Kravets OA*

Doctor of Medical Sciences, Brachytherapy Department, Institute of Nuclear Medicine, JSC "Medicine" (Clinic of Academician Roitberg), Moscow, Khimki, Department of Therapy, General Medical Practice and Nuclear Medicine, N.I. Pirogov, Russian National Research Medical University, Russia

*Corresponding Author: Kravets OA, Doctor of Medical Sciences, Brachytherapy Department, Institute of Nuclear Medicine, JSC "Medicine" (Clinic of Academician Roitberg), Moscow, Khimki, Department of Therapy, General Medical Practice and Nuclear Medicine, N.I. Pirogov, Russian National Research Medical University, Russia.

Received: July 21, 2022; Published: August 25, 2022

Abstract

Purpose: This study reported clinical results of patients with locally advanced cervical cancer who treated with radiotherapy and image-guided adapted brachytherapy and combinations of cytotoxic drugs.

Material and Methods: This study included 190 patients with cervical cancer IIb, IIIb, IVb (metastases in para-aortic lymph nodes) during 2011-2015 treated with external-beam radiotherapy or chemoradiotherapy, total dose for D95 50Gy for 25 fractions following Image-guided brachytherapy HDR with prescribing dose for CTV-HR D90 7.5 Gy weekly 4 fractions. Total dose CTV-HR D90 40 Gy (EQD2). Total dose for HR-CTV D90 was 95.0 ± 0.67 Gy (EQD2). Presented group A (n = 72) - radiation therapy, B (n = 40) - chemoradiation therapy with cisplatin C (n = 39) - chemoradiation therapy with a combination of irinotecan + cisplatin, 2 courses of adjuvant chemotherapy D (n = 39) - chemoradiation therapy with a combination of paclitaxel + cisplatin, 2 courses of adjuvant chemotherapy. Clinical outcomes including local control (LC), cancer-specific survival (CSS), overall survival (OS), and toxicity were analyzed.

Results: Three-year OS and CSS in groups A were: 88.4% ± 4.5% and 64.4% ± 7.3%; B - 77.7% ± 7.6% and 77.5% ± 7.1%; C - 69.8% ± 9.6% and 66.3% ± 8.9%; D - 81.3% ± 6.4% and 62.1% ± 8.0%, respectively (p> 0.05). The use of chemoradiotherapy in the groups did not increase the 3-year OS in cervical cancer stage IIIb: in group A - 84.0% ± 7.5%, B - 76.2% ± 9.4; C - 77.2% ± 9.1% and D - 84.9% ± 7.0% (p> 0.05). But CSS was higher on the 1st year of observation in group C - 96.3% ± 3.6% compared with group A - 74.2% ± 7.5% (p = 0.049). With a 3-year observation - 75.7% ± 9.6% and 59.0% ± 11.4%, respectively (p = 0.31). Combined chemoradiation therapy in patients with cervical cancer increases the time to progression: from 9.5 months (in groups A and B) up to 19.4 months and 16.4 months (in groups C and D), respectively (p = 0.05). A decrease in the number of local relapses during 3 years was obtained in groups B and D compared with group A (100% versus 90.3%, p = 0.05). Local control within 3 years among 190 patients was 94.7% ± 1.6%. Gastrointestinal early toxicity was noted higher in group C compared to A, B, D (rectites G2-3 - 25.7% versus 5.6%, 5.0% and 2.6%, respectively, p = 0.05). Late cystitis G2-3 is higher in groups B, C, D compared with group A (15.4% versus 4.2%, p = 0.07).

Conclusion: The study showed high efficiency of treatment of patients with cervical cancer due to the introduction of modern technologies in radiotherapy, as well as chemoradiotherapy programs with acceptable toxicity.

Keywords: Cervical Cancer; Radiation Therapy; Chemoradiotherapy; Image-Guided Brachytherapy; Adjuvant Chemotherapy

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Citation

Citation: Kravets OA. “Clinical Results of Chemoradiation Therapy and Adjuvant Chemotherapy of Locally Advanced Cervix Cancer". Acta Scientific Women's Health 4.9 (2022): 46-55.

Copyright

Copyright: © 2022 Kravets OA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.