 340 (15) 1137-1143
- Thomas G, Dembo A, Fyles A, Gadalla T, Beale F, Bean H. et al Concurrent chemoradiation in advanced cervical cancer. Gynecol Oncol 1990; Sep; 38 (03) 446-451
- Shrivastava S, Mahantshetty U, Engineer R, Chopra S, Hawaldar R, Hande V. et al Cisplatin chemoradiotherapy vs radiotherapy in FIGO stage IIIB squamous cell carcinoma of the uterine cervix: a randomized clinical trial. JAMA Oncol 2018; Apr; 4 (04) 506-513
- Perez CA, Breaux S, Madoc-Jones H, Bedwinek JM, Camel HM, Purdy JA. et al Radiation therapy alone in the treatment of carcinoma of uterine cervix. I. Analysis of tumor recurrence. Cancer 1983; Apr; 51 (08) 1393-1402
- Nam EJ, Lee M, Yim GW, Kim JH, Kim S, Kim SW. et al Comparison of carboplatin- and cisplatinbased concurrent chemoradiotherapy in locally advanced cervical cancer patients with morbidity risks. Oncologist 2013; Jul; 18 (07) 843-849
- Corn BW, Hernandez E, Anderson L, Fein DA, Dunton CJ, Heller P.. Phase I/II study of concomitant irradiation and carboplatin for locally advanced carcinoma of the uterine cervix: an interim report. Am J Clin Oncol 1996; Jun; 19 (03) 317-321
- Dubay RA, Rose PG, O'Malley DM, Shalodi AD, Ludin A, Selim MA.. Evaluation of concurrent and adjuvant carboplatin with radiation therapy for locally advanced cervical cancer. Gynecol Oncol 2004; Jul; 94 (01) 121-124
- Duenas-Gonzalez A, Cetina L, Sánchez B, Gomez E, Rivera L, Hinojosa J. et al A phase I study of carboplatin concurrent with radiation in FIGO stage IIIB cervix uteri carcinoma. Int J Radiat Oncol Biol Phys 2003; Aug; 56 (05) 1361-1365
- Higgins RV, Naumann WR, Hall JB, Haake M.. Concurrent carboplatin with pelvic radiation therapy in the primary treatment of cervix cancer. Gynecol Oncol 2003; Jun; 89 (03) 499-503
- Micheletti E, La Face B, Bianchi E, Cagna E, Apostoli P, Ruggeri G. et al Continuous infusion of carboplatin during conventional radiotherapy treatment in advanced squamous carcinoma of the cervix uteri IIB-IIIB (UICC). A phase I/II and pharmacokinetic study. Am J Clin Oncol 1997; Dec; 20 (06) 613-620
- Sebastião AM, Rocha LSS, Gimenez RD, Barros LAB, Fukushima JT, Silva SCS. et al Carboplatin-based chemoradiotherapy in advanced cervical cancer: an alternative to cisplatin-based regimen?. Eur J Obstet Gynecol Reprod Biol 2016; Jun; 201: 161-165
- Cetina L, Rivera L, Candelaria M, Garza J, DueñasGonzález A.. Chemoradiation with gemcitabine for cervical cancer in patients with renal failure. Anticancer Drugs 2004; Sep; 15 (08) 761-766
- McGuire WP, Blessing JA, Moore D, Lentz SS, Photopulos G.. Paclitaxel has moderate activity in squamous cervix cancer. A Gynecologic Oncology Group study. J Clin Oncol 1996; Mar; 14 (03) 792-795
- Thomas G, Dembo A, Ackerman I, Franssen E, Balogh J, Fyles A. et al A randomized trial of standard versus partially hyperfractionated radiation with or without concurrent 5-fluorouracil in locally advanced cervical cancer. Gynecol Oncol 1998; May; 69 (02) 137-145
- Franckena M.. Review of radiotherapy and hyperthermia in primary cervical cancer. Int J Hyperth 2012; 28 (06) 543-548
- Cerqueira EM, Santoro CL, Donozo NF, Freitas BA, Pereira CA, Bevilacqua RG. et al Genetic damage in exfoliated cells of the uterine cervix. Association and interaction between cigarette smoking and progression to malignant transformation? Acta Cytol 1998; May/Jun; 42 (03) 639-649
- Mahajan R.. Real world data: additional source for making clinical decisions. Int J Appl Basic Med Res 2015; Aug; 5 (02) 82
- Mitchell AP, Harrison MR, Walker MS, George DJ, Abernethy AP, Hirsch BR.. Clinical trial participants with metastatic renal cell carcinoma differ from patients treated in real-world practice. J Oncol Pract 2015; Nov; 11 (06) 491-497