Cisplatin and gemcitabine concurrent with radiotherapy in locally advanced cervical cancer. Institutional experience
Creators
- 1. Fundación Cáncer, FUCA, Buenos Aires (Argentina)
- 2. Servicio de Oncología Clínica, Instituto Alexander Fleming, Buenos Aires (Argentina)
- 3. Servicio de Radioterapia, Instituto Alexander Fleming, Buenos Aires (Argentina)
Description
Purpose: To describe the characteristics of the patients with locally advanced cervical cancer who received treatment with cisplatin and gemcitabine concurrent with radiotherapy (C + G / Rt), to evaluate the toxicity profile and its efficacy in terms of complete response rate (ORR), relapse-free survival (PFS), and overall survival (OS) in a real world setting. Materials and methods: Descriptive, retrospective and observational study of the Alexander Fleming Institute medical records of patients with locally advanced cervical cancer who received treatment with C + G / Rt between July 2008 and July 2020. Results: 57 patients were identified. Median age at diagnosis was 42 years (r 21-72). Histology: squamous 89% (51). Stage IIIA to IVA at diagnosis 79% (45). Forty seven patients (82%) performed the treatment as the primary modality and 10 (18%) performed it adjuvant after surgery due to adverse risk factors. Median of concurrent chemotherapy cycles (QT) was 6 (r 4-10). Fifty two patients (91%) performed 3D RT and 5 patients (9%) Intensity modulated Rt (IMRT). 36 (63%) received RT in the pelvis and 21 (37%) in the pelvis and retroperitoneum (RTP). The 95% (54) underwent brachytherapy (BQT). The median duration of the C + G / Rt treatment was 9 weeks (r 6-23), 53% (30) completed the treatment in 9 weeks or less. Most frequent adverse events (AE): diarrhea 86% (49), grade (G) 3-4 24% (12); enterocolitis 35% (20), G3-4 25% (5); actinic rectitis 42% (24), 100% G1- 2; anemia 54% (31), G3-4 11 (35%); neutropenia 68% (39), G3-4 18 (46%); febrile neutropenia 6 (15%); thrombocytopenia 30 (52%), G3-4 13 (43%). Two intestinal perforations were registered and 2 patients presented fistulas. Fifteen patients (26%) required hospitalization due to adverse effects (AE). No deaths were reported from the treatment. Thirty one patients (54%) had some interruption of Rt due to AE, 32 patients (56%) of concurrent chemotherapy (CT) and 36 (63%) required dose reduction. An ORR of 77% was observed. With a median follow-up of 31 months, 79% of the patients (45) are relapse-free and 91% (52) are alive. Conclusion: This retrospective, real-life study allows us to confirm the efficacy of concurrent treatment with C + G / Rt in patients with locally advanced cervical cancer, with a manageable AE profile in experienced and highly complex centers under exhaustive monitoring and control of patients. (authors)
Abstract (Spanish)
Objetivos: Describir las características de las pacientes con cáncer de cérvix localmente avanzado de la vida real, que recibieron tratamiento con cisplatino y gemcitabina concurrente con radioterapia (C+G/Rt), evaluar el perfil de toxicidad y eficacia del mismo en términos de tasa de respuesta completa (TR), supervivencia libre de recaída (SLR) y supervivencia global (SG). Materiales y métodos: Estudio descriptivo, retrospectivo y observacional de pacientes con cáncer de cérvix localmente avanzado que recibieron tratamiento con C+G/Rt entre julio del 2008 y julio del 2020 en el Instituto Alexander Fleming. Resultados: Se identificaron 57 pacientes. Edad mediana al diagnóstico fue de 42 años (r 21-72). Histología: escamoso 89% (51). Estadio IIIA a IVA al diagnóstico el 79% (45). Cuarenta y siete pacientes (82%) realizaron el tratamiento como modalidad primaria y 10 (18%) lo realizó de manera adyuvante luego de cirugía por factores de riesgo adversos. Mediana de ciclos de quimioterapia (QT) concurrente fue 6 (r 4-10). Cincuenta y dos pacientes (91%) realizaron Rt 3D y 5 (9%) Rt de intensidad modulada (IMRT). 36 (63%) recibieron Rt en pelvis y 21 (37%) en pelvis y retroperitoneo (RTP). El 95% (54) realizó braquiterapia (BQT). La mediana de duración del tratamiento concurrente con C+G/ Rt fue de 9 semanas (r 6-23). Eventos adversos (EA) más frecuentes: diarrea 86% (49), grado (G)3-4 24% (12); enterocolitis 35% (20), G3-4 25% (5); rectitis actínica 42% (24), 100% G1-2; anemia 54% (31), G3-4 11 (35%); neutropenia 68% (39), G3-4 18 (46%); neutropenia febril 6 (10%); trombocitopenia 30 (52%), G3-4 13 (43%). Se registraron 2 perforaciones intestinales y 2 pacientes presentaron fístulas. Quince pacientes (26%) requirieron internación por EA. No se reportaron muertes por el tratamiento. Treinta y un pacientes (54%) tuvieron alguna interrupción de la Rt por EA, 32 (56%) de la QT concurrente y 36 (63%) requirieron reducción de dosis. Se observó una TR del 77%. Con un seguimiento mediana de 31 meses, el 79% de las pacientes (45) están libres de recaída y el 91% (52) están vivas. Conclusión: Este estudio retrospectivo de la vida real nos permite confirmar la eficacia del tratamiento concurrente con C+G/Rt en pacientes con cáncer de cérvix localmente avanzado, con un perfil de EA manejable en centros con experiencia y de alta complejidad bajo un monitoreo y control exhaustivo de las pacientes. (autores)Additional details
Additional titles
- Original title (Spanish)
- Cisplatino y gemcitabina concurrente con radioterapia en cáncer de cuello uterino localmente avanzado. Experiencia institucional
Identifiers
Publishing Information
- Journal Title
- Oncologia Clinica (Online)
- Journal Volume
- 28
- Journal Issue
- 2
- Journal Page Range
- p. 23-31
- ISSN
- 2953-531X
INIS
- Country of Publication
- Argentina
- Country of Input or Organization
- Argentina
- INIS RN
- 55004756
- Subject category
- S62: RADIOLOGY AND NUCLEAR MEDICINE;
- Descriptors DEI
- CARCINOMAS; CHEMOTHERAPY; COMBINED THERAPY; RADIOTHERAPY; UTERUS
- Descriptors DEC
- BODY; DISEASES; FEMALE GENITALS; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY
Optional Information
- Notes
- 6 refs., 7 figs., 2 tabs.