Weekly Versus Triweekly Cisplatin-Based Chemotherapy Concurrent With Radiotherapy in the Treatment of Cervical Cancer: A Meta-Analysis

Chen, Xingxing; Zou, Haizhou; Li, Huifang; Lin, Ruifang; Su, Meng; Zhang, Wenyi; Zhou, Yilong; Zhang, Ping; Hou, Meng; Deng, Xia; Zou, Changlin

doi:10.1097/igc.0000000000000883

Cited by 28 publications

(24 citation statements)

References 20 publications

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“…95 The potential benefit of weekly versus 3-weekly cisplatin-based concurrent CTRT in LACC has also been investigated in 2 meta-analyses. 122,123 and a retrospective single-institution review. 124 The conclusions from these studies are blurred because of the inclusion of both singleagent cisplatin and mostly combination regimes in a triweekly arm and the inclusion of retrospective studies with adjuvant CTRT in patients postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Datta

Stutz

Gómez

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Treatment options in locally advanced cervix cancer (LACC) have evolved around radiation therapy (RT) and/or chemotherapy (CT), hypoxic cell sensitizers, immunomodulators (Imm), and locoregional moderate hyperthermia (HT). A systematic review and network meta-analysis was conducted to synthesize the evidence for efficacy and safety in terms of long-term locoregional control (LRC), overall survival (OS), and grade !3 acute morbidity (AM) and late morbidity (LM). Five databases were searched, and 6285 articles (1974-2018) were screened per the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Fifty-nine randomized trials in untreated LACC without surgical intervention were shortlisted. These used 13 different interventions: RT alone and/or neoadjuvant CT (NACT), adjuvant CT (ACT), concurrent chemoradiation therapy (CTRT) (weekly cisplatin [CDDP]/3-weekly CDDP/combination CT with CDDP/non-CDDP-based CT), hypoxic cell sensitizers, Imm, or HT. Odds ratios (ORs) using random effects network meta-analysis were estimated. Interventions for each endpoint were ranked according to their corresponding surface under cumulative ranking curve values. Of the 9894 patients evaluated, the total events reported for LRC, OS, AM, and LM were 5431 of 8197, 4482 of 7958, 1710 of 7183, and 441 of 6333, respectively. ORs and 95% credible intervals (CrIs) for the 2 best strategies were HT þ RT versus CTRT þ ACT (OR, 1.23; 95% CrI, 0.49-3.19) for LRC, CTRT (3-weekly CDDP) versus HTCTRT (OR, 1.14; 95% CrI, 0.35-3.65) for OS, RT þ ACT versus RT (OR, 0.01; 95% CrI, 0.00-1.04) for AM, and NACT þ RT þ ACT versus RT þ Imm (OR, 0.42; 95% CrI, 0.02-7.39) for LM. The 3 interventions with the highest cumulative surface under cumulative ranking curve values for all 4 endpoints were HTRT, HTCTRT, and CTRT (3-weekly CDDP). Articles with low risk of bias and those published during 2004 to 2018 also retained these interventions as the best. Two-step cluster analysis grouped these 3 modalities in a single distinctive NotedAn online CME test for this article can be taken at https:// academy.astro.org.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Datta

Stutz

Gómez

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…10 Although RTOG 90-01 used high-dose cisplatin 1 5-FU administered every 3 weeks, subsequent studies have shown that single-agent cisplatin administered weekly is less toxic and equally efficacious. [26][27][28] Virtually all patients in the cisplatin cohort of our study received weekly cisplatin, with a median of 5 cycles. Obtaining $5 cycles was required for benefit, with no difference in CSM seen in patients receiving 1 to 4 cycles versus no cisplatin.…”

Section: Discussionmentioning

confidence: 99%

“…A limitation of our study is that pharmacologic dose information is not available in the SEER-Medicare database. However, the most common dose of weekly cisplatin is 40 mg/m 2 , 26,27 suggesting that a total cisplatin dose of at least 200 mg/m 2 may be required for clinical benefit. This threshold is similar to that established in the GOG 109 study of patients treated with CRT in the adjuvant setting, in which at least 210 mg/m 2 (3 cycles of high-dose cisplatin) was required for benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have shown that CRT increases hematologic and gastrointestinal toxicities, 12,13,20,29 although the rate of hematologic toxicity is lower with single-agent weekly cisplatin compared with high-dose cisplatin 1 5-FU. 27,28,31 Whether the rate of gastrointestinal toxicity is also lower with weekly cisplatin is questionable. 27,28 One explanation of why we did not observe increased gastrointestinal toxicity with cisplatin is that this occurs less commonly in the intensitymodulated RT era.…”

