Treatment outcomes of high-dose-rate intracavitary brachytherapy for cervical cancer: a comparison of Ir-192 versus Co-60 sources.

OBJECTIVE: To determine and compare treatment outcomes between cobalt-60 (Co-60) and iridium-192 (Ir-192) high dose rate (HDR) brachytherapy in stage IB2-IIIB cervical cancer patients at Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindrahiraj University. METHODS: A retrospective cohort study of patients diagnosed with cervical cancer and treated with radiotherapy at the Department of Radiation Oncology, Faculty of Medicine Vajira Hospital between 2004 and 2014. Survival rate was analyzed by Kaplan-Meier method and were compared between groups with log-rank test. Multivariate analysis was performed using Cox proportional hazards model. RESULTS: A total of 480 patients with cervical cancer and treated with radiotherapy were included, 274 patients for Ir-192 group and 206 patients for Co-60 group. The 2- and 5-year disease-free survival rate in Ir-192 group were 80.4% and 73.1% and in Co-60 group were 82.5% and 74.7%, respectively (p=0.365). Overall survival rates at 2 and 5 years were 89.4% and 77% of the Ir-192 group, and 91.6% and 81.9% in the Co-60 group, respectively (p=0.238). The complications were primarily grade 1 or 2. Grade 3 and 4 complications were found in 13 of 274 and 7 of 206 in Ir-192 and Co-60 groups, respectively (p=0.232). Grade and clinical stage of cancer significantly affected the survival outcome. CONCLUSION: Cervical cancer patients who were treated with HDR Co-60 brachytherapy were comparable in survival and toxicity outcomes of those with HDR Ir-192 brachytherapy. Co-60 source has lots of economic advantages over Ir-192 and hence suitable for low resource radiotherapy setting.

Treatment outcomes of concurrent weekly carboplatin with radiation therapy in locally advanced cervical cancer patients.

OBJECTIVE: To evaluate treatment outcomes of locally advanced cervical cancer patients who received concurrent weekly carboplatin with radiation therapy. METHODS: Patients with locally advanced cervical cancer who had primary radiation treatment in concurrent with weekly carboplatin (100mg/m(2) or AUC 2) from 1997 to 2008 were identified. Demographic data, chemotherapy cycles, total treatment time, toxicities, and treatment outcomes were recorded. RESULTS: One hundred and forty-eight patients with stage IIB (50.7%), IIIB (48.0%) and IVA (1.3%) cervical cancer patients were included in the study. Median total treatment time was 53.5 days (range, 45-100 days). Carboplatin was given for a median number of 6 cycles (range, 3-6 cycles). Complete response was achieved in 142 patients (95.9%) while six (4.1%) had persistent diseases. Among the 142 responders, 36 experienced recurrences: pelvic recurrences in seven (4.7%), distant failure in 25 (16.9%), and both pelvic and distant in four (2.7%). The 2-year and 5-year progression-free survival rates were 75.1% and 63.0%, respectively with the corresponding 2-year and 5-year overall survival rates of 81.9% and 63.5%. No grade 3 or 4 hematologic and non-hematologic toxicities were observed during treatment in any patients. Late grade 3-4 gastrointestinal or genitourinary toxicities were 10.1% and 0.7%, respectively. CONCLUSION: Concurrent weekly carboplatin with radiation therapy yields high response rate with modest progression-free and overall survivals in locally advanced cervical cancer. The regimen is feasible with minimal toxicities.

Pretreatment levels of serum vascular endothelial growth factor do not correlate with outcome in patients with locally advanced cervical cancer.

