Chemoradiation for invasive cervical cancer in elderly patients: Outcomes and morbidity

Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, Iowa, USA.
International Journal of Gynecological Cancer (Impact Factor: 1.95). 12/2007; 18(1):95-103. DOI: 10.1111/j.1525-1438.2007.00967.x
Source: PubMed

ABSTRACT Age may impact survival and treatment in cervical cancer patients. We sought to determine if treatment and survival were different in elderly patients and whether chemoradiation increased morbidity. We performed a retrospective chart review to identify patients treated with definitive radiation therapy at the University of Iowa Hospitals and Clinics between 1997 and 2001. Three hundred sixty-four patients had a new diagnosis of invasive cervical cancer, of which 150 patients were treated with radiation. We excluded patients treated postoperatively or with palliative intent, leaving 96 patients treated with definitive radiation therapy. Patients were divided into two age categories: elderly (>/=65) and nonelderly (<65). We compared these groups with respect to treatment received, morbidity, and survival. Sixty-nine (72%) women were less than 65 years old, and 27 (28%) women were greater than or equal to 65 years old. Chemoradiation was associated with decreased mortality (P < 0.01). The decrease in mortality did not differ between the two age cohorts (all causes: P = 0.66; cancer specific: P = 0.65), nor was there a difference in the complication rate due to chemoradiation (P = 0.70). Although elderly patients were more likely to be diagnosed with nonsquamous histologies (P < 0.01), their odds of receiving chemoradiation were 0.35 (95% CI: 0.13-0.90) times the odds for nonelderly. Elderly cervical cancer patients more often have nonsquamous histology and are likely to receive only radiation therapy compared to younger patients. Treatment with chemoradiation was associated with similar survival increases in both age cohorts. Complication rates between the two were similar. Chemoradiation should be considered in elderly patients with invasive cervical cancer.

Download full-text


Available from: Brian J Smith, Nov 13, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We propose a method for assigning upper level gene ontology terms (GO categories) to genes using relevant documents. This method represents each gene as a vector using relevant documents to the gene. Then, binary classifiers are made for the GO categories using such supervised learning methods as support vector machines and maximum entropy method. We applied this method for assigning GO categories to yeast genes and achieved an average F-measure of 0.67, which is > 0.3 higher than the existing method developed by Raychaudhun et al. We also applied this method to genome-wide annotation for yeast by all GO Slim categories provided by SGD and achieved average F-measures of 0.58, 0.72, and 0.60, respectively, for the three GO parts: cellular component, molecular function, and biological process.
    Computational Systems Bioinformatics Conference, 2004. CSB 2004. Proceedings. 2004 IEEE; 09/2004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: With respect to cervical cancer management, Finland and the Netherlands are comparable in relevant characteristics, e.g., fertility rate, age-of-mother at first birth and a national screening programme for several years. The aim of this study is to compare trends in incidence of and mortality from cervical cancer in Finland and the Netherlands in relation to the introduction and intensity of the screening programmes. Therefore, incidence and mortality rates were calculated using the Cancer Registries of Finland and the Netherlands. Data on screening intensity were obtained from the Finnish Cancer Registry and the Dutch evaluation centre at ErasmusMC-Rotterdam. Women aged 30-60 have been screened every 5 years, in Finland since 1992 and in the Netherlands since 1996. Screening protocols for smear taking and referral to the gynaecologist are comparable. Incidence and mortality rates have declined more in Finland. In 2003, age-adjusted incidence and mortality in Finland were 4.0 and 0.9 and in the Netherlands 4.9 and 1.4 per 100,000 woman-years, respectively. Excess smear use in the Netherlands was estimated to be 24 per 1,000 women during a 5-year interval compared to 121 in Finland. The decline in mortality in Finland seems to be almost completely related to the screening programme whereas in the Netherlands it was initially considered to be a natural decline. Differences in risk factors might also play a role: the Netherlands has higher population density and higher percentages of immigrants and (female) smokers. The greater excess smear use in Finland might also have affected incidence.
    International Journal of Cancer 04/2007; 122(8):1854-8. DOI:10.1002/ijc.23276 · 5.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In The Netherlands, despite a national screening programme since 1996, invasive cervical cancers have been detected in screened and non-screened women. The aim of this study was to determine differences between Pap-smear history, tumour characteristics and survival of patients with a tumour detected by the screening programme (SP) or outside the screening programme (OSP) in the region of the Comprehensive Cancer Centre Stedendriehoek Twente in the period 1992-2001. In this period, 263 cervical cancer cases in women aged 30-60 were selected from the regional cancer registry. Patient and tumour characteristics, treatment and follow-up data were extracted. Also, detection modality of the tumour and Pap score of the smear which led to the diagnosis ('diagnostic smear') and the 'previous smear' were registered. Thirty-five percent were SP tumours and 65% were OSP tumours. SP tumours had a lower stage (FIGO I) than OSP tumours: 84% versus 57%. The OSP group exhibited a twofold increase in risk of death (p<0.05) compared to the SP group. Subsequently 61 women (23%) and 46 (17%) women had an abnormal Pap smear (Pap II or higher) 5 and 3 years before the 'diagnostic smear', respectively. Furthermore, 37 women (14%) and 23 women (9%) had a normal smear 5 and 3 years before diagnosis, respectively. SP tumours have a lower stage and a better prognosis, probably due to the fact that the screening programme detects the slow growing tumours which in general have a better prognosis. Furthermore, detection and treatment of patients with suspicious smears have been suboptimal and attention should therefore be paid to prompt follow-up of suspicious smears.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 12/2007; 139(2):204-9. DOI:10.1016/j.ejogrb.2007.10.017 · 1.63 Impact Factor
Show more