Chemoradiotherapy in the treatment of cervical cancer – a single institution retrospective review

Czech version

Authors: Z. Pechačová ¹; R. Lohynská ^1,2; Z. Weitoschová ¹; M. Zikán ³; O. Dubová ³; V. Tomancová ^1,4; E. Kmoníčková ¹; M. Pála ¹; T. Drbohlavová ¹
Authors‘ workplace: Ústav radiační onkologie, 1. LF UK a FN Bulovka, Praha ¹; Onkologická klinika 1. LF UK a FTN Praha ²; Gynekologicko-porodnická klinika 1. LF UK a FN Bulovka, Praha ³; Onkologická klinika 1. LF UK a VFN v Praze ⁴
Published in: Klin Onkol 2022; 35(2): 139-149
Category: Original Articles
doi: https://doi.org/10.48095/ccko2022139

Overview

Background: The aim of this study is a retrospective analysis of treatment outcomes and toxicity in a group of patients with cervical cancer who underwent (chemo) radiotherapy at the Institute of Radiation Oncology in Bulovka University Hospital in Prague in the period 2014–2017. Patients and methods: During this period, 141 patients were treated, 105 (74.5%) of them underwent combined (chemo) radiotherapy with radical intent and palliative radiotherapy was performed in 36 (25.5%) cases. According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification, the most numerous stages were IIB in 39 (27.7%) and IIIB in 64 (45.4%) cases; according to FIGO 2018, a significant number of newly established stages is evident: IIIC1 in 55 (39.0%) patients and IIIC2 in 22 (15.6%) cases. Results: The median progression-free survival (PFS) and overall survival (OS) reached 31.3, resp. 40.1 months in the whole group. In the subgroup of patients treated with radical intent, the median PFS was 44.0 months and OS 48.8 months; in the palliative subgroup, the median PFS was 9.4 months and OS 14.8 months. In a radically treated subgroup, 7 (6.7%) patients had gastrointestinal or genitourinary manifestations of G3–4 toxicity, and overall acute toxicity (including skin and haematological reactions) of G3–4 occurred in 18 (17.1%) patients. Late toxicity of G3–4 was reported in 13 (12.4%) cases. Patients who underwent complete brachytherapy (BRT) showed significantly better survival compared to patients with a lower number of BRT fractions. The prognostic potential of PS (performance status) and anemia was confirmed; significantly longer overall survival was observed in patients in good general condition or in those without anemia. Conclusion: Our results confirmed the key role of BRT for the delivery of the curative dose to the target volume. The prognostic role of PS and anemia is evident. The side effects were in acceptable limits but we expect improvements because of the use of modern radiotherapy technologies.

Keywords:

cervical cancer – radiotherapy – concurrent chemoradiotherapy – brachytherapy

Sources

1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. [online]. Dostupné z: http: //www.svod.cz.

2. Stankušová H. Současná radioterapie a chemoterapie ca hrdla děložního. XVI. Jihočeské onkologické dny, abstrakt 009. [online]. Dostupné z: https: //www.linkos.cz/lekar-a-multidisciplinarni-tym/celozivotni-vzdelavani/kongresy/kongresovy-kalendar/xxvi-jihoceske-onkologicke-dny/.

3. Green JA, Kirwan JM, Tierney JF et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001; 358 (9284): 781–786. doi: 10.1016/S0140-6736 (01) 05965-7.

4. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008; 26 (35): 5802–5812. doi: 10.1200/JCO.2008.16.4368.

5. Cibula D, Pötter R, Planchamp F et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 2018; 28 (4): 641–655. doi: 10.1016/j.radonc.2018.03.003.

6. Modrá kniha České onkologické společnosti, 27. aktualizace. [online]. Dostupné z: https: //www.linkos.cz/lekar-a-multidisciplinarni-tym/personalizovana-onkologie/modra-kniha-cos/aktualni-vydani-modre-knihy/.

7. Národní radiologické standardy – radiační onkologie. Věstník Ministerstva zdravotnictví České republiky 2/2016. Praha 2016.

8. Naga Ch P, Gurram L, Chopra S et al. The management of locally advanced cervical cancer. Curr Opin Oncol 2018; 30 (5): 323–329. doi: 10.1097/CCO.0000000000000471.

