THE ROLE OF SURGICAL STAGE IN COMBINATION THERAPY FOR PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER
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Keywords

LOCALLY ADVANCED CERVICAL CANCER
NEOADJUVANT CHEMORADIATION THERAPY
CYTOREDUCTIVE SURGERY

How to Cite

Reyes Santyago, D., Khadzhimba, A., Smirnova, M., & Maksimov, S. (2019). THE ROLE OF SURGICAL STAGE IN COMBINATION THERAPY FOR PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER. Voprosy Onkologii, 65(5), 749–755. https://doi.org/10.37469/0507-3758-2019-65-5-749-755

Abstract

Objective: to justify the expediency of the surgical stage as a part of the combination treatment for stage IIA-IIIB cervical cancer.

Materials and methods. The study included 343 women with stage IIA-IIIB cervical cancer treated from 2013 to 2016 with mandatory follow-up for at least 2 years. Patients were divided into 2 groups. The first group included 214 patients who received a combination treatment. At the first stage, neoadjuvant chemoradiation therapy was performed (remote radiation therapy 5 days a week with radio modification with Cisplatin once a week at a dose of 40 mg/m2). After evaluating the effect, patients were subjected to surgical treatment or continued chemoradiotherapy. The second group (n = 129) received standard combined radiation therapy. Various schemes of combination and complex treatment and standard combined radiation therapy were evaluated using the indices of general and relapse-free survival.

Results. The proposed scheme for the combination therapy for patients with locally advanced cervical cancer showed significantly higher survival rates at all the analyzed stages. For the combined treatment group with complete cytoreduction, the two-year overall and relapse-free survival with stage IIA is 94.1% vs. 82.4%, with IIB 90.8% vs. 80.3%, with IIB 87.5% vs. 75%, with IIB with metastatic lesion of regional lymph nodes 85% vs. 70%. For the second group, two-year overall and relapse-free survival with stage IIA 75% vs. 50%, with IIB 70.9% vs. 56.3%, with IIB 59.1% vs. 40.9%, with IIB with metastatic lesion of regional lymph nodes 62.2% and 40.5%. The advantages of this approach are most clearly seen within patients with metastatic lesions of regional lymph nodes (85% vs. 62% accordingly).

Conclusion. Cytoreductive surgery in combination with the combination therapy allows to achieve a significant increase in overall and relapse-free survival for patients with locally advanced cervical cancer compared with standard treatment programs.

https://doi.org/10.37469/0507-3758-2019-65-5-749-755
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References

Torre L.A., Bray F., Siegel R.L. et al. Global cancer statistics, 2012 // CA Cancer J. Clin. - 2015. - Vol. 65(2). - P. 87-108. - DOI: 10.3322/caac.21262

Bray F., Ferlay J., Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of cancer incidence and mortality for 36 cancers in 185 countries // CA Cancer J. Clin. - 2018. - Vol. 68(6). - P. 394-424. - DOI: 10.3322/caac.21492

Jemal A., Bray F., Center M.M. et al. Global cancer statistics // CA Cancer J. Clin. - 2011. - Vol. 61(2). - P. 69-90. - DOI: 10.3322/caac.20107

International Agency for Research on Cancer, World Health Organization.Cervical Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. - Lyon, Geneva: International Agency for Research on Cancer, World Health Organization, 2012.

Kokka F., Bryant A., Brockbank E. et al. Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced cervical cancer // Cochrane Database Syst. Rev. -2015. - №4. - CD010260. - DOI: 10.1002/14651858.cd010260.pub2

Каприн А.Д., Старинский В.В., Петрова Г.В. Состояние онкологической помощи населению России в 2017 г. / М.: МНИОИ им. П.А.Герцена - филиал ФГБУ "НМИЦ радиологии" Минздрава России, 2018. - C. 18-157.

Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2017 г. (заболеваемость и смертность) // М.: МНИОИ им. П.А.Герцена - филиал ФГБУ "НМИЦ радиологии" Минздрава России, 2018. - 13 с.

Ашрафян Л.А., Киселёв В.И., Муйжнек Е.Л. и др. Современные принципы эффективной терапии рака яичников // Опухоли женской репродуктивной системы. -2015. - Vol. 11(2). - P. 68-75. - DOI: 10.17650/1994-4098-2015-11-2-68-75

Zheng D., Mou H.P., Diao P. et al. Chemoradiotherapy in combination with radical surgery is associated with better outcome in cervical cancer patients // Oncotarget. - 2018. - Vol. 9(2). - P. 3627- 3634. - DOI: 10.18632/oncotarget.23165

Lu H., Wu Y, Liu X. et al. A prospective study on neoadjuvant chemoradiotherapy plus anti-EGFR monoclonal antibody followed by surgery for locally advanced cervical cancer // Onco Targets Ther. - 2018. - Vol. 11. - P. 3785-3792. - DOI: 10.2147/ott.s164071

Matsuo K., Shimada M., Yokota H. et al. Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer // Oncotarget. - 2017. - Vol. 8(63). - P. 106866-106875. - DOI: 10.18632/oncotarget.22437

Keys H.M., Bundy B.N., Stehman F.B. et al. Suggs 3rd, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma // N. Engl. J. Med. - 1999. - Vol. 340(15). - P. 1154-1161. DOI: 10.1056/nejm199904153401503

Gadducci A., Landoni F., Cosio S. et al. Neoadjuvant Platinum-based Chemotherapy Followed by Radical Hysterectomy for Stage Ib2-IIb Adenocarcinoma of the Uterine Cervix - An Italian Multicenter Retrospective Study // Anticancer Res. - 2018. - Vol. 38(6). - P. 3627-3634. - DOI: 10.21873/anticanres.12637

Гусейнов К.Д., Максимов С.Я., Урманчеева А.Ф., и др. Неоадьювантная химиолучевая терапия в комбинированном лечении больных раком шейки матки Ib2-III стадии // Вопросы онкологии. - 2014. - Т. 60(3). - С. 384-387.

Максимов С.Я. Первично-множественные опухоли органов женской репродуктивной системы // Практическая онкология. - 2009. - Т. 10(2). - С. 117-123.

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