Assessment of intensified neoadjuvant chemotherapy regimens for locally advanced cervical cancer


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Resumo

Background. Cervical cancer is the most common malignant tumor of the female reproductive system in the reproductive period. The age of patients at the initial detection of cervical cancer is becoming more and more young. The search for the optimal modality of neoadjuvant treatment of patients with locally advanced cervical cancer is a promising area of research. Systemic chemotherapy as a stage of neoadjuvant treatment of patients with locally advanced cervical cancer is currently considered as the therapy of choice, being a competitive alternative to chemoradiotherapy. Objective. Evaluation of the results of using neoadjuvant dose-intensive platinum-containing chemotherapy in patients with FIGOIB2 -IIB locally advanced cervical cancer. Methods. The efficacy and toxicity of three cycles of intravenous dose-intensive neoadjuvant chemotherapy according to the AP scheme (cisplatin 75 mg/m2, doxorubicin 35 mg/m2) and TP scheme (cisplatin 60 mg/m2 and paclitaxel at a dosage of 60 mg/m2) were studied in the patients participating in the study. Results. The study included 105 primary patients (75 in the AP group and 30 in the TP group) at the age of27-68 years (mean age, 44 years) with verified cervical cancer (cT1B2Nx, 0M0 - cT2BNx, 0M0). In the AP group, surgical treatment was performed in 88% (66 patients), in the TP group - in 80% (24 patients). Disease progression was detected in 8.0% (6 cases) in the AP group and in 3.3% (1 case) in the TP group. In 4 patients (2.8%) in the AP group, a relapse of the disease was diagnosed, and no relapses were recorded in the TP group. Dose-dense chemotherapy regimen did not lead to significant complications at the medicinal and surgical stages. Conclusion. Analysis of the research results showed that dose-intensive neoadjuvant chemotherapy is an effective method with an objective response rate of 84% (63 cases) in the AP group and 56.7% in the TP group (17 cases). The pathological tumor response in the AP group was 89.4% (66 cases), and complete tumor regression (CTR) was confirmed in 10.6% (7 cases); in the TP group - 79.2% (24 cases), in 16,7% (4 cases) tumor regression was confirmed by a complete pathologic response. Dose-intensive neoadjuvant chemotherapy may be considered as an alternative to the standard treatment for locally advanced cervical cancer, but requires further research due to the small number of observations.

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Sobre autores

O. Smirnova

N.N. Petrov National Medical Research Center of Oncology

Email: ssmirnova.oa@gmail.com
68, Leningradskaya Street, Pesochny settlement, St. Petersburg 197758, Russian Federation

N. Bondarev

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

E. Ulrikh

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

N. Mikaya

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

Kh. Kotiv

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

A. Petrova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

A. Ivantsov

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

T. Gorodnova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

E. Nekrasova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

O. Lavrinovich

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

M. Yakovleva

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

A. Abramova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

D. Malyutina

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

Sh. Parsyan

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

G. Mkrtchyan

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

Z. Ibragimov

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

Yu. Trifanov

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

A. Sidoruk

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

A. Urmancheeva

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

I. Berlev

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

Bibliografia

  1. Бохман Я.В. Руководство по онкогинекологии. Монография. Л.: Медицина. 1989. 463 с. [Bohman YV Guide oncogynecology. Monograph. L.: Meditsinа, 1989. 463 p. (In Russ.)].
  2. Rydzewska L., Tierney J., Vale C.L., Symonds P.R. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev. 2012;12:CD007406. doi: 10.1002/14651858.CD007406.pub3.
  3. Cаевец В.В. Особенности многокомпонентного лечения местно-распространенного рака шейки матки с учетом гистологического строения опухоли. Злокачественные опухоли. 2014;3:40-5.
  4. Чуруксаева О.Н., Коломиец Л.А. Неоадъювантная химиотерапия при лечении местнораспространенного рака шейки матки. Сибирский онкологический журнал. 2013;2(56);18-24.
  5. Вашакмадзе С.Л. Возможности современной ультразвуковой диагностики в оценке эффекта неоадъювантной химиотерапии местнораспространенного рака шейки матки: Автореф. дисс. канд. мед. наук. М., 2016.
  6. Thigpen T. Cisplatinum in treatment of advanced or recurrent sguamons cell carcinoma of the cervix. A phase II study of the Gynecologie Oncologie Group. Cancer. 1981;48:899-903.
  7. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer. 2003;39(17):2470-86.
  8. Duenas-Gоnzalez A. А phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Ann Oncol. 2003;14(8):1278-84.
  9. Vizza E, Pellegrino A., Milani R., et a!. Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy. EurJSurgOncol. 2011;37(4):364-69. Doi:10.W16/j.ejso.20W.12.001.
  10. Sardi J. Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri. Gynecol Oncol. 1990;38(3):486-93.
  11. Esserman L.J. Accelerating identification and regulatory approval of investigational cancer drugs. JAMA. 2011;306:2608-09. Doi:10.1001/ jama.2011.1837.
  12. Gupta S. Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Concomitant Chemotherapy and Radiotherapy in Patients with Stage IB2, IIA, or HB Squamous Cervical Cancer: A Randomized Controlled Trial. J Clin Oncol. 2018;36(16):1548-55. doi: 10.1200/JCO.2017.75.9985.
  13. Robova H., Rob L., Halaska M.J., et al. High-dose density neoadjuvant chemotherapy in bulky IB cervical cancer. Gynecol Oncol. 2013;128(1):49-53. doi: 10.1016/j.ygyno.2012.10.002.
  14. Park D.C., Kim J.H., Lew YO., et al. C. Phase II trial of neoadjuvant paclitaxel and cisplatin in uterine cervical cancer. Gynecol Oncol. 2004; 92(1):59-63.
  15. Park D.C., Suh M.J., Yeo S.G. Neoadjuvant paclitaxel and cisplatin in uterine cervical cancer: long-term results. Int J Gynecol Cancer. 2009;19(5):943-47. doi: 10.1111/IGC.0b013e3181a23c2e.
  16. Lindsey A. Torre. Global Cancer Statistics 2018. CA CANCER J CLIN. 2018;0:1-31.
  17. Каприн А.Д. Злокачественные новообразования в России в 2017 году (заболеваемость и смертность). Под ред. В.В. Старинского, Г.В. Петровой. МНИОИ им. П.А. Герцена, филиал ФГБУ «НМИРЦ» Минздрава России. М., 2018.
  18. Peters W.A., Liu P.Y., Barrett R.J., et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606-13.
  19. Важенин А.В. Особенности многокомпонентного лечения запущенных форм рака шейки матки с применением индукционной полихимиотерапии. Очерки лучевой терапии рака шейки матки. Челябинск, 2002. С. 144-2002

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