Safety and Efficacy of Docetaxel plus Cisplatin Versus Cisplatin Concurrent with Radiation in Local Advanced Cervical Cancer: Midterm Results of A Phase III, Multicenter and Randomized Trial

Abstract

To report the physical dosimetry study and preliminary results of a prospective study evaluating 3D-printing template assisted with CT-guidance for 125 I seed brachytherapy to treat recurrent or metastatic gynecological carcinoma. Materials/Methods: In this retrospective study, with median follow-up of 10 months for all patients, 95 patients were enrolled and analyzed; inclusion criteria were Karnofsky performance status 60 to 100, expected overall survival >3 months, patients were pathologically or radiologically confirmed to be recurrent or metastatic gynecological carcinoma and the tumors were unresectable due to individual rejection or surgeon consultation. All patients have accepted 3D-printing template assisted with CTguidance for 125 I seed brachytherapy. Kaplan-Meier survival analysis was used to estimate local control (LC), overall survival (OS), and progressionfree survival (PFS). We analyzed the confounding factors that affected LC, PFS, and OS by using Cox proportional hazards regression model. Acute and late toxic effects were prospectively assigned by using the Radiation Therapy Oncology Group (RTOG) and European Organization for Research and Treatment of Cancer (EORTC) criteria. Results: Of 87 patients (median [range] age, 53 [29-92] years; vulvar cancer, 2 [2%]; endometrial cancer, 10 [11%]; cervical cancer, 72 [83%]; ovarian cancer, 3 [3%]), 32 (37%) were alive at last follow-up. 9 (10%) patients adopted secondary RIS implantation on different sites. 75% quantile LC was 16 months (1-year LC, 85%; 95%CI, 77%-93%). Median PFS was 12 months (1-year PFS, 48%; 95%CI, 36%-59%). Median OS was 15 months (1-year OS, 65%; 95%CI, 54%-76%). On multivariate analysis, GTV D 100 >60Gy independently correlative for good LC (hazard ratio [HR], 0.139; 95% CI, 0.037-0.527; PZ.004), PFS (HR, 0.346; 95% CI, 0.180-0.666; PZ.001) and OS (HR, 0.185; 95% CI, 0. 083-0.416; P<.001). Rates of grade 2 acute radiothermitis, vomiting, proctitis and hematuresis were 2 (2%), 1 (1%), 3 (3%) and 2 (2%). Acute grade 3 proctitis occurred in 1 (1%) patient. Late toxic effects were uncommon: 1 (1%) patient developed an hematuresis (grade 2) and 1 (1%) patient developed an rectovaginal fistula. There were no acute or late grade 5 toxic effects. Conclusion: 125I seed brachytherapy to treat recurrent or metastatic gynecologic carcinoma showed promising clinical outcomes and rates of toxic effects. Further optimization of 125 I seed brachytherapy is needed in order to improve the accuracy of treatment.

Comparison between curative concurrent chemoradiotherapy followed by adjuvant chemotherapy and curative concurrent chemoradiotherapy alone in patients with locally advanced cervical carcinoma: a meta-analysis

“…When comparing to CCRT, the efficiency of CCRT followed by ACT is still controversial and needs further research. Zhang's [11] results in 2019 revealed that statistical difference was not found in OS and PFS among CCRT followed by ACT and CCRT, the same results were also reported in the results of Chatterjee [27] and Cheng [12]. However, Chen's [10] results indicated that CCRT followed by ACT was associated with better PFS.…”