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Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer.

Kim HJ, Rhee WJ, Choi SH, Nam EJ, Kim SW, Kim S, Kim YT, Kim GE, Kim YB - Radiat Oncol J (2015)

Bottom Line: In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS.Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control.More effective systemic treatments might be needed to reduce distant metastasis in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer.

Materials and methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method.

Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS.

Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier disease-free survival curve for total lesion glycolysis (TLG).
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Figure 3: Kaplan-Meier disease-free survival curve for total lesion glycolysis (TLG).

Mentions: Preoperative PET/CT was performed in 40 of 148 patients. For metabolic parameters, such as SUVmax, SUVmean, MTV, and TLG, we intended to analyze their prognostic value. Among these patients, death occurred in only 1 patient, and recurrence occurred in 5 patients. Locoregional recurrence occurred in 2 patients, while distant metastasis was present in 4 patients, including 1 patient with simultaneous regional failure. The median SUVmax and the median SUVmean were 7.1 (range, 2.7 to 38.8) and 3.9 (range, 2.6 to 10.3). ROC analysis identified a cutoff of 4.55 for SUVmax (AUC = 0.583; p = 0.135; 95% CI, 0.318 to 0.848) and 3.15 for SUVmean (AUC = 0.571; p = 0.131; 95% CI, 0.314 to 0.829). Cutoff values for MTV and TLG were measured as 12.695 (AUC = 0.623; p = 0.137; 95% CI, 0.355 to 0.891) and 191304.5 (AUC = 0.629; p = 0.151; 95% CI, 0.333 to 0.925), respectively. Based on the ROC curve analysis, patients could be divided into two groups. In univariate analysis of clinicopathologic variables and metabolic parameters, pathologic type (p = 0.009), PALN involvement (p < 0.001), and TLG (p = 0.001) were identified as prognostic factors for DFS (Table 4, Fig. 3). In multivariate analysis, TLG was the only prognostic factor for DFS (p = 0.031; HR = 18.745; 95% CI, 1.30 to 270.24). For OS, pathologic type (p = 0.001), tumor size (p = 0.015), PALN involvement (p < 0.001), and TLG (p = 0.001) were identified as prognostic factors in univariate analysis; however, no variable was identified as significant in multivariate analysis.


Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer.

Kim HJ, Rhee WJ, Choi SH, Nam EJ, Kim SW, Kim S, Kim YT, Kim GE, Kim YB - Radiat Oncol J (2015)

Kaplan-Meier disease-free survival curve for total lesion glycolysis (TLG).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493424&req=5

Figure 3: Kaplan-Meier disease-free survival curve for total lesion glycolysis (TLG).
Mentions: Preoperative PET/CT was performed in 40 of 148 patients. For metabolic parameters, such as SUVmax, SUVmean, MTV, and TLG, we intended to analyze their prognostic value. Among these patients, death occurred in only 1 patient, and recurrence occurred in 5 patients. Locoregional recurrence occurred in 2 patients, while distant metastasis was present in 4 patients, including 1 patient with simultaneous regional failure. The median SUVmax and the median SUVmean were 7.1 (range, 2.7 to 38.8) and 3.9 (range, 2.6 to 10.3). ROC analysis identified a cutoff of 4.55 for SUVmax (AUC = 0.583; p = 0.135; 95% CI, 0.318 to 0.848) and 3.15 for SUVmean (AUC = 0.571; p = 0.131; 95% CI, 0.314 to 0.829). Cutoff values for MTV and TLG were measured as 12.695 (AUC = 0.623; p = 0.137; 95% CI, 0.355 to 0.891) and 191304.5 (AUC = 0.629; p = 0.151; 95% CI, 0.333 to 0.925), respectively. Based on the ROC curve analysis, patients could be divided into two groups. In univariate analysis of clinicopathologic variables and metabolic parameters, pathologic type (p = 0.009), PALN involvement (p < 0.001), and TLG (p = 0.001) were identified as prognostic factors for DFS (Table 4, Fig. 3). In multivariate analysis, TLG was the only prognostic factor for DFS (p = 0.031; HR = 18.745; 95% CI, 1.30 to 270.24). For OS, pathologic type (p = 0.001), tumor size (p = 0.015), PALN involvement (p < 0.001), and TLG (p = 0.001) were identified as prognostic factors in univariate analysis; however, no variable was identified as significant in multivariate analysis.

Bottom Line: In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS.Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control.More effective systemic treatments might be needed to reduce distant metastasis in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer.

Materials and methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method.

Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS.

Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.

No MeSH data available.


Related in: MedlinePlus