OBJECTIVE: To evaluate pretreatment levels of serum VEGF in locally advanced cervical cancer patients, and assess any association with clinocopathological parameters and response to radiotherapy. METHODS: Patients with histologically proven and diagnosed locally advanced cervical cancer or stages IIB-IVA were included in this study. Blood serum was obtained by peripheral venous puncture about 24 hours before the beginning of radiotherapy. All patients were followed up at one and three month intervals from the last day of the complete treatment for evaluating the responses to radiotherapy. RESULTS: Mean age of the 40 patients was 52.8 ± 11.1 years. Sixty percent were in stage IIB and 90% had squamous cell carcinoma. The median pretreatment level of serum VEGF was 611.3 pg/ml (0.00-4,067 pg/ml). The pretreatment levels of serum VEGF did not correlate with stage (p=0.75), tumor histology (p=0.91), tumor size (p=0.46) or tumor characteristics (p=0.49). Almost all patients received concurrent chemoradiation as a curative treatment, with a complete response found in 94.9%. Values for patients who were completed response was rather lower than in patients with persistent disease, but without statistical significance (581.4 pg/ml vs 759.6 pg/ml, p=0.37). CONCLUSION: Pretreatment levels of serum VEGF do not correlate with clinicopathological factors or response to radiation therapy.

Treatment outcomes and prognostic factors of patients with breast cancer: a retrospective review.

OBJECTIVE: To determine overall survival (OS), disease-free survival (DFS), and prognostic factors for survival in patients with invasive breast cancer treated with combined-modality therapy at BMA Medical College and Vajira Hospital. MATERIAL AND METHOD: The authors retrospectively analyzed the patient-tumor characteristic and treatment outcomes of 615 patients with invasive breast cancer who were treated in our radiation oncology division between 1997 and 2006. The authors used the Kaplan-Meier method to describe OS and DFS. The authors analyzed associations of patients and tumor characteristics with OS using the log-rank test and Cox proportional hazards models. RESULTS: The median follow-up time of 60 months, there were 46 loco-regional relapses, 108 distant relapses, and 129 deaths. The 5-year OS and DFS were 77.5% and 73.8%, respectively. The median times to local recurrence (LR) and to distant recurrence (DR) were 23 months (range, 10-67 months) and 24 months (range, 5-91 months). Characteristic statistically significant associated with decreased OS included lymphocascular invasion (LVI), estrogen receptor (ER) and progesterone receptor (PR) status, tumor stage, nodal stage, lymph node involvement > or =20%, and stage of disease. CONCLUSION: Overall, the prognosis of patients with breast cancer was good However the subgroup of patients who presented with LVI, ER, and PR negative, T3-4 stage, N3-nodal stage, lymph node involvement > OR =20%, and higher stage of disease had a poor long-term outcome.

Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial.

BACKGROUND AND PURPOSE: To evaluate the efficacy and the safety of WF10 as adjunct to standard treatment in the management of late hemorrhagic radiation cystitis compared to standard treatment alone. PATIENTS AND METHODS: Cervical cancer patients with Grade 2 or 3 late hemorrhagic radiation cystitis, were randomized and treated with WF10 0.5 ml/kg body weight, diluted in physiological saline or 5% dextrose water 250 ml, intravenous infusions over 2 h on 5 consecutive days, every 3 weeks for 2 cycles plus standard treatment (WF10 group) or standard treatment alone (control group). Fifty patients in each group were evaluated by questioning; urinalysis and cystoscopy during a 1 year follow up. RESULTS: At week 7, 37 patients (74%) in the WF10 group and 32 patients (64%) in the control group showed complete resolution in objective hematuria (P = 0.28). Significantly lower use of antibiotics (P = 0.002) and antispasmodics (P < 0.001) was found in the WF10 group. Among the responders, 24 patients (77%) in the control group experienced recurrent objective hematuria, whereas in the WF10 group only 17 patients (47%) experienced a recurrence (P = 0.01). Recurrence of objective hematuria occurred significantly faster in the control group as evidenced by Kaplan-Meier and log-rank statistics (P = 0.004), suggesting a long-term effect of WF10. Cystoscopy, at the end of the treatment period and after the one year follow up showed overall improvement without significant difference between two groups. No severe toxicity was monitored. CONCLUSIONS: WF10 therapy is a safe, non-invasive and convenient method in the management of late hemorrhagic radiation cystitis. WF10 therapy, as adjunct to standard treatment, has significantly reduced recurrence of objective hematuria, compared to standard treatment alone, during a one year follow up.