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ABSTRACT: BACKGROUND: The aim of this retrospective study was to investigate the feasibility of primary treatment with extended-field irradiation and weekly cisplatin (extended-field concurrent chemoradiotherapy, EFCCRT) as initial therapy in patients with International Federation of Gynecology and Obstetrics IB1 to IIIB cervical cancer with paraaortic or high common iliac lymph node metastases. METHODS: Participants comprised patients with confirmed cervical cancer, showing paraaortic or high common iliac lymph node metastases on diagnostic imaging, treated with EFCCRT. Total external radiation doses were 50.4 Gy to the whole pelvis and 45.0 Gy to the lumbar paraaortic region. High-dose-rate intracavitary brachytherapy was performed to deliver a total dose of 18-24 Gy in 6-Gy fractions prescribed at point A. Weekly cisplatin (30-40 mg/m(2)) was given concurrently with radiotherapy. RESULTS: Twenty-four patients were treated. Median follow-up interval was 34 months. The dose of cisplatin was 30 mg/m(2) in 2 cases, 35 mg/m(2) in 8 cases, and 40 mg/m(2) in 14 cases. Twenty-two cases (92 %) received more than 160 mg/m(2) cisplatin. Ten cases (42 %) experienced acute grade 3/4 hematological toxicity, and 9 cases (38 %) experienced acute grade 3 nonhematological toxicity. No case presented late grade 3/4 toxicity. Three-year progression-free and overall survival rates were 54 % and 72 %, respectively. Eleven cases recurred during follow-up. Sites of recurrence were within the irradiation field in 4 cases, outside the field in 6 cases, and in both fields in 1 case. CONCLUSION: EFCCRT and high-dose-rate intracavitary brachytherapy for patients with paraaortic or high common iliac lymph node metastases from cervical cancer is feasible.
International Journal of Clinical Oncology 04/2013; · 1.41 Impact Factor
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Kenji Umayahara,
Ryo Kitagawa,
Masahiko Oguchi,
Takashi Uno,
Hideyuki Sakurai,
Yuzuru Niibe,
Yasuyuki Hirashima,
Miki Fukutani,
Tomoko Kazumoto,
Satoshi Ishikura,
Yoichi Aoki,
Kazuo Hatano,
Takafumi Toita,
Shingo Kato,
Tetsuo Nishimura, Ken Takizawa,
Japanese Gynecologic Oncology Group and Disease Committee of Radiation Oncology,
Kayoko Tsujino,
Takeshi Kodaira
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ABSTRACT: OBJECTIVE: To assess the feasibility and acute toxicity of concurrent chemoradiotherapy (CCRT) with high-dose rate intracavitary brachytherapy (HDR-ICBT) and standard dose delivery of cisplatin for Japanese patients with cervical cancer. MATERIALS AND METHODS: The phase 2 study included Japanese patients with International Federation of Gynecology and Obstetrics stage III to IVA uterine cervical cancer who had no para-aortic lymphadenopathy (>10 mm) assessed by computed tomography. Patients were 20 to 70 years of age and had Eastern Cooperative Oncology Group performance status of 0 to 1. The radiotherapy protocol consisted of whole-pelvis external beam radiotherapy and HDR-ICBT. The cumulative linear quadratic equivalent dose (EQD2) was 62 to 65 Gy prescribed at point A. Cisplatin was administered weekly at a dose of 40 mg/m for 5 courses. RESULTS: Between March 2008 and January 2009, 72 patients from 25 institutions were enrolled, and 71 patients were eligible and evaluable for compliance and severe toxicity. The median age of the patients was 57 years (range, 32-70 years). Sixty-five patients (92%) received the planned 5 courses of chemotherapy. Four patients had cisplatin dose reduction according to the protocol. Radiotherapy was completed per protocol in 68 patients (96%). Median overall treatment time was 50 days (range, 37-66 days). The following grade 3 or 4 acute adverse events were observed: neutropenia in 31 patients (44%), anemia in 10 patients (14%), diarrhea in 4 patients (6%), and anorexia in 3 patients (4%). CONCLUSIONS: Concurrent chemoradiotherapy with HDR-ICBT and standard weekly delivery of cisplatin was feasible with acceptable toxicity in Japanese patients with cervical cancer.
