Is Adjuvant Chemoradiotherapy Overtreatment in Cervical Cancer Patients With Intermediate Risk Factors?
ABSTRACT To determine whether adjuvant chemoradiotherapy (CRT) improves the outcome of cervical cancer patients with intermediate risk factors.
Between January 2000 and June 2006, the medical records of 735 patients who had undergone radical surgery for Stage IB-IIA cervical cancer were reviewed retrospectively. Of the 735 patients, 172 with two or more intermediate risk factors (i.e., lymphovascular space involvement, deep stromal invasion, and tumor size≥2 cm) were grouped as follows according to the adjuvant treatment received: 34 patients, no further treatment; 49 patients, RT; and 89 patients, CRT. The significance of the clinical parameters and recurrence-free survival of each group were analyzed.
Of the 172 patients with any of the intermediate risk factors, 137 (79.6%) had two or more intermediate risk factors. Of the 172 patients, 12 developed recurrences (6.4%)->(7.0%), with 6 in the pelvis and 6 in distant sites. All 12 recurrences occurred in those who had two or more intermediate risk factors (sensitivity, 100%); however, only six recurrences were detected in patients who met the Gynecologic Oncology Group criteria for the intermediate-risk group (sensitivity, 50%; Z test, p<.05). A statistically significant difference was found in the 3-year recurrence-free survival rate among the no further treatment, RT, and CRT groups (67.5%, 90.5%, and 97.5%, respectively; p<.05). The incidence of Grade 3-4 hematologic and gastrointestinal toxicities was not significantly different statistically between the RT and CRT groups (6.1% and 13.4%, respectively; p > .05).
Postoperative adjuvant CRT can improve the outcome of cervical cancer patients with intermediate risk factors, with low increase in toxicity.
- SourceAvailable from: Joo Hyun Nam
[Show abstract] [Hide abstract]
- "This study demonstrated that our 'four-factor model' including any two of four intermediate-risk factors (3CM, LVSI, OUT, and ADE) could predict recurrence and survival more effectively than other criteria in patients with intermediate-risk factors after radical hysterectomy. According to the Classic criteria, the intermediate-risk group is defined by the presence of any two factors among three variables (2CM, MID, and LVSI) (Delgado et al, 1989; Samlal et al, 1997; Van de Putte et al, 2005; Ryu et al, 2011). Despite their simplicity and convenience, the Classic criteria define the intermediate-risk "
ABSTRACT: Background: In this study, we sought to identify a criterion for the intermediate-risk grouping of patients with cervical cancer who exhibit any intermediate-risk factor after radical hysterectomy. Methods: In total, 2158 patients with pathologically proven stage IB–IIA cervical cancer with any intermediate-risk factor after radical hysterectomy were randomly assigned to two groups, a development group and a validation group, at a ratio of 3 : 1 (1620 patients:538 patients). To predict recurrence, multivariate models were developed using the development group. The ability of the models to discriminate between groups was validated using the log-rank test and receiver operating characteristic (ROC) analysis. Results: Four factors (histology, tumour size, deep stromal invasion (DSI), and lymphovascular space involvement (LVSI)) were significantly associated with disease recurrence and included in the models. Among the nine possible combinations of the four variables, models consisting of any two of the four intermediate-risk factors (tumour size ⩾3 cm, DSI of the outer third of the cervix, LVSI, and adenocarcinoma or adenosquamous carcinoma histology) demonstrated the best performance for predicting recurrence. Conclusion: This study identified a ‘four-factor model' in which the presence of any two factors may be useful for predicting recurrence in patients with cervical cancer treated with radical hysterectomy.British Journal of Cancer 12/2013; 110(2). DOI:10.1038/bjc.2013.716 · 4.84 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The potential of pine cones as a natural biosorbent was investigated for adsorptive removal of Basic Red 46 (BR 46) from aqueous solutions. Various physico-chemical parameters were studied such as solution pH, biosorbent dosage, biosorbent size, dye concentration, temperature, contact time and ionic strength. The equilibrium data fitted well with the Langmuir isotherm. The monolayer sorption capacity was found as 73.53 mg g−1. Kinetic data were best described by the pseudo-second order model. The thermodynamic studies indicated that the biosorption reactions were spontaneous and endothermic. Activation energy was calculated as 32.33 kJ mol−1. The BR 46 was desorbed from the pine cones with 0.1 M HCl solution. The recovery for the dye was found to be higher than 90%. Thus, this study demonstrated that the pine cones could be used as a low-cost biosorbent for the treatment of the wastewater streams bearing dye.Research Highlights►The monolayer sorption capacity was found as 73.53 mg g−1. ►Kinetic data were best described by the pseudo-second order model. ►The biosorption reactions were spontaneous and endothermic. ►The pine cones as a natural biosorbent may be an alternative to more costly materials.Desalination 04/2011; 270(1-3):199-205. DOI:10.1016/j.desal.2010.11.046 · 3.76 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The use of adjuvant radiotherapy for early stage node negative patients varies for different institutions. The recognized factors such as deep stromal invasion, lymph vascular space invasion, and size of tumor are the most common factors cited for adjuvant radiotherapy. Studies done have shown that this increases local control but may increase chronic toxicity rates. We report on our use of the GOG score to tailor our treatment decisions. A review of all patients staged IB-IIA who underwent Type 3 Radical Hysterectomy and pelvic lymph node dissection (RH) from 1997 to 2007. The GOG score proposed by Delgado et al. was applied, and patients were stratified into 3 groups; <40: no adjuvant treatment, 40-120: Small Field RT (SmRT), and >120: Standard Field RT (StRT) RESULTS: A total of 126 patients matched these criteria. Sixty one patients underwent either SmRT or StRT. There were only 2 known relapses and one death due to inter current illness. The median follow up was 57 months and the 5 year Disease Free Survival was 98.2%. There were no documented Grade 3 or 4 chronic toxicities. There were significantly less (p=0.025) patients with lower limb lymphedema in the SmRT group compared to StRT. Our study confirms the utility of the GOG score to tailor radiotherapy for this cohort of patients. This has been proven to be high in efficacy and low in morbidity.Gynecologic Oncology 07/2011; 123(2):225-9. DOI:10.1016/j.ygyno.2011.06.040 · 3.77 Impact Factor