Cargando…
The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse
BACKGROUND: Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aim...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432701/ https://www.ncbi.nlm.nih.gov/pubmed/30984261 http://dx.doi.org/10.1155/2019/1217838 |
_version_ | 1783406186332160000 |
---|---|
author | Fabri, Vanessa A. Queiroz, Ana C. M. Mantoan, Henrique Sanches, Solange M. Guimarães, Andrea P. G. Ribeiro, Adriana R. G. Souza, Ronaldo P. Maya, Joyce M. L. Santos, Elizabeth S. Castro, Fabrício S. Lima, João P. N. S. Chen, Michael J. Baiocchi, Glauco da Costa, Alexandre A. B. A. |
author_facet | Fabri, Vanessa A. Queiroz, Ana C. M. Mantoan, Henrique Sanches, Solange M. Guimarães, Andrea P. G. Ribeiro, Adriana R. G. Souza, Ronaldo P. Maya, Joyce M. L. Santos, Elizabeth S. Castro, Fabrício S. Lima, João P. N. S. Chen, Michael J. Baiocchi, Glauco da Costa, Alexandre A. B. A. |
author_sort | Fabri, Vanessa A. |
collection | PubMed |
description | BACKGROUND: Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aimed to evaluate the benefit of consolidation CT compared to no additional treatment in patients treated with RTCT. METHODS: This is a retrospective study including 186 patients with FIGO stage IB2, IIA2, or IIB to IVB (paraaortic lymph nodes only) uterine cervical cancer who were treated with standard RTCT alone or RTCT followed by consolidation CT. Overall survival (OS), progression free survival (PFS), and the risk of distant and local relapses were compared between the two treatment groups. RESULTS: At 3 years OS was 91% versus 82.3% (p=0.027), PFS 84.3% versus 54.4% (p=0.047), and distant metastasis free survival (DMFS) 80.4% versus 62.5% (p=0.027) in favor of the consolidation CT group. Multivariate analysis confirmed the benefit of consolidation CT. There was no difference in locoregional free survival (LRFS). Positive lymph node was related to a higher risk of distant relapse. In the lymph node positive subgroup consolidation CT resulted in longer OS (p=0.050), PFS (p=0.014), and DMFS (p=0.022); in the lymph node negative subgroup there was no benefit from consolidation CT. CONCLUSIONS: Use of consolidation CT resulted in longer OS and PFS, mostly due to control of distant relapses. Patients at higher risk of distant relapse showed the greatest benefit. This data generates a hypothesis that could help to better select patients to consolidation CT. |
format | Online Article Text |
id | pubmed-6432701 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-64327012019-04-14 The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse Fabri, Vanessa A. Queiroz, Ana C. M. Mantoan, Henrique Sanches, Solange M. Guimarães, Andrea P. G. Ribeiro, Adriana R. G. Souza, Ronaldo P. Maya, Joyce M. L. Santos, Elizabeth S. Castro, Fabrício S. Lima, João P. N. S. Chen, Michael J. Baiocchi, Glauco da Costa, Alexandre A. B. A. J Oncol Research Article BACKGROUND: Treatment of advanced uterine cervical cancer has advanced little in the last 15 years. Although two phase III trials showed survival benefit with the addition of consolidation chemotherapy (CT) after cisplatin-based chemoradiotherapy (RTCT), it is not considered standard of care. We aimed to evaluate the benefit of consolidation CT compared to no additional treatment in patients treated with RTCT. METHODS: This is a retrospective study including 186 patients with FIGO stage IB2, IIA2, or IIB to IVB (paraaortic lymph nodes only) uterine cervical cancer who were treated with standard RTCT alone or RTCT followed by consolidation CT. Overall survival (OS), progression free survival (PFS), and the risk of distant and local relapses were compared between the two treatment groups. RESULTS: At 3 years OS was 91% versus 82.3% (p=0.027), PFS 84.3% versus 54.4% (p=0.047), and distant metastasis free survival (DMFS) 80.4% versus 62.5% (p=0.027) in favor of the consolidation CT group. Multivariate analysis confirmed the benefit of consolidation CT. There was no difference in locoregional free survival (LRFS). Positive lymph node was related to a higher risk of distant relapse. In the lymph node positive subgroup consolidation CT resulted in longer OS (p=0.050), PFS (p=0.014), and DMFS (p=0.022); in the lymph node negative subgroup there was no benefit from consolidation CT. CONCLUSIONS: Use of consolidation CT resulted in longer OS and PFS, mostly due to control of distant relapses. Patients at higher risk of distant relapse showed the greatest benefit. This data generates a hypothesis that could help to better select patients to consolidation CT. Hindawi 2019-03-11 /pmc/articles/PMC6432701/ /pubmed/30984261 http://dx.doi.org/10.1155/2019/1217838 Text en Copyright © 2019 Vanessa A. Fabri et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Fabri, Vanessa A. Queiroz, Ana C. M. Mantoan, Henrique Sanches, Solange M. Guimarães, Andrea P. G. Ribeiro, Adriana R. G. Souza, Ronaldo P. Maya, Joyce M. L. Santos, Elizabeth S. Castro, Fabrício S. Lima, João P. N. S. Chen, Michael J. Baiocchi, Glauco da Costa, Alexandre A. B. A. The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title | The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title_full | The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title_fullStr | The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title_full_unstemmed | The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title_short | The Impact of Addition of Consolidation Chemotherapy to Standard Cisplatin-Based Chemoradiotherapy in Uterine Cervical Cancer: Matter of Distant Relapse |
title_sort | impact of addition of consolidation chemotherapy to standard cisplatin-based chemoradiotherapy in uterine cervical cancer: matter of distant relapse |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432701/ https://www.ncbi.nlm.nih.gov/pubmed/30984261 http://dx.doi.org/10.1155/2019/1217838 |
work_keys_str_mv | AT fabrivanessaa theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT queirozanacm theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT mantoanhenrique theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT sanchessolangem theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT guimaraesandreapg theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT ribeiroadrianarg theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT souzaronaldop theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT mayajoyceml theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT santoselizabeths theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT castrofabricios theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT limajoaopns theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT chenmichaelj theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT baiocchiglauco theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT dacostaalexandreaba theimpactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT fabrivanessaa impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT queirozanacm impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT mantoanhenrique impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT sanchessolangem impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT guimaraesandreapg impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT ribeiroadrianarg impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT souzaronaldop impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT mayajoyceml impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT santoselizabeths impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT castrofabricios impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT limajoaopns impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT chenmichaelj impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT baiocchiglauco impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse AT dacostaalexandreaba impactofadditionofconsolidationchemotherapytostandardcisplatinbasedchemoradiotherapyinuterinecervicalcancermatterofdistantrelapse |