9. Gupta S. Adjuvant chemotherapy in locally advanced cervical cancer: the ceiling remains unbroken. J Gynecol Oncol 2019; 30 (4): e97. doi: 10.3802/jgo.2019.30.e97.

10. Gupta S, Maheshwari A, Parab P et al. Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol 2018; 36 (16): 1548–1555. doi: 10.1200/JCO.2017.75.9985.

11. Benson R, Pathy S, Kumar L et al. Locally advanced cervical cancer – neoadjuvant chemotherapy followed by concurrent chemoradiation and targeted therapy as maintenance: a phase II study. J Cancer Res Ther 2019; 15 (6): 1359–1364. doi: 10.4103/jcrt.JCRT_39_18.

12. Kagabu M, Nagasawa T, Sato C et al. Immunotherapy for uterine cervical cancer using checkpoint inhibitors: future directions. Int J Mol Sci 2020; 21 (7): 2335. doi: 10.3390/ijms21072335.

13. Mouková L, Nenutil R, Fabian P et al. Prognostické faktory karcinomu děložního hrdla. Klin Onkol 2013; 26 (2): 83–90. doi: 10.14735/amko201383.

14. Sehnal B, Kmoníčková E, Sláma J et al. Současný FIGO staging karcinomu děložního hrdla a léčba jednotlivých stadií. Klin Onkol 2019; 32 (3): 224–231. doi: 10.14735/amko2019224.

15. Gill BS, Lin JF, Krivak TC et al. National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys 2014; 90 (5): 1083–1090. doi: 10.1016/j.ijrobp.2014.07. 017.

16. Fischerova D, Cibula D, Stenhova H et al. Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int J Gynecol Cancer 2008; 18 (4): 766–772. doi: 10.1111/j.1525-1438.2007.01072.x.

17. Haldorsen IS, Lura N, Blaakær J et al. What is the role of imaging at primary diagnostic work-up in uterine cervical cancer? Curr Oncol Rep 2019; 21 (9): 77. doi: 10.1007/s11912-019-0824-0.

18. Viswanathan C, Faria S, Devine C et al. [18F]-2-fluoro-2-deoxy-D-glucose-PET assessment of cervical cancer. PET Clin 2018; 13 (2): 165–177. doi: 10.1016/j.cpet.2017.11. 004.

19. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346. doi: 10.1016/0360-3016 (95) 00060-C.

20. Pála M, Holečková P, Veselý J et al. Konkomitantní chemoradioterapie v léčbě nádorů ORL oblasti. Výsledky ÚRO 2002-2005. Klin Onkol 2007; 20 (3): 248–252.

21. Holečková P, Pála M, Mašek M et al. Retrospektivní hodnocení léčebných výsledků u pacientů s nasofaryngeálním karcinomem léčených v ÚRO FNB Praha od roku 1990 do roku 2005. Klin Onkol 2007; 20 (1): 35–37.

22. Pechačová Z, Kmoníčková E, Zikán M et al. Léčba karcinomu hrdla děložního s postižením paraaortálních uzlin – retrospektivní hodnocení vlastního souboru. Klin Onkol 2020; 33 (2): 123–131. doi: 10.14735/amko2020123.

23. Lohynská R, Nýdlová A, Drbohlavová T et al. Hematologická toxicita u IMRT/VMAT v kurativní léčbě análního karcinomu. Klin Onkol 2020; 33 (4): 288–294. doi: 10.14735/amko2020288.

24. Sochor M, Sláma O, Loučka M. Časná integrace paliativní péče do standardní onkologické péče – benefit, limitace, bariéry a druhy paliativní péče. Klin Onkol 2015; 28 (3): 171–176. doi: 10.14735/amko2015171.

25. Pechačová Z, Končeková J, Lohynská R et al. Paliativní radioterapie v managementu symptomů pokročilého onkologického onemocnění. Onkologie 2020; 14 (6): 271–277.

26. Vorlíček J, Skřičková J. Paliativní léčba u onkologických nemocných. Klin Onkol 1993; 6 (4): 119–122.

27. Klastersky J. Podpůrná léčba onkologicky nemocných. Klin Onkol 1994; 7 (1): 9–13.

28. Skliarenko J, Barnes EA. Palliative pelvic radiotherapy for gynaecologic cancer. [online]. Available from: https: //link.springer.com/article/10.1007/s13566-012-0050-y.