Section: Discussionmentioning

confidence: 99%

“…27,28,31 Whether the rate of gastrointestinal toxicity is also lower with weekly cisplatin is questionable. 27,28 One explanation of why we did not observe increased gastrointestinal toxicity with cisplatin is that this occurs less commonly in the intensitymodulated RT era. However, it is also possible that some of the increase in hypovolemia associated with cisplatin was caused by clinically significant diarrhea that was not fully captured in the Medicare claims, which represents a potential limitation of this study.…”

Section: Discussionmentioning

confidence: 99%

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Benefit of Cisplatin With Definitive Radiotherapy in Older Women With Cervical Cancer

Xiang

Kidd

2019

Journal of the National Comprehensive Cancer Network

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Background: Cisplatin with definitive radiotherapy (RT) is considered the standard of care for cervical cancer; however, older women are frequently undertreated and have worse outcomes compared with younger patients. Because women aged ≥65 years have been disproportionately underrepresented in clinical trials, uncertainties exist regarding how much they benefit from the addition of cisplatin to RT. Patients and Methods: Women aged ≥65 years with nonmetastatic cervical cancer treated with definitive external-beam RT and brachytherapy were identified in the SEER-Medicare database. Death attributable to cervical cancer (cancer-specific mortality [CSM]) was evaluated against competing risks of death using Gray’s test. Propensity score analysis and the Fine-Gray multivariable regression model were used to adjust for baseline differences, including comorbidity. Results: The total cohort comprised 826 patients, of whom 531 (64%) received cisplatin, 233 (28%) were FIGO stage I, 374 (45%) were stage II, and 219 (27%) were stage III–IVA. Older age and chronic kidney disease significantly predicted omission of cisplatin. Virtually all cisplatin dosing was weekly, with a median of 5 cycles. Death from cervical cancer was significantly lower with cisplatin than without (5-year CSM, 31% vs 39%; P=.02; adjusted hazard ratio, 0.72; P=.02), which persisted in propensity score analysis. Receiving ≥5 cycles was required for benefit, as no difference in CSM was seen in patients receiving 1 to 4 cycles versus no cisplatin. Subgroup analyses revealed that the benefit of cisplatin persisted in women aged ≥75 years and those with early-stage disease. Incidence of cytopenia, nausea/vomiting, and hypovolemia increased in patients treated with cisplatin. Conclusions: Administration of cisplatin with definitive RT in women aged ≥65 years was associated with a significant benefit in the incidence of death attributable to cervical cancer, despite competing risks for mortality in an older population. Receiving at least 5 cycles of weekly cisplatin was required for benefit.

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Near‐infrared emissive polymer‐coated IR‐820 nanoparticles assisted photothermal therapy for cervical cancer cells

Zhu

Chen

Yan

et al. 2021

Journal of Biophotonics

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Photothermal therapy (PTT) has attracted wide attention due to its noninvasiveness and its thermal ablation ability. As photothermal agents are crucial factor in PTT, those with the characteristics of biocompatibility, non-toxicity and high photothermal stability have attracted great interest. In this work, new indocyanine green (IR-820) was utilized as a photothermal agent and nearinfrared (NIR) fluorescence imaging nanoprobe. To improve the biocompatibility, poly(styrene-co-maleic anhydride) (PSMA) was utilized to encapsulate the IR-820 molecules to form novel IR-820@PSMA nanoparticles (NPs). Then, the optical and thermal properties of IR-820@PSMA NPs were studied in detail. The IR-820@PSMA NPs showed excellent photothermal stability and biocompatibility. The cellular uptaking ability of the IR-820@PSMA NPs was further confirmed in HeLa cells by the NIR fluorescent confocal microscopic imaging technique. The IR-820@PSMA NPs assisted PTT of living HeLa cells was conducted under 793 nm laser excitation, and a high PTT efficiency of 73.3% was obtained.

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Weekly Versus Triweekly Cisplatin-Based Chemotherapy Concurrent With Radiotherapy in the Treatment of Cervical Cancer: A Meta-Analysis

Cited by 28 publications

References 20 publications

Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Efficacy and Safety Evaluation of the Various Therapeutic Options in Locally Advanced Cervix Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

Benefit of Cisplatin With Definitive Radiotherapy in Older Women With Cervical Cancer

Near‐infrared emissive polymer‐coated IR‐820 nanoparticles assisted photothermal therapy for cervical cancer cells

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