International Journal of Gynecological Cancer 08/2012; 22(8):1420-1426. · 1.65 Impact Factor
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ABSTRACT: A multicenter phase II trial was conducted to assess the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with high-dose-rate intracavitary brachytherapy (HDR-ICBT) using a low cumulative prescribed dose schedule in patients with locally advanced uterine cervical cancer.
The Japanese Gynecologic Oncology Group (JGOG) study JGOG1066 enrolled patients with FIGO stages III-IVA uterine cervical cancer who had no para-aortic lymphadenopathy (>10 mm) assessed by CT. Patients received definitive radiotherapy (RT) consisting of external beam whole pelvic RT and HDR-ICBT. The cumulative linear quadratic equivalent dose (EQD2) was 62-65 Gy prescribed at point A. Cisplatin 40 mg/m(2) weekly was administered concurrently with RT for 5 courses.
Of the 72 patients registered, 71 were eligible. With a median follow-up of 28 months, the 2-year progression-free survival rate and pelvic disease progression-free rate were 66% (95% CI, 54% to 76%) and 73% (95% CI, 61% to 82%), respectively. Progression-free survival decreased significantly with increased central tumor size (P=0.036). The 2-year cumulative late complication rates were 24% for all grades, 9% for grade 1, 12% for grade 2, 3% for grade 3, and 0 for grades 4/5.
The JGOG1066 demonstrated that CCRT using HDR-ICBT with a low cumulative RT dose schedule achieved comparable outcome as those achieved with global dose schedules (EQD2=85 Gy) with a lower incidence of late toxicity for locally advanced uterine cervical cancer in a Japanese population.
Gynecologic Oncology 04/2012; 126(2):211-6. · 3.89 Impact Factor
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Takafumi Toita,
Shingo Kato,
Satoshi Ishikura,
Kayoko Tsujino,
Takeshi Kodaira,
Takashi Uno,
Kazuo Hatano,
Hideyuki Sakurai,
Yuzuru Niibe,
Tomoko Kazumoto,
Tetsuo Nishimura,
Ryo Kitagawa,
Miki Fukutani,
Masahiko Oguchi,
Kenji Umayahara, Yasuyuki Hirashima,
Yoichi Aoki,
Ken Takizawa
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ABSTRACT: To assess radiotherapy protocol compliance in a multi-institutional phase II study of concurrent chemoradiotherapy for patients with locally advanced cancer of the uterine cervix (JGOG1066).
For study protocol development, various radiotherapy parameters were examined and consensus was reached by Japanese radiation oncologists with cervical cancer treatment expertise. Quality assurance (QA) was also discussed and included in the protocol. A credentialing process was used to select institutions for participation in the study. Individual case reviews referring to 18 QA items were undertaken for each patient. Radiotherapy data were submitted to the Japanese Gynecologic Oncology Group (JGOG) data center and reviewed by the members of the radiotherapy committee. The QA evaluation was classed as per protocol, deviation, and violation.
Individual case reviews were performed on 69 of 72 patients entered in the study. In 24 patients (35%), there were no deviations for any QA items. There were also no deviations seen for 5 of the 18 items in 69 patients evaluated. Deviations of 64 QA items were seen in 45 cases, and violations were seen in 4 cases (4 items). The most common deviation concerned appropriate application for the external beam radiotherapy (EBRT) boost to involved nodes or parametrium (32 cases). The 4 violations were identified in the QA items regarding high-dose rate intracavitary brachytherapy.
Radiotherapy protocol compliance was favorable except for the EBRT boost indications. The results of this study validate the quality of radiotherapy in JGOG1066, and indicate that the final analysis will provide meaningful results.
International Journal of Clinical Oncology 02/2011; 16(4):379-86. · 1.41 Impact Factor
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ABSTRACT: We have conducted a retrospective, comparative analysis of the accuracy of preoperative diagnosis and frozen section diagnosis relative to postoperative diagnosis.
Subjects consisted of 168 patients with endometrial cancer, and frozen section was also performed. The diagnostic accuracy and the under-diagnosis rates in regard to both the myometrial invasion (MI) and the histological type and grade (HTG) were determined.
The diagnostic accuracy rate for preoperative HTG and MI were 64.3 and 54.8%, while the under-diagnosis rate was 25.0 and 35.7%. In contrast, the corresponding diagnostic accuracy rate for frozen HTG and MI were 84.5 and 85.7%, while under-diagnosis was 9.5 and 9.5%. Statistical analysis showed that the diagnostic accuracy rate for HTG and MI were significantly higher with frozen section diagnosis than with preoperative diagnosis (P<0.0001) and the under-diagnosis rate for HTG and MI were significantly lower with frozen section diagnosis than with preoperative diagnosis (P<0.0001).
Frozen section diagnosis was clearly more effective than preoperative diagnosis involving MRI as a basis for deciding the operative technique for endometrial cancer.
Archives of Gynecology 10/2009; 281(5):913-7. · 0.91 Impact Factor
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ABSTRACT: In the treatment of endometrial carcinoma, young patients desire the preservation of the uterus, and therefore hormonal therapy has been administered.
The patient was a 39-year-old nullipara diagnosed with stage 1a endometrial carcinoma. The patient desired the preservation of the uterus, and oral administration of MPA was prescribed for 18 weeks, which after the cancer tissue disappeared. However, about 1 year and 6 months later, the patient was diagnosed as having recurrent endometrial carcinoma in the left external iliac lymph node.
In the literature, there is no patient with relapse at another site in the absence of endometrial relapse after MPA therapy for stage 1a endometrial carcinoma, as performed in the present patient.
Archives of Gynecology and Obstetrics 03/2008; 278(4):365-7. · 1.28 Impact Factor
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ABSTRACT: Glassy cell carcinoma of the uterine cervix is a rare tumor, and has a poor prognosis because of its aggressive clinical behavior and resistance to radiotherapy and chemotherapy. We report a case of bulky glassy cell carcinoma of the uterine cervix that effectively responded to paclitaxel and carboplatin in a neoadjuvant setting. The patient was a 30-year-old woman who became aware of vaginal bleeding and was referred to our hospital because of a cancerous tumor of the uterine cervix. Physical examination showed the cervical tumor to be approximately 8 cm in diameter with no involvement of the parametrium or vagina. The biopsy results suggested a diagnosis of glassy cell carcinoma. The final diagnosis was glassy cell carcinoma of the uterine cervix, stage 1b2. Neoadjuvant chemotherapy with paclitaxel and carboplatin was administered for downstaging. The response rate was 67.9% (partial response) under magnetic resonance imaging, and elevated serum cancer-related antigen 125 (119 U/ml) and squamous cancer cell antigen (34 ng/ml) were reduced to 34 U/ml and 3.3 ng/ml, respectively. Following neoadjuvant chemotherapy, she underwent radical hysterectomy and adjuvant chemotherapy with the same regimen. The clinical course was very good. We speculate that glassy cell carcinoma is a sensitive tumor to paclitaxel and carboplatin. Further evaluation concerning diagnosis and treatment, however, is needed to improve the prognosis of patients with glassy cell carcinoma.
Anti-Cancer Drugs 08/2006; 17(6):715-8. · 2.41 Impact Factor
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ABSTRACT: A 56-year-old woman with bulky cervical cancer was treated with high-dose-rate interstitial brachytherapy combined with external beam irradiation and chemotherapy. Inverse planning (IP) was used in the treatment planning for brachytherapy. Source dwell positions were selected automatically, once the required information had been input, for example, to prohibit dwelling inside the organs at risk (OARs) and to permit dwelling inside the planning target volume with a 2-mm inner margin. IP was compared with conventional geometrical optimization (GO) and dose point optimization (DO). The dwell positions of 3 plannings (IP, GOIP, and DOIP) were the same as IP, while in the other 2 plannings (GOConv and DOConv) dwell positions had the same length in all the applicators without concern for anatomy. D90 was equalized in all plannings as 100% prescription dose, and so the coverage index was always 90%. There was no definite tendency in dose non-uniformity ratio in the 5 plannings. As for sparing OARs such as the bladder, urethra, and rectum, IP showed the best % V75. The calculation time of the computer was fast enough. This is the first report in Japan on the clinical use of IP in interstitial brachytherapy, and it implies the usefulness of IP.
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 04/2003; 63(4):171